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        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>482745505</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>482745505</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PHARMACY SERVICES</Desc>
        <BusinessCd>456110</BusinessCd>
        <TotalRevenueColumnAmt>78401381</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>62627692</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>15773689</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>RETIREMENT COMMUNITIES</Desc>
        <BusinessCd>623311</BusinessCd>
        <TotalRevenueColumnAmt>30665091</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>30665091</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>WELLNESS AND EDUCATION</Desc>
        <BusinessCd>611699</BusinessCd>
        <TotalRevenueColumnAmt>7367852</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>7367852</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>7673620</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>7673620</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>2248754149</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>28915736</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>28915736</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>31106663</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>35034214</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>-3927551</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>-3927551</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>-3927551</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>6495043</SecuritiesAmt>
        <OtherAmt>8530003</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>0</SecuritiesAmt>
        <OtherAmt>8045362</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>6495043</SecuritiesAmt>
        <OtherAmt>484641</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>6979685</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>6979685</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncomeFromGamingGrp>
      <GrossSalesOfInventoryAmt>0</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>CAFETERIA REVENUE</Desc>
        <BusinessCd>722514</BusinessCd>
        <TotalRevenueColumnAmt>4128903</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>4128903</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>OTHER REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>2849765</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2849765</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>TRANSITION AND RADIOSURGERY SERVICES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1597632</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1597632</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>212626</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>212626</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>8788926</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>2321430276</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2266054835</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>288758</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>23167352</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>4713169</TotalAmt>
        <ProgramServicesAmt>4713169</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>127782</TotalAmt>
        <ProgramServicesAmt>127782</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>37162973</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>37162973</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>982096</TotalAmt>
        <ProgramServicesAmt>78665</ProgramServicesAmt>
        <ManagementAndGeneralAmt>903431</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>793403912</TotalAmt>
        <ProgramServicesAmt>711092583</ProgramServicesAmt>
        <ManagementAndGeneralAmt>81112535</ManagementAndGeneralAmt>
        <FundraisingAmt>1198794</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>17188517</TotalAmt>
        <ProgramServicesAmt>12384149</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4804368</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>85776897</TotalAmt>
        <ProgramServicesAmt>74165683</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11465940</ManagementAndGeneralAmt>
        <FundraisingAmt>145274</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>49684120</TotalAmt>
        <ProgramServicesAmt>44590754</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5008260</ManagementAndGeneralAmt>
        <FundraisingAmt>85106</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>39719946</TotalAmt>
        <ProgramServicesAmt>18025671</ProgramServicesAmt>
        <ManagementAndGeneralAmt>21694275</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>802173</TotalAmt>
        <ProgramServicesAmt>179278</ProgramServicesAmt>
        <ManagementAndGeneralAmt>622895</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>6588556</TotalAmt>
        <ProgramServicesAmt>1228424</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5360132</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>159721</TotalAmt>
        <ProgramServicesAmt>159721</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>324915</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>324915</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>131169168</TotalAmt>
        <ProgramServicesAmt>122519637</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8266862</ManagementAndGeneralAmt>
        <FundraisingAmt>382669</FundraisingAmt>
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      <AdvertisingGrp>
        <TotalAmt>12956024</TotalAmt>
        <ProgramServicesAmt>1508708</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11439636</ManagementAndGeneralAmt>
        <FundraisingAmt>7680</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>20788799</TotalAmt>
        <ProgramServicesAmt>15451554</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4634959</ManagementAndGeneralAmt>
        <FundraisingAmt>702286</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>83729332</TotalAmt>
        <ProgramServicesAmt>30240559</ProgramServicesAmt>
        <ManagementAndGeneralAmt>53405179</ManagementAndGeneralAmt>
        <FundraisingAmt>83594</FundraisingAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>104339493</TotalAmt>
        <ProgramServicesAmt>87909891</ProgramServicesAmt>
        <ManagementAndGeneralAmt>16297231</ManagementAndGeneralAmt>
        <FundraisingAmt>132371</FundraisingAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>2574102</TotalAmt>
        <ProgramServicesAmt>1984812</ProgramServicesAmt>
        <ManagementAndGeneralAmt>570035</ManagementAndGeneralAmt>
        <FundraisingAmt>19255</FundraisingAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>18690</TotalAmt>
        <ProgramServicesAmt>17190</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1500</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>17669417</TotalAmt>
        <ProgramServicesAmt>7309705</ProgramServicesAmt>
        <ManagementAndGeneralAmt>10359712</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>69178877</TotalAmt>
        <ProgramServicesAmt>60447552</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8704014</ManagementAndGeneralAmt>
        <FundraisingAmt>27311</FundraisingAmt>
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      <InsuranceGrp>
        <TotalAmt>116217667</TotalAmt>
        <ProgramServicesAmt>13346266</ProgramServicesAmt>
        <ManagementAndGeneralAmt>102871401</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>326849941</TotalAmt>
        <ProgramServicesAmt>326849626</ProgramServicesAmt>
        <ManagementAndGeneralAmt>315</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>SERVICES FROM AFFILIATES</Desc>
        <TotalAmt>256320310</TotalAmt>
        <ProgramServicesAmt>232264842</ProgramServicesAmt>
        <ManagementAndGeneralAmt>24028055</ManagementAndGeneralAmt>
        <FundraisingAmt>27413</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAID ASSESSMENT</Desc>
        <TotalAmt>63245713</TotalAmt>
        <ProgramServicesAmt>63245713</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT EXPENSES</Desc>
        <TotalAmt>37399311</TotalAmt>
        <ProgramServicesAmt>37399311</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>12440447</TotalAmt>
        <ProgramServicesAmt>11696935</ProgramServicesAmt>
        <ManagementAndGeneralAmt>739867</ManagementAndGeneralAmt>
        <FundraisingAmt>3645</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>2291532068</TotalAmt>
        <ProgramServicesAmt>1878938180</ProgramServicesAmt>
        <ManagementAndGeneralAmt>409778490</ManagementAndGeneralAmt>
        <FundraisingAmt>2815398</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1105877</BOYAmt>
        <EOYAmt>3734297</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>471893788</BOYAmt>
        <EOYAmt>446619855</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>54001</BOYAmt>
        <EOYAmt>3577553</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>261521098</BOYAmt>
        <EOYAmt>303880362</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>31015473</BOYAmt>
        <EOYAmt>30184628</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>32871240</BOYAmt>
        <EOYAmt>39531412</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>1215014496</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>729349480</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>479053827</BOYAmt>
        <EOYAmt>485665016</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>16691113</BOYAmt>
        <EOYAmt>19372505</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>8705346</BOYAmt>
        <EOYAmt>10252904</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>60536036</BOYAmt>
        <EOYAmt>70870469</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>40483311</BOYAmt>
        <EOYAmt>40483311</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>127013911</BOYAmt>
        <EOYAmt>113735558</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>1530945021</BOYAmt>
        <EOYAmt>1567907870</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>364595903</EOYAmt>
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      <GrantsPayableGrp>
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        <EOYAmt>0</EOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>64790820</BOYAmt>
        <EOYAmt>67370251</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
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        <EOYAmt>0</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
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        <EOYAmt>0</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
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        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>507962452</BOYAmt>
        <EOYAmt>504497982</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>956975871</BOYAmt>
        <EOYAmt>936464136</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>547910559</BOYAmt>
        <EOYAmt>604975936</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>26058591</BOYAmt>
        <EOYAmt>26467798</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <CapStkTrPrinCurrentFundsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </CapStkTrPrinCurrentFundsGrp>
      <PdInCapSrplsLandBldgEqpFundGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PdInCapSrplsLandBldgEqpFundGrp>
      <RtnEarnEndowmentIncmOthFndsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RtnEarnEndowmentIncmOthFndsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>573969150</BOYAmt>
        <EOYAmt>631443734</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>1530945021</BOYAmt>
        <EOYAmt>1567907870</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>29898208</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>22337085</NetUnrlzdGainsLossesInvstAmt>
      <DonatedServicesAndUseFcltsAmt>5909</DonatedServicesAndUseFcltsAmt>
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        <DepreciationAmt>0</DepreciationAmt>
        <BookValueAmt>0</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <InvestmentCostOrOtherBasisAmt>0</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>658242067</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>462420518</DepreciationAmt>
        <BookValueAmt>195821549</BookValueAmt>
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        <OtherCostOrOtherBasisAmt>30453836</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>19465290</DepreciationAmt>
        <BookValueAmt>10988546</BookValueAmt>
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      <TotalBookValueLandBuildingsAmt>485665016</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Other Assets</Desc>
        <BookValueAmt>2111432</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Obligation Operating Lease</Desc>
        <BookValueAmt>111624126</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>113735558</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>OTHER CURRENT LIABILITIES</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>OBLIGATION UNDER CAPITAL LEASE</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>NOTE PAYABLE-CURRENT</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>CONTINGENT LIABILITY</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>OTHER NON-CURRENT LIABILITIES</Desc>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>INTERCOMPANY PAYABLES</Desc>
        <Amt>321413739</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>PENSION AND OTHER LIABILITIES</Desc>
        <Amt>143722651</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>CAPITAL LEASE</Desc>
        <Amt>28725992</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>INTERCOMPANY NOTE</Desc>
        <Amt>10635600</Amt>
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      <TotalLiabilityAmt>504497982</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part V, Line 4 Intended uses of endowment funds</FormAndLineReferenceDesc>
        <ExplanationTxt>ENDOWMENT FUNDS ARE USED FOR SCHOLARSHIPS</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>RIVERSIDE HEALTHCARE ASSOCIATION GROUP IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF RIVERSIDE HEALTHCARE ASSOCIATION, INC. AND SUBSIDIARIES. THE FOOTNOTE ON THE CONSOLIDATED FINANCIAL STATEMENTS READS: THE SYSTEM HAS RECEIVED A GROUP EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) UNDER THE CORPORATION NAME RIVERSIDE HEALTHCARE ASSOCIATION, INC. RECOGNIZING EACH OF ITS WHOLLY OWNED SUBSIDIARIES, EXCEPT FOR RIVERSIDE MEDICAL EQUIPMENT COMPANY, INC., NEWPORT NEWS GENERAL AND NON-SECTARIAN HOSPITAL ASSOCIATION, INC., SHORE HEALTH SERVICES, INC., SHORE LIFE CARE, INC., TILDEN AND VIRGINIA DAVIS SUPPORT FOUNDATION, INC., AND PENINSULA HOSPITAL SERVICES, INC., STATING THEY ARE EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501(C)(3) OF THE IRC, EXCEPT FOR UNRELATED BUSINESS INCOME. NEWPORT NEWS GENERAL AND NON-SECTARIAN HOSPITAL ASSOCIATION, INC. HAS RETAINED ITS DETERMINATION LETTER FROM THE IRS STATING IT IS EXEMPT FROM INCOME TAXES PURSUANT TO IRC SECTION 501(C)(2). SHORE HEALTH SERVICES, INC., SHORE LIFE CARE, INC., AND TILDEN AND VIRGINIA DAVIS SUPPORT FOUNDATION, INC. HAVE RETAINED THEIR DETERMINATION LETTERS STATING THEY ARE EXEMPT FROM INCOME TAXES PURSUANT TO IRC SECTION 501(C)(3). NO PROVISION FOR INCOME TAXES WAS REQUIRED FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. AS OF DECEMBER 31, 2023 AND 2022, THERE WERE NO UNCERTAIN TAX POSITIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
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      <FinancialAssistancePolicyInd>true</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>true</WrittenPolicyInd>
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      <FPGReferenceFreeCareInd>true</FPGReferenceFreeCareInd>
      <Percent200Ind>X</Percent200Ind>
      <FPGReferenceDiscountedCareInd>true</FPGReferenceDiscountedCareInd>
      <Percent400Ind>X</Percent400Ind>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>true</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>false</ExpensesExceedBudgetInd>
      <AnnualCommunityBnftReportInd>true</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>true</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <ActivitiesOrProgramsCnt>0</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>0</PersonsServedCnt>
        <TotalCommunityBenefitExpnsAmt>20907395</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>0</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>20907395</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.0093</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <ActivitiesOrProgramsCnt>0</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>0</PersonsServedCnt>
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        <NetCommunityBenefitExpnsAmt>0</NetCommunityBenefitExpnsAmt>
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      <TotalFinancialAssistanceTyp>
        <ActivitiesOrProgramsCnt>0</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>0</PersonsServedCnt>
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        <NetCommunityBenefitExpnsAmt>20907395</NetCommunityBenefitExpnsAmt>
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      <CommunityHealthServicesGrp>
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        <PersonsServedCnt>0</PersonsServedCnt>
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        <NetCommunityBenefitExpnsAmt>1395329</NetCommunityBenefitExpnsAmt>
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      <CashAndInKindContributionsGrp>
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      <TotalOtherBenefitsGrp>
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        <PersonsServedCnt>0</PersonsServedCnt>
        <TotalCommunityBenefitExpnsAmt>91956648</TotalCommunityBenefitExpnsAmt>
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        <NetCommunityBenefitExpnsAmt>74468129</NetCommunityBenefitExpnsAmt>
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      <TotalCommunityBenefitsGrp>
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      <PhysicalImprvAndHousingGrp>
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      <EconomicDevelopmentGrp>
        <NetCommunityBenefitExpnsAmt>0</NetCommunityBenefitExpnsAmt>
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      <WrittenDebtCollectionPolicyInd>true</WrittenDebtCollectionPolicyInd>
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        </BusinessName>
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        <StateLicenseNum>H1887</StateLicenseNum>
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        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
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        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <OtherDesc>INPAT PSYCHIATRIC</OtherDesc>
        <FacilityReportingGroupCd>A</FacilityReportingGroupCd>
      </HospitalFacilitiesGrp>
      <HospitalFacilitiesGrp>
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        <BusinessName>
          <BusinessNameLine1Txt>RIVERSIDE WALTER REED HOSPITAL</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>7519 HOSPITAL DRIVE</AddressLine1Txt>
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          <StateAbbreviationCd>VA</StateAbbreviationCd>
          <ZIPCd>23061</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>WWW.RIVERSIDEONLINE.COM/RWRH/</WebsiteAddressTxt>
        <StateLicenseNum>H1890</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <FacilityReportingGroupCd>A</FacilityReportingGroupCd>
      </HospitalFacilitiesGrp>
      <HospitalFacilitiesGrp>
        <FacilityNum>3</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>RIVERSIDE DOCTORS HOSP WILLIAMSBURG</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>1500 COMMONWEALTH AVENUE</AddressLine1Txt>
          <CityNm>WILLIAMSBURG</CityNm>
          <StateAbbreviationCd>VA</StateAbbreviationCd>
          <ZIPCd>23185</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>WWW.RIVERSIDEONLINE.COM/RDHW/</WebsiteAddressTxt>
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      <HospitalFacilitiesGrp>
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        <BusinessName>
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        </BusinessName>
        <USAddress>
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          <CityNm>YORKTOWN</CityNm>
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          <ZIPCd>23693</ZIPCd>
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      </HospitalFacilitiesGrp>
      <HospitalFacilitiesGrp>
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        <BusinessName>
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        <ImplementationStrategyAdoptInd>true</ImplementationStrategyAdoptInd>
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        <StrategyPostedWebsiteInd>true</StrategyPostedWebsiteInd>
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        <EligCriteriaExplainedInd>true</EligCriteriaExplainedInd>
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        <FPGFamilyIncmLmtFreeCarePct>200.0</FPGFamilyIncmLmtFreeCarePct>
        <FPGFamilyIncmLmtDscntCarePct>400.0</FPGFamilyIncmLmtDscntCarePct>
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        <InsuranceStatusCriteriaInd>X</InsuranceStatusCriteriaInd>
        <ResidencyCriteriaInd>X</ResidencyCriteriaInd>
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        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
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        <FAPAvailableOnWebsiteURLTxt>SEE STATEMENT</FAPAvailableOnWebsiteURLTxt>
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        <FAPAppAvailableOnWebsiteURLTxt>SEE STATEMENT</FAPAppAvailableOnWebsiteURLTxt>
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        <FAPSummaryOnWebsiteURLTxt>SEE STATEMENT</FAPSummaryOnWebsiteURLTxt>
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        <CollectionActivitiesInd>false</CollectionActivitiesInd>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 3E</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility Reporting Group: A The significant health needs of the community identified in the CHNA are prioritized according to the community needs.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 3 Facility A, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 1 - FACILITY REPORTING GROUP: A. In addition to the required components of the CHNA, Riverside used the opportunity to examine and reflect on many aspects of the areas served by the facility as well as the varied individuals who live and work there. Additional issues examined included, but were not limited to: * Housing insecurity * Broadband internet access * Unemployment rates * Major employers in the region * Food insecurity and number of children accessing free or reduced lunch * Basic literacy and numeracy rates * Populations with limited English proficiency and what those other languages in the market were * Crime rates and types of crimes (against People, Property and Society) * Rates of multiple screenings (i.e. mammography and colonoscopy). We also examined key behaviors (such as smoking and vaccination against COVID-19 and Influenza) as well as some of the motivations behind those behaviors in respect to why or why not individuals had been or intended to be vaccinated against COVID-19. * How individuals felt their lives had been impacted by the pandemic from a physical health, mental / emotional heath, and financial wellbeing. * Examined preventable hospitalizations, premature mortality and potential life lost by racial group * Causes of death and mortality rates by type (accidental, homicide, natural death, suicide, motor vehicle and gun fatalities) * Types of behavioral health discharges * Deep dive examining impact opioids have had on the community vs the state * Perceived knowledge of how to access existing services in the region for various situations (health, safety, food, housing, etc.) * Perceived bias experienced when seeking care as far as gender, sex, education, insurance states, physical disabilities, language, race, ethnicity, religious beliefs, intellectual disabilities, immigration status, sexual orientation, and age as well as their satisfaction with how the community is addressing issues of diversity, equity, and inclusion. * Perceived trusted sources of health information</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 5 Facility A, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 1 - FACILITY REPORTING GROUP: A. As described in the CHNA, Riverside conducted a community survey between late November 2021 thru February 2022. The CHNA incorporated input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of and expertise in public health. In addition to the facilities and healthcare organizations named in the question 6a, Riverside collaborated closely with the Virginia Department of Health (VDH), with representatives from the Peninsula and Hampton District offices actively involved with the survey for stakeholders and community members and analyzing results. In fact, the stakeholder survey was sent out under the signature of VDH. Other health districts within VDH also utilized the results. In addition, groups such as the Peninsula Community Health Collaborative (a group that includes the major health systems in Hampton Roads as well as organizations such as the Foodbank of the Virginia Peninsula, Healthy Suffolk, and other non-profit organizations), Virginia Organization for Inclusive Concepts and Equitable Solutions (VOICES) (a group focused on listening to minority members of the community). In addition, specific organizations, and companies, such as Children's Hospital of the King's Daughters, Sentara Healthcare, Bon Secours Mercy Health system, Hampton Roads, Hampton and Peninsula Health Districts, Virginia Department of Health, Riverside Health System, and VOICES were consulted during the process. VOICES conducted a series of Equity Community Focus Groups and surveys in Hampton Roads for a community equity needs assessment targeted to people of color and residents of underserved communities. All data collected was shared with the Virginia Department of Health and health systems to aid in their equity initiative on social determinants of health. Focus Groups will be conducted by a trusted partner - EVMS Community Inclusion and Health Equity Initiative. Riverside also continues to seek out information year-round - not only within the CHNA process - to ensure we are listening to all members of our community. This is done with various focus groups, patient advisory groups, "contact us" inquiries via our website and input from and through our community board members.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6a Facility A, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 1 - Facility Reporting Group A. Yes. Parts of the CHNA were conducted with other hospital facilities. Specifically, Riverside Shore Memorial Hospital, Riverside Doctors Hospital of Williamsburg, Riverside Regional Medical Center, Riverside Behavioral Health Center, Riverside Walter Reed Hospital, Riverside Rehabilitation Hospital and Select Specialty Hospital worked together to pull the same data components and share information on some shared geographic areas as well as shared services and programs. In addition to the hospitals named already, Sentara Health System, Children's Hospital of the King's Daughters and Bon Secours Mercy Health System collaborated jointly on the qualitative community and stakeholder surveys.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6b Facility A, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 1 - Facility Reporting Group A. Yes. As noted in question 5, Riverside worked closely with organizations such as the Virginia Department of Health and the Foodbank of the Virginia Peninsula.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 7 Facility A, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 1 - FACILITY REPORTING GROUP: A. In addition to posting online and having paper copies available, Riverside promoted the results through social media channels. Additionally, when Riverside gives community presentations to various organizations, clubs, places of worship, professional groups, or governments the speakers pull heavily from the information included in the CHNA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility A, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 1 - FACILITY REPORTING GROUP: A. The COVID-19 pandemic experience demonstrated the impact Riverside could have on the health of our community when all of the resources across the health system were focused on solving the same problem. While during previous CHNA cycles each hospital across Riverside Health System identified unique priorities, the 2023 - 2025 cycle decided to focus on two key community health issues across the health system in order to leverage the full strength of the organization to impact the problems. Each hospital across the health system continues to address other community health issues outside of the CHNA process. This may include things like community education and outreach, health screenings, providing critical services, health professions education and partnering with local organizations to address issues of health equity. The following needs that were identified in the CHNA survey results that are not being addressed in the CHNA implementation plan are cardiovascular health &amp; wellness and cancer. The CHNA Steering Committee reviewed the potential areas of focus as well as discussed internal projects underway. The needs listed above not being addressed, would pose an overlap with other programs already existing in community efforts. For cardiovascular health &amp; wellness and cancer, activities such as screenings, community talks, education on risk factors and signs of stroke and heart attack, exercise opportunities and healthy eating promotion are already a part of RSMH's community work. For mental health and wellness, Riverside has been focused on expanding these services to the broader community by expanding its Hampton facility, Riverside Behavioral Health Center, which is part of Riverside Regional Medical center but located on a separate campus. While this is not located on the Eastern Shore, as the health system expands its resources in this area, RSMH will continue to benefit through telemedicine access and support as well as being able to tap into the clinical expertise of experts in the field. While only two areas were selected to officially be part of the CHNA Implementation Plan, Opioid Steward and Memory and Dementia Services, other community health initiatives will continue outside of the CHNA process. These community health initiatives include addressing areas such as: * Public health education on wellness and prevention, including nutrition and healthy food. * Public education on symptom recognition of signs &amp; symptoms of heart attack, diabetes, and stroke. * Mental health and wellness. * Vaccinations. * Healthy parenting. * Cancer prevention &amp; screening. * Health equity issues. 1st Initiative: Memory and Dementia Care Caring for dementia patients is complex and an ever-moving target. The experience varies by cause and type, individual patient, setting and caregiver support among other variables. With the combined expertise of Riverside's Neurological and Spine Institute and Riverside's Martha W. Goodson Center, Riverside has many key components in place to provide the best care, support and experience for dementia patients and their loved ones. In the 2023-2025 timeframe, Riverside will be delineating a more detailed vision of what memory and dementia services can become, including building additional connections between the different areas of the health system for seamless care. In the area of Memory and Dementia Care, Riverside Regional Medical Center and Riverside Behavioral Health Center will be addressing the complex problems facing patients and their caregivers through the following: * Memory Cafes: These are social gatherings where both the individual with memory problems and their caregiver or loved ones attend to spend time with others in the same situation. There are currently Memory Cafes active in York County and Williamsburg, and Riverside will look to build upon these in-person gatherings as we can secure space where people can safely meet. Riverside will continue to support these, as well as other support group offerings. * Martha W. Goodson Memory Care Center: Established by the generous donation from the Goodson family in 2022, this center will expand memory care services for those living with dementia and improve access to supportive resources for their caregivers. * Awareness &amp; Access: Riverside will work to ensure families are connected to the right services at the right time, as well as improve access to various therapies such as PT, OT, speech, music, art, exercise, and others. Riverside will also work with families to increase access to legal support to facilitate advance care planning opportunities.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility A, 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 2 - FACILITY REPORTING GROUP: A CONTINUED. * Purple Flower Project: The Alzheimer's Association notes that Alzheimer's Disease isn't a "red "blue" issue, but one that impacts all Americans, making it a purple issue. A flower - based on a forget-me-not-is chosen to represent those dealing with memory issues or those remembering loved ones lost to dementia. RRMC piloted a project in which patients (or residents in our lifelong health areas) who have dementia will be identified by a discreet purple flower on the door or chart as a way to quietly notify staff that the patient or resident in the room has a memory issue. Staff underwent additional training on the best ways to communicate with individuals who may be confused or agitated due to their diagnosis. This notification system, along with special training for team members, will help staff and volunteers adjust their communications with and expectations of the individual. Following a successful implementation at RDHW, other RHS acute care facilities implemented the Purple Flower Program on December 5, 2023. * Strengthen Services and Offerings Across RHS and the Community: Riverside will continue to refine, strengthen, and expand upon the existing services across Riverside Medical Group, and Lifelong Health. Potential projects include: * Optimizing the EMR to facilitate tracking and reporting of patient outcomes for patients with memory and dementia problems. * Facilitate an integrated, multidisciplinary approach to memory and dementia care services across RHS. * Strengthen orientation and continuing education for team members and clinicians across the health system. 2nd Initiative: Opioid Stewardship and Substance Use Disorder The importance of this issue was clear in both quantitative and qualitative data obtained in the CHNA process. Fatal drug overdoses in Virginia and across the country have risen rapidly in the past 13 years and had an extremely high increase during the pandemic. Both stakeholders and community members noted that substance use disorder was one of the most important health issues for youth and adults. Working with the experts across the health system, Riverside has identified multiple areas where it can begin to impact some of the complex factors involved. To build the plan for the health system to address this issue in a cohesive manner, the VP of Pharmacy led an interdisciplinary team that included inpatient and outpatient physicians, nurses, pharmacists, mental and behavioral health experts, and others representing all the hospitals as well as critical support areas such as the electronic medical record (EMR) team. The team pulled from the National Quality Partners (NQP) Opioid Stewardship Action Team's NQP Playbook: Opioid Stewardship as well as from research, presentations and case studies shared nationally including the splendid work done by Carillion in the western part of Virginia. The Virginia Department of Health's 2021 Best Practices for Opioid Related Emergencies in the Emergency Department was also used as a valuable resource. The team reviewed and learned about recommended areas of Primary, Secondary, and Tertiary overdose prevention strategies. Primary strategies focus on preventing the onset of substance use disorder by avoiding exposure to opioids with tactics such as developing evidence-based prescribing guidelines to promote alternate pain management approaches where appropriate, monitoring prescriptions, preventing diversion, executing pain management agreements for chronic pain patients, and educating the public on storage and disposal. Secondary strategies focus on screening for individuals who are substantial risk for substance use disorder so that more aggressive prevention and treatment approaches can be pursued. Tertiary strategies focus on helping individuals with substance use disorders prevent fatal overdoses using measures to reduce harm and to get off the drug using medication assisted treatment, naloxone prescriptions, and other strategies. There are additional factors that impact this national crisis, such as increasing supply of illegally manufactured opioids available to the public without a prescription, which are outside the scope of this plan at this time. Due to the nature of opioids as an addictive and controlled substance, not every aspect of the implementation plan will be publicly detailed. Nonetheless, the team identified projects in each of the prevention areas (primary, secondary, and tertiary). For Primary Overdose Prevention Strategies (Primary strategies focus on preventing the onset of substance use disorder by avoiding exposure to opioids): * While not as visible to the public, Riverside has identified areas to continually monitor and design evidenced based processes to track prescriptions, appropriate use, policy adherence and diversion prevention. This will be done by the pharmacy team, Riverside Medical Group and RRMC staff, the EMR team and other internal support areas. * Riverside explored the need for a partnership with law enforcement and the DEA in hosting a Riverside Drug Take Back Day or ascertain if current resources in this region are adequate. Riverside participated in several Drug Take Back Days throughout Riverside in 2023. * Riverside will create and maintain local partnerships to combat opioid addiction in the community. Riverside will continue working with the Hampton Roads Opioid Working Group, a regional collaborative that uses a community-based and action-oriented approach to reduce opioid-related deaths. * Led by the new Mental and Behavioral Health Service Line leadership, Riverside will identify opportunities throughout Riverside and the community for community outreach and education.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility A, 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility A, 3 - FACILITY REPORTING GROUP: A CONTINUED. Secondary Overdose Prevention Strategies (Identifying those at increased risk of SUD so that more aggressive prevention and treatment approaches can be pursued): * Working across the health system, RHS developed and implemented consistent screening processes to identify those individuals at high risk for developing SUD. * These processes were tailored to each setting such as the Emergency Department, surgical patients, inpatient, and in RMG offices; therefore, the process developed for each setting and the resulting next steps will be appropriate for that setting. * Once piloted and finalized at other RHS facilities, these may be implemented at RRMC as well. Tertiary Overdose Prevention Strategies (Assisting individuals living with SUD prevent fatal overdoses using measures to reduce harm and to get off the drug using medication assisted treatment, naloxone prescriptions and other strategies): * Across the health system, there will be different pilot projects addressing this issue. Once a program is successfully implemented and shown to be beneficial, it will be replicated at RRMC. For example, a sister facility will explore piloting a program trialing Medication Assisted Therapy (MAT) beginning in the ED to bridge individuals from the initial emergency visit through the first few days it takes to get into an outpatient MAT program. This may be replicated at RRMC following the pilot. * Riverside will continue to facilitate access to inpatient and outpatient addiction services. * The entire health system will also be able to draw on the expertise of the clinical staff at the Riverside Behavioral Health Center in Hampton. As materials, protocols, telemedicine programs or other opportunities are developed, RRMC will be able to build off those to better serve the individuals in the Peninsula region dealing with SUD. Suicide Prevention: Suicide and attempted suicide are preventable, is devastating to individuals and families across the Middle Peninsula. While the emergency room is a place of last resort, ideally the mental and behavioral health challenges that drive someone to attempt suicide are best managed in other environments - both to improve the patient experience as well as to conserve resources in the emergency room. Suicide death rates in Gloucester County are higher than any surrounding county. Since the pandemic, suicide and attempted suicide has been increasing in teens and adults. Preventing suicide will be focus for RWRH with a goal of preventing visits seen in the emergency department for suicide attempts. To achieve this, RWRH will partner with RHS experts, including Riverside Mental Health and Recovery Center staff, as well as community partners such as Bacon Street to develop educational materials targeted at the community. RWRH will also work to increase referrals to appropriate resources for patients at risk of suicide. Additionally, RWRH will also explore additional iCare screening tools and active observation in the emergency room and inpatient units, the utilization of one-on-one sitters and ligature assessments to help care for this patient population. Transportation: As seen in rural areas around the country, public transportation and medical transportation remains difficult to secure on the Middle Peninsula. No Uber or other third-party transportation is available on the Middle Peninsula other than one taxi company and Bay Transit - which does not operate after hours or weekend. Patients traveling to and from appointments or home from the hospital or an emergency room visit struggle to secure services. Bay Transit currently has limited scope of service across the county and limited 'stops.' In order to expand services, Bay Transit is planning to re-evaluate and possibly discontinue the two buses running 8a-4p M-F only, including the two stops at RWRH ("Gloucester Hive Xpress"). This would leave 'on demand' services only "Bay Transit Express" with seven stops in and around the Courthouse Area. According to the Transportation Director, Ken Pollock, the Bay Transit Express is expanding later this year to extend down to the Point and further north to Saluda. As medical transport continues to be a challenge for individuals on the Middle Peninsula, RWRH will collaborate with Bay Transit and other services to investigate, establish, and implement innovative transportation option. Ideally this will help patients requiring a ride home from the hospital; patients requiring a ride to and from medical appointments; and diagnostic procedures and/or medical treatments, such as chemotherapy or radiation oncology treatments.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 3E</FormAndLineReferenceDesc>
        <ExplanationTxt>FACILITY REPORTING GROUP: B THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED IN THE CNHA ARE PRIORITIZED ACCORDING TO THE COMMUNITY NEEDS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 3 Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. In addition to the required components of the CHNA, Riverside used the opportunity to examine and reflect on many aspects of the areas served by the facility as well as the varied individuals who live and work there. Additional issues examined included, but were not limited to: * Housing insecurity * Broadband internet access * Unemployment rates * Major employers in the region * Food insecurity and number of children accessing free or reduced lunch * Basic literacy and numeracy rates * Populations with limited English proficiency and what those other languages in the market were * Crime rates and types of crimes (against People, Property and Society) * Rates of multiple screenings (i.e. mammography and colonoscopy). We also examined key behaviors (such as smoking and vaccination against COVID-19 and Influenza) as well as some of the motivations behind those behaviors in respect to why or why not individuals had been or intended to be vaccinated against COVID-19. * How individuals felt their lives had been impacted by the pandemic from a physical health, mental / emotional heath, and financial wellbeing. * Examined preventable hospitalizations, premature mortality and potential life lost by racial group * Causes of death and mortality rates by type (accidental, homicide, natural death, suicide, motor vehicle and gun fatalities) * Types of behavioral health discharges * Deep dive examining impact opioids have had on the community vs the state * Perceived knowledge of how to access existing services in the region for various situations (health, safety, food, housing, etc.) * Perceived bias experienced when seeking care as far as gender, sex, education, insurance states, physical disabilities, language, race, ethnicity, religious beliefs, intellectual disabilities, immigration status, sexual orientation, and age as well as their satisfaction with how the community is addressing issues of diversity, equity, and inclusion. * Perceived trusted sources of health information</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 5 Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. As described in the CHNA, Riverside conducted a community survey between late November 2021 thru February 2022. The CHNA incorporated input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of and expertise in public health. In addition to the facilities and healthcare organizations named in the question 6a, Riverside collaborated closely with the Virginia Department of Health (VDH), with representatives from the Peninsula and Hampton District offices actively involved with the survey for stakeholders and community members and analyzing results. In fact, the stakeholder survey was sent out under the signature of VDH. Other health districts within VDH also utilized the results. In addition, groups such as the Peninsula Community Health Collaborative (a group that includes the major health systems in Hampton Roads as well as organizations such as the Foodbank of the Virginia Peninsula, Healthy Suffolk, and other non-profit organizations), Virginia Organization for Inclusive Concepts and Equitable Solutions (VOICES) (a group focused on listening to minority members of the community). In addition, specific organizations, and companies, such as Children's Hospital of the King's Daughters, Sentara Healthcare, Bon Secours Mercy Health system, Hampton Roads, Hampton and Peninsula Health Districts, Virginia Department of Health, Riverside Health System, and VOICES were consulted during the process. VOICES conducted a series of Equity Community Focus Groups and surveys in Hampton Roads for a community equity needs assessment targeted to people of color and residents of underserved communities. All data collected was shared with the Virginia Department of Health and health systems to aid in their equity initiative on social determinants of health. Focus Groups will be conducted by a trusted partner - EVMS Community Inclusion and Health Equity Initiative. Riverside also continues to seek out information year-round - not only within the CHNA process - to ensure we are listening to all members of our community. This is done with various focus groups, patient advisory groups, "contact us" inquiries via our website and input from and through our community board members.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6a Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. Yes. Parts of the CHNA were conducted with other hospital facilities. Specifically, Riverside Shore Memorial Hospital, Riverside Doctors Hospital of Williamsburg, Riverside Regional Medical Center, Riverside Behavioral Health Center, Riverside Walter Reed Hospital, Riverside Rehabilitation Hospital and Select Specialty Hospital worked together to pull the same data components and share information on some shared geographic areas as well as shared services and programs. In addition to the hospitals named already, Sentara Health System, Children's Hospital of the King's Daughters and Bon Secours Mercy Health System collaborated jointly on the qualitative community and stakeholder surveys.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6b Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. Yes. As noted in question 5, Riverside worked closely with organizations such as the Virginia Department of Health and the Foodbank of the Virginia Peninsula.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 7 Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. In addition to posting online and having paper copies available, Riverside promoted the results through social media channels. Additionally, when Riverside gives community presentations to various organizations, clubs, places of worship, professional groups, or governments the speakers pull heavily from the information included in the CHNA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. The COVID-19 pandemic experience demonstrated the impact Riverside could have on the health of our community when all of the resources across the health system were focused on solving the same problem. While during previous CHNA cycles each hospital across Riverside Health System identified unique priorities, the 2023 - 2025 cycle decided to focus on two key community health issues across the health system in order to leverage the full strength of the organization to impact the problems. Each hospital across the health system continues to address other community health issues outside of the CHNA process. This may include things like community education and outreach, health screenings, providing critical services, health professions education and partnering with local organizations to address issues of health equity. The following needs that were identified in the CHNA survey results that are not being addressed in the CHNA implementation plan are cardiovascular health &amp; wellness and cancer. The CHNA Steering Committee reviewed the potential areas of focus as well as discussed internal projects underway. The needs listed above not being addressed, would pose an overlap with other programs already existing in community efforts. For cardiovascular health &amp; wellness and cancer, activities such as screenings, community talks, education on risk factors and signs of stroke and heart attack, exercise opportunities and healthy eating promotion are already a part of RSMH's community work. For mental health and wellness, Riverside has been focused on expanding these services to the broader community by expanding its Hampton facility, Riverside Behavioral Health Center, which is part of Riverside Regional Medical center but located on a separate campus. While this is not located on the Eastern Shore, as the health system expands its resources in this area, RSMH will continue to benefit through telemedicine access and support as well as being able to tap into the clinical expertise of experts in the field. While only two areas were selected to officially be part of the CHNA Implementation Plan, Opioid Steward and Memory and Dementia Services, other community health initiatives will continue outside of the CHNA process. These community health initiatives include addressing areas such as: * Public health education on wellness and prevention, including nutrition and healthy food. * Public education on symptom recognition of signs &amp; symptoms of heart attack, diabetes, and stroke. * Mental health and wellness. * Vaccinations. * Healthy parenting. * Cancer prevention &amp; screening. * Health equity issues. 1st Initiative: Memory and Dementia Care Caring for dementia patients is complex and an ever-moving target. The experience varies by cause and type, individual patient, setting and caregiver support among other variables. With the combined expertise of Riverside's Neurological and Spine Institute and Riverside's Martha W. Goodson Center, Riverside has many key components in place to provide the best care, support and experience for dementia patients and their loved ones. In the 2023-2025 timeframe, Riverside will be delineating a more detailed vision of what memory and dementia services can become, including building additional connections between the different areas of the health system for seamless care. In the area of Memory and Dementia Care, Riverside Regional Medical Center and Riverside Behavioral Health Center will be addressing the complex problems facing patients and their caregivers through the following: * Memory Cafes: These are social gatherings where both the individual with memory problems and their caregiver or loved ones attend to spend time with others in the same situation. There are currently Memory Cafes active in York County and Williamsburg, and Riverside will look to build upon these in-person gatherings as we can secure space where people can safely meet. Riverside will continue to support these, as well as other support group offerings. * Martha W. Goodson Memory Care Center: Established by the generous donation from the Goodson family in 2022, this center will expand memory care services for those living with dementia and improve access to supportive resources for their caregivers. * Awareness &amp; Access: Riverside will work to ensure families are connected to the right services at the right time, as well as improve access to various therapies such as PT, OT, speech, music, art, exercise, and others. Riverside will also work with families to increase access to legal support to facilitate advance care planning opportunities.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility B, 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 2 - FACILITY REPORTING GROUP: B CONTINUED. * Purple Flower Project: The Alzheimer's Association notes that Alzheimer's Disease isn't a "red "blue" issue, but one that impacts all Americans, making it a purple issue. A flower - based on a forget-me-not-is chosen to represent those dealing with memory issues or those remembering loved ones lost to dementia. RRH piloted a project in which patients (or residents in our lifelong health areas) who have dementia will be identified by a discreet purple flower on the door or chart as a way to quietly notify staff that the patient or resident in the room has a memory issue. Staff underwent additional training on the best ways to communicate with individuals who may be confused or agitated due to their diagnosis. This notification system, along with special training for team members, will help staff and volunteers adjust their communications with and expectations of the individual. Following a successful implementation at RDHW, other RHS acute care facilities implemented the Purple Flower Program on December 5, 2023. * Strengthen Services and Offerings Across RHS and the Community: Riverside will continue to refine, strengthen, and expand upon the existing services across Riverside Medical Group, and Lifelong Health. Potential projects include: * Optimizing the EMR to facilitate tracking and reporting of patient outcomes for patients with memory and dementia problems. * Facilitate an integrated, multidisciplinary approach to memory and dementia care services across RHS. * Strengthen orientation and continuing education for team members and clinicians across the health system. 2nd Initiative: Opioid Stewardship and Substance Use Disorder The importance of this issue was clear in both quantitative and qualitative data obtained in the CHNA process. Fatal drug overdoses in Virginia and across the country have risen rapidly in the past 13 years and had an extremely high increase during the pandemic. Both stakeholders and community members noted that substance use disorder was one of the most important health issues for youth and adults. Working with the experts across the health system, Riverside has identified multiple areas where it can begin to impact some of the complex factors involved. To build the plan for the health system to address this issue in a cohesive manner, the VP of Pharmacy led an interdisciplinary team that included inpatient and outpatient physicians, nurses, pharmacists, mental and behavioral health experts, and others representing all the hospitals as well as critical support areas such as the electronic medical record (EMR) team. The team pulled from the National Quality Partners (NQP) Opioid Stewardship Action Team's NQP Playbook: Opioid Stewardship as well as from research, presentations and case studies shared nationally including the splendid work done by Carillion in the western part of Virginia. The Virginia Department of Health's 2021 Best Practices for Opioid Related Emergencies in the Emergency Department was also used as a valuable resource. The team reviewed and learned about recommended areas of Primary, Secondary, and Tertiary overdose prevention strategies. Primary strategies focus on preventing the onset of substance use disorder by avoiding exposure to opioids with tactics such as developing evidence-based prescribing guidelines to promote alternate pain management approaches where appropriate, monitoring prescriptions, preventing diversion, executing pain management agreements for chronic pain patients, and educating the public on storage and disposal. Secondary strategies focus on screening for individuals who are substantial risk for substance use disorder so that more aggressive prevention and treatment approaches can be pursued. Tertiary strategies focus on helping individuals with substance use disorders prevent fatal overdoses using measures to reduce harm and to get off the drug using medication assisted treatment, naloxone prescriptions, and other strategies. There are additional factors that impact this national crisis, such as increasing supply of illegally manufactured opioids available to the public without a prescription, which are outside the scope of this plan at this time. Due to the nature of opioids as an addictive and controlled substance, not every aspect of the implementation plan will be publicly detailed. Nonetheless, the team identified projects in each of the prevention areas (primary, secondary, and tertiary). For Primary Overdose Prevention Strategies (Primary strategies focus on preventing the onset of substance use disorder by avoiding exposure to opioids): * While not as visible to the public, Riverside has identified areas to continually monitor and design evidenced based processes to track prescriptions, appropriate use, policy adherence and diversion prevention. This will be done by the pharmacy team, Riverside Medical Group and RRMC staff, the EMR team and other internal support areas. * Riverside explored the need for a partnership with law enforcement and the DEA in hosting a Riverside Drug Take Back Day or ascertain if current resources in this region are adequate. Riverside participated in several Drug Take Back Days throughout Riverside in 2023. * Riverside will create and maintain local partnerships to combat opioid addiction in the community. Riverside will continue working with the Hampton Roads Opioid Working Group, a regional collaborative that uses a community-based and action-oriented approach to reduce opioid-related deaths. * Led by the new Mental and Behavioral Health Service Line leadership, Riverside will identify opportunities throughout Riverside and the community for community outreach and education.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility B, 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 3 - FACILITY REPORTING GROUP: B CONTINUED. Secondary Overdose Prevention Strategies (Identifying those at increased risk of SUD so that more aggressive prevention and treatment approaches can be pursued): * Working across the health system, RHS developed and implemented consistent screening processes to identify those individuals at high risk for developing SUD. * These processes were tailored to each setting such as the Emergency Department, surgical patients, inpatient, and in RMG offices; therefore, the process developed for each setting and the resulting next steps will be appropriate for that setting. * Once piloted and finalized at other RHS facilities, these may be implemented at RRMC as well. Tertiary Overdose Prevention Strategies (Assisting individuals living with SUD prevent fatal overdoses using measures to reduce harm and to get off the drug using medication assisted treatment, naloxone prescriptions and other strategies): * Across the health system, there will be different pilot projects addressing this issue. Once a program is successfully implemented and shown to be beneficial, it will be replicated at RRMC. For example, a sister facility will explore piloting a program trialing Medication Assisted Therapy (MAT) beginning in the ED to bridge individuals from the initial emergency visit through the first few days it takes to get into an outpatient MAT program. This may be replicated at RRMC following the pilot. * Riverside will continue to facilitate access to inpatient and outpatient addiction services. * The entire health system will also be able to draw on the expertise of the clinical staff at the Riverside Behavioral Health Center in Hampton. As materials, protocols, telemedicine programs or other opportunities are developed, RRMC will be able to build off those to better serve the individuals in the Peninsula region dealing with SUD.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 20 Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. WHILE THE HOSPITAL FACILITY MADE REASONABLE EFFORTS TO ORALLY NOTIFY ALL INDIVIDUALS ABOUT THE FAP AND FAP APPLICATION PROCESS, THIS MAY NOT HAVE BEEN UNIFORMLY PERFORMED FOR 100% OF THE PATIENTS RECEIVING TREATMENT DESPITE THE HOSPITAL'S BEST EFFORTS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 20 Facility B, 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility B, 1 - FACILITY REPORTING GROUP: B. PRESUMPTIVE ELIGIBILITY IS NOT USED. DUE TO THE LIMITED NUMBER OF PATIENTS AND APPLICANTS FOR FINANCIAL ASSISTANCE, PERSONNEL WORK WITH PATIENTS TO COMPLETE THE APPLICATION. PRESUMPTIVE MODELS ARE NOT USED.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>7</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>THE GARDENS AT WARWICK FOREST</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>1000 OLD DENBIGH BLVD</AddressLine1Txt>
            <CityNm>NEWPORT NEWS</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23602</ZIPCd>
          </USAddress>
          <FacilityTxt>CONVALESCENT SERVICES NURSING HOME</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>PATRIOTS COLONY</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>6000 PATRIOTS COLONY DR</AddressLine1Txt>
            <CityNm>WILLIAMSBURG</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23188</ZIPCd>
          </USAddress>
          <FacilityTxt>RETIREMENT CENTER</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>SANDERS RETIREMENT VILLAGE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>7385 WALKER AVE</AddressLine1Txt>
            <CityNm>GLOUCESTER</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23061</ZIPCd>
          </USAddress>
          <FacilityTxt>RETIREMENT CENTER</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>RIVERSIDE CONVALESCENT CENTER MATHEWS</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>603 MAIN STREET</AddressLine1Txt>
            <CityNm>MATHEWS</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23109</ZIPCd>
          </USAddress>
          <FacilityTxt>CONVALESCENT SERVICES NURSING HOME</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>RIVERSIDE CONVALESCENT SALUDA</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>672 GLOUCESTER ROAD</AddressLine1Txt>
            <CityNm>SALUDA</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23149</ZIPCd>
          </USAddress>
          <FacilityTxt>CONVALESCENT SERVICES NURSING HOME</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>RIVERSIDE HEALTHY LIVING COMMUNITY SMITH</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>101 JOHN ROLFE DRIVE</AddressLine1Txt>
            <CityNm>SMITHFIELD</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23430</ZIPCd>
          </USAddress>
          <FacilityTxt>CONVALESCENT SERVICES NURSING HOME</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>WARWICK FOREST RETIREMENT COMMUNITY</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>886 OLD DENBIHG BLVD</AddressLine1Txt>
            <CityNm>NEWPORT NEWS</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>23602</ZIPCd>
          </USAddress>
          <FacilityTxt>RETIREMENT CENTER</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 3c SCH H, PART I, LINE 3C</FormAndLineReferenceDesc>
        <ExplanationTxt>RIVERSIDE DOES NOT USE ANY OTHER ASSET THRESHOLD IN DETERMINING FINANCIAL ELIGIBILITY. RIVERSIDE ONLY USES FPL IN DETERMINING FAP-ELIGIBILITY. FREE CARE USES 200% AND DISCOUNTED CARE USES 400% OF THE FPG.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FACILITY REPORTING GROUP: A</FormAndLineReferenceDesc>
        <ExplanationTxt>WWW.RIVERSIDEONLINE.COM/PATIENTS-AND-VISITORS/PAYING-FORHEALTHCARE-SERVICES/FINANCIAL-ASSISTANCE</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FACILITY REPORTING GROUP: A</FormAndLineReferenceDesc>
        <ExplanationTxt>WWW.RIVERSIDEONLINE.COM/PATIENTS-AND-VISITORS/PAYING-FORHEALTHCARE-SERVICES/FINANCIAL-ASSISTANCE</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FACILITY REPORTING GROUP: A</FormAndLineReferenceDesc>
        <ExplanationTxt>WWW.RIVERSIDEONLINE.COM/PATIENTS-AND-VISITORS/PAYING-FORHEALTHCARE-SERVICES/FINANCIAL-ASSISTANCE</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FACILITY B,4</FormAndLineReferenceDesc>
        <ExplanationTxt>WWW.RIVERSIDE-REHABILITATION.COM/PATIENTS-AND-CAREGIVERS/ADMISSIONS/FINANCIALASSISTANCE/</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FACILITY B,4</FormAndLineReferenceDesc>
        <ExplanationTxt>WWW.RIVERSIDE-REHABILITATION.COM/PATIENTS-AND-CAREGIVERS/ADMISSIONS/FINANCIALASSISTANCE/</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FACILITY B,4</FormAndLineReferenceDesc>
        <ExplanationTxt>WWW.RIVERSIDE-REHABILITATION.COM/PATIENTS-AND-CAREGIVERS/ADMISSIONS/FINANCIALASSISTANCE/</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FACILITY B,5</FormAndLineReferenceDesc>
        <ExplanationTxt>HTTPS://WWW.SELECTSPECIALTYHOSPITALS.COM/LOCATIONS-ANDTOURS/ VA/NEWPORT-NEWS/HAMPTON-ROADS/</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FACILITY B,5</FormAndLineReferenceDesc>
        <ExplanationTxt>HTTPS://WWW.SELECTSPECIALTYHOSPITALS.COM/LOCATIONS-ANDTOURS/ VA/NEWPORT-NEWS/HAMPTON-ROADS/</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FACILITY B,5</FormAndLineReferenceDesc>
        <ExplanationTxt>HTTPS://WWW.SELECTSPECIALTYHOSPITALS.COM/LOCATIONS-ANDTOURS/ VA/NEWPORT-NEWS/HAMPTON-ROADS/</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation</FormAndLineReferenceDesc>
        <ExplanationTxt>37399311</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>PART I LINE 7A: THE FINANCIAL ASSISTANCE COST IS FROM THE MEDICARE COST REPORT. PART I LINE 7B: MEDICAID COST AND NET REVENUE ARE DIRECTLY FROM THE MEDICAID COST REPORT. PART I LINE 7E: COMMUNITY HEALTH IMPROVEMENT IS THE ACTUAL COST ACCUMULATED BY THE INDIVIDUALS PARTICIPATING IN THE ACTIVITIES. PART I LINE 7I: CASH AND IN-KIND CONTRIBUTIONS ARE THE ACTUAL CURRENT YEAR DOLLAR VALUE OF THE CASH OR ITEMS GIVEN.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount</FormAndLineReferenceDesc>
        <ExplanationTxt>FACILITY: B,5 Hospital records uncollectible accounts that are not a result of credit worthiness as a direct offset to revenue in accordance with current GAAP revenue recognition standards. Hospital's methodology to record a reserve for uncollectible accounts is based on recording, on a monthly basis, a reserve which is equal to the % of write-offs to net patient revenue for the prior twelve calendar months multiplied by the current month's recorded patient revenue. FACILITY REPORTING GROUP: A Bad debt is the amount remaining on a patient's account after cash payments, third-party payer contractual adjustments, and hospital discounts have been taken. Before the amount is written off to bad debt, the account is sent to a collection agency which returns the account when they have exhausted all possible effort. Upon return, the account balance is written off to bad debt.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 3 Bad Debt Expense Methodology</FormAndLineReferenceDesc>
        <ExplanationTxt>IF THE PATIENT WAS UNINSURED AND HAD A HOUSEHOLD INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL OR WAS INSURED AND HAD A HOUSEHOLD INCOME AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL THE PATIENT WOULD QUALIFY FOR 100% FINANCIAL ASSISTANCE WRITE OFF AND WOULD NOT BE INCLUDED IN BAD DEBT. THE ONLY POPULATION THAT MAY FALL INTO THE BAD DEBT IS IF THE PATIENT WAS UNINSURED WITH A HOUSEHOLD INCOME BETWEEN 201% AND 400% OF THE FEDERAL POVERTY LEVEL WHICH RECEIVED A 75% FINANCIAL ASSISTANCE WRITE OFF OF ELIGIBLE BILLED CHARGES. THE PATIENT WOULD HAVE A LIABILITY OF 25% OF THE BILLED AMOUNT. IF THE PATIENT DID NOT PAY THE 25% AMOUNT, THAT LIABILITY COULD BE SENT TO BAD DEBT. THE FINANCIAL ASSISTANCE WRITE OFF OF 75% IS NOT APPLIED TO BAD DEBT. HOWEVER, OUR PROCEDURES FOR IDENTIFYING FAP-ELIGIBLE INDIVIDUALS ARE THOROUGH, THEREFORE WE DO NOT ESTIMATE ANY AMOUNT OF BAD DEBT TO BE ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>Footnote 3 of the audited financial statements states: If the system identifies subsequent adjustments to the transaction price that would cause adverse changes in a patient or payor's ability to pay, the amounts are recorded as bad debt expense. Bad debt expense is included in operating expenses in the accompanying consolidated statement of operations. The amount included as bad debt expense for the years ended December 31, 2023, and 2022 was not material to the system.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 8 Community benefit &amp; methodology for determining medicare costs</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION USES CMS COST REPORTING GUIDELINES AND METHODOLOGY TO DETERMINE ALLOWABLE MEDICARE COSTS. THE HEALTH SYSTEM ASSURES THAT THE ESSENTIAL EMERGENCY AND ACUTE CARE SERVICES ARE PROVIDED FOR THE POPULATION'S HEALTH. THE SHORTFALL FROM MEDICARE SHOULD BE RECOGNIZED AS A COMMUNITY BENEFIT, SINCE THE PATIENTS ARE PROVIDED SERVICES AT A LOSS FOR THE FACILITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>Reasonable efforts will be made to determine whether a patient is eligible for financial assistance prior to sending an account to collections. If the patient qualifies for financial assistance the account is adjudicated based on their FAP-eligibility. Patients may need to complete a financial assistance application to determine eligibility or may request reconsideration under this financial assistance policy by submitting a financial assistance application. Upon receipt of an application for financial assistance, collection actions are suspended until a final eligibility determination is made. If the patient is deemed eligible for financial assistance, the account will be returned from collections and all collection efforts will be reversed.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FAP website</FormAndLineReferenceDesc>
        <ExplanationTxt>A - RIVERSIDE REGIONAL MEDICAL CENTER: Line 16a URL: SEE STATEMENT; B - RIVERSIDE REHABILITATION HOSPITAL: Line 16a URL: SEE STATEMENT; B - SELECT SPECIALTY HOSPITAL-HAMPTON ROADS: Line 16a URL: https://www.selectspecialtyhospitals.com/locations-and-tours/va/newport-news/hampton-roads/;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FAP Application website</FormAndLineReferenceDesc>
        <ExplanationTxt>A - RIVERSIDE REGIONAL MEDICAL CENTER: Line 16b URL: SEE STATEMENT; B - RIVERSIDE REHABILITATION HOSPITAL: Line 16b URL: SEE STATEMENT; B - SELECT SPECIALTY HOSPITAL-HAMPTON ROADS: Line 16b URL: https://www.selectspecialtyhospitals.com/locations-and-tours/va/newport-news/hampton-roads/;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FAP plain language summary website</FormAndLineReferenceDesc>
        <ExplanationTxt>A - RIVERSIDE REGIONAL MEDICAL CENTER: Line 16c URL: SEE STATEMENT; B - RIVERSIDE REHABILITATION HOSPITAL: Line 16c URL: SEE STATEMENT; B - SELECT SPECIALTY HOSPITAL-HAMPTON ROADS: Line 16c URL: https://www.selectspecialtyhospitals.com/locations-and-tours/va/newport-news/hampton-roads/;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 2 Needs assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>Assessing, understanding, and listening to our communities is an ongoing process at Riverside. The formal CHNA process occurs on a three-year cycle, but it is only one component of how Riverside works to better understand the needs of the communities we serve. Other ways Riverside utilizes to do this include but aren't limited to: a. Community representatives and leaders on our volunteer board of directors that represent a wide range of diverse expertise, interests, professions, and geographic areas. b. Committees of patients, family members and residents' family members that provide feedback c. Listening to "alumni" consisting of retired employees d. Partnering with local organizations, communities, and universities to learn about their needs formally and informally e. Making connections with individual neighborhood and community influencers to host health fairs or provide speakers on topics of interests they seek out f. Meeting with small focus groups on certain topics to better understand how we can address barriers to care and improve clinical outcomes</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 3 Patient education of eligibility for assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>NOTIFICATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT'S BILLS, PROVIDING THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES, PATIENT FINANCIAL SERVICES OFFICES, AND AT OTHER PUBLIC PLACES AS RIVERSIDE HEALTH SYSTEM MAY ELECT. RIVERSIDE HEALTH SYSTEM ALSO PUBLISHES AND WIDELY PUBLICIZES THIS FINANCIAL ASSISTANCE POLICY ON THE FACILITY WEBSITE. THE PLAIN LANGUAGE SUMMARY IS INCLUDED WITH THE BILLING STATEMENT 30 DAYS BEFORE REFERRING A PATIENT'S ACCOUNT TO COLLECTIONS. PATIENTS MAY OBTAIN ADDITIONAL INFORMATION AND/OR PAPER COPIES OF ANY FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, OR APPLICATION IN PERSON BY VISITING ANY RIVERSIDE HOSPITAL DEPARTMENT BY MAIL, VIA OUR WEBSITE, OR BY CALLING OUR CUSTOMER SERVICE CENTER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 4 Community information</FormAndLineReferenceDesc>
        <ExplanationTxt>The service area for Riverside Healthcare Association, dba Riverside Health System, covers a wide geographic area from rural areas along the Rappahannock River in the north down to south of the James River in southeastern Virginia and west through the greater Williamsburg area. RRMC serves the broad Virginia Peninsula area as well as the western Tidewater region south of the James River surrounding Smithfield and northern Suffolk. The southern most areas south of James are growing significantly, and Riverside is in the process of building a new hospital to specifically serve this unique region. For Peninsula residents, access to health care facilities not located on the Peninsula is restricted by tunnels and bridges, with three connections to various points across the James and the Bay, and one bridge north across the York. Numerous waterways, inlets and marshlands are prominent in the landscape and restrict traffic in certain areas, requiring a system of bridges or circuitous routes for local travel. Interstate 64 runs the length of the Peninsula, providing access some 75 miles from Newport News to downtown Richmond and 40 miles to downtown Norfolk (via Hampton Roads Bridge Tunnel). The Virginia Peninsula region, per 2025 Census Projections, is just under 420 million people. It is approximately 50% White, 38% Black, and the remaining 12% a combination of Asian, Native American, Other and Two or More Races. While still a small overall percentage, the Hispanic community is growing, though still smaller than the entire commonwealth. Median household income is projected to be just over $69,000 in 2025, with Per Capita Income projected to be just under $35,000. The median age is projected to be 36.9 in 2025. The community's population of people over age 65 is growing quickly, and that aging population points to even stronger hospital utilization in the coming years. The age group of 65 and older comprises 17 percent of the population. Within the market, all of the localities with the exception of the city of Poquoson qualify for full or partial designation as Medically Underserved Service Areas. While the military only accounts for 10% of the direct employment in the region, the impact of the armed forces is much larger. With the largest private employer being Huntington Ingalls Newport News Shipbuilding (maker of nuclear-powered aircraft carriers and submarines) with more than 20,000 local workers, and the many smaller contracting companies that support the Newport News Shipyard, local Navy bases, Joint Base Langley / Ft. Eustis, and NASA Langley, more than 50% of the regional economy is connected to the defense industry. It is also a popular destination for military retirees. In terms of demographics and occupations, the Riverside service area is primarily what has traditionally been defined as a blue-collar community. More than one third of adults over age 25 have high school or less as the highest level of educational attainment. The area is also home to several institutions of higher learning including Christopher Newport University and Hampton University. There is strong competition within 60 miles of Riverside Regional Medical Center. Within seven miles on each side and 20 miles north there are three medical surgical hospitals and within 20 to 60 miles across the Hampton Roads harbor there are six facilities. The greater Williamsburg region consists of the City of Williamsburg, James City County, New Kent County and parts of King William and Charles City Counties and is projected to have a US Census 2025 population of approximately 130,000, with a 6.5% growth between 2020 and 2025. The same 2025 census projections estimate 73% white, 17% Black, with the remaining a combination of Asian, Native American, Some Other Race and Two or More Races. Median projected age is 44.7, with more than 25% of the population over the age of 65. It is a relatively prosperous region with a median household income of approximately $105,000 and per capita income of just over $54,000. The education level within the region varies greatly by locality, with extremely high levels in the City of Williamsburg and James City of County and much lower average levels in more rural areas, such as Charles City County. The area is a popular retirement destination, especially for military and federal government retirees. It is also a significant tourism destination and home to the College of William and Mary. Other major employers include Colonial Williamsburg Foundation, Busch Entertainment (Busch Gardens), businesses supporting tourism, such as hotels and restaurants, and the local school systems. Within the region there is one major competitor in the healthcare industry located on the western edge of the market. There is also competition west in Richmond and east on the Peninsula in Hampton and Newport News. The Middle Peninsula, mainly composed of the counties of Essex, Gloucester (where RWRH is located), King &amp; Queen, Mathews, and Middlesex, is located between the Virginia Peninsula to the south and the Northern Neck to the north. The Middle Peninsula is bordered on the north by the Rappahannock River and the south by the York River. Eastward is the Chesapeake Bay. Again, numerous waterways restrict direct travel in certain areas. A majority of the workforce commutes out of the region each day either south to the Peninsula or west to Richmond. The Middle Peninsula has a primary service area projected to have just over 75,000 in 2025 and is generally considered to have a high quality of life in accordance with standard socioeconomic variables, and a comparatively low cost of living. Riverside Walter Reed Hospital on the Middle Peninsula is approximately 30 miles from the closest hospital. Two of the four closest hospitals are Riverside facilities. The Middle Peninsula region, per 2025 Census Projections, is approximately 82% White, 12% Black, and the remainder mainly consisting of people classifying themselves as Two or More Races. While still a small overall percentage, the Asian and Hispanic communities are growing, as well as the multi-racial component of the population. Median household income is projected to be $73,662 in 2025, with Per Capita Income projected to be at $39,405. The median age is projected to be 48.8 in 2025. The community's population of people over age 65 is growing quickly, and that aging population points to even stronger hospital utilization in the coming years. The age group of 65 and older is projected to comprise 27 percent of the population in 2025. Within the market, all of the localities qualify for full or partial designation as Medically Underserved Service Areas.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 5 Promotion of community health</FormAndLineReferenceDesc>
        <ExplanationTxt>Promotion of Community Health: As noted in other sections, Riverside is always working to serve its communities. In addition to the formal things noted in the CHNA and Implementation Plan, there are countless other ways Riverside works to promote community health in its service areas, the state, and the nation. One of the large ways Riverside works to do this is through education. We have two branches of formal health professions education through the Riverside College of Health Careers and the Riverside Graduate Medical Education Program. Riverside has programs to train future nurses (LPN and RN to BSN programs), medical assistants, CNAs, radiology techs, cardiovascular/ echo techs, OR / surgical techs, and PT Assistants. Riverside's Graduate Medical Education program offers residency multiple residency programs include family practice, OB/GYN, emergency medicine and a transitional residency. Riverside also offers residency programs in Pharmacy, Clinical Pastoral Education and will soon be offering a one-year Clinical Ultrasound Fellowship Program which is pending accreditation by the Emergency Ultrasound Fellowship Accreditation Council (EUFAC). In addition to these programs, Riverside facilities and practices serve as clinical rotation locations for students in other training programs including nursing, pharmacy, medical students, and many others. Additionally, Riverside is involved with education at early levels, such as its partnership with the Achievable Dream Academy in Newport News where Riverside has a clinic to care for students and their families. Or partnering with local community colleges, such as on the Eastern Shore. Riverside also provides multiple scholarships and helps train qualified individuals to take care of the future generations of our communities. And Riverside works closely with local first responders through the Peninsula EMS and Tidewater EMS societies to train, as well as provide physician support to those programs. We also work and train with local military and first responder groups on regional safety drills addressing scenarios like incidents at the Huntington Ingalls Newport News Shipyard, at the Surry Power Plant and other locations. Community health education is another large part of Riverside's efforts in caring for its communities. The pandemic changed how people seek out, learn and trust health information, and Riverside is proud to serve as a trusted, local source of truth. As part of that, Riverside provides extensive amounts of accessible education to community members in person, online and one on one. Examples include health lectures in person and online, providing speakers to local groups and organizations on a variety of topics, providing valuable content in written blogs and often in infographic forms so individuals at varying literacy levels can use it. We are also active in local community health fairs and other events where we are able to provide various screenings, education and information including awareness of heart attack and stroke symptoms, the importance of calling 911, cancer screenings, smoking and vaping cessation information, cardiovascular health information including healthy diet, exercise, stress management and importance of taking medications and monitoring Hba1c. We also work with specific population groups to identify opportunities to provide education and outreach on topics of specific concern to those individuals. This has included hosting a nationally recognized African American chef to address the importance of diet in heart health and examining how foods traditionally made in an unhealthy way can be adapted to be made healthier while still celebrating family and community culture and traditions. We have also offered cancer screening information specific to the trans community to help provide clarity on complex issues. Another example is providing skin cancer screening and education focused on the Waterman communities on the Eastern Shore, Middle Peninsula and Peninsula that work in the Chesapeake Bay harvesting things like crab and oysters and spends so much time exposed to the sun. Another aspect of how Riverside takes care of its communities is by investing in programs, technology and professional to assure they are available when needed. A great example of this is Riverside's commitment to providing OB/GYN services on the Eastern Shore despite the fact that the small population size makes it difficult to make the program break even. But without that program, women on the Shore would have to drive to Maryland where Virginia Medicaid isn't accepted or cross a 25+ mile bridge to Virginia Beach that is closed in high winds and hurricanes. Another example is how Riverside invests in specialists and technology that many health systems this size don't have, such as having neurovascular coverage and a biplane suite to provide the most advanced stroke interventions to the people of our community. Another example is how Riverside partnered with the University of Virginia and Chesapeake Regional Medical Center to bring Gamma Knife and Varian Edge radiosurgery technologies to the area, and those are expanding in the near future. A final example of this investment is how Riverside, in response to the ever-increasing need for mental and behavioral health services, opened its first and the only freestanding psychiatric emergency room and expanding our mental health services in Hampton, Virginia. Other important investments include research, partnering with community groups such as the Urban League and The American Diabetes Association to help address specific needs and concerns locally and nationally. Additionally, our clinical and administrative leaders work with local and state organizations to ensure our public health and healthcare infrastructure is in place to care for our communities in a crisis. This became exceptionally clear during the pandemic when our leaders were key in providing storage and distribution for vaccinations as well as in caring for our communities during crisis points. When COVID-19 went through the poultry processing plants on the Eastern Shore, the health system pulled together to care for the small community and was recognized nationally for its efforts. As the needs evolve, Riverside is there to care for the community, whether it is a tornado, pandemic, mass casualty motor vehicle incident or outbreak of gun violence in our schools.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 6 Affiliated health care system</FormAndLineReferenceDesc>
        <ExplanationTxt>RIVERSIDE HEALTH SYSTEM WORKS TOGETHER TO CARE FOR ITS COMMUNITIES ACROSS A WIDE RANGE OF GEOGRAPHIC REGIONS AND SERVICES. EACH REGION HAS A LOCAL ACUTE CARE FACILITY THAT WORKS TO SERVE THE IMMEDIATE NEEDS OF THE AREA. THE ACUTE CARE SERVICES (INPATIENT AND OUTPATIENT) WORK CLOSELY WITH OUR RIVERSIDE MEDICAL GROUP PHYSICIAN PRACTICES AND RIVERSIDE LIFELONG HEALTH THAT ADDRESSES SENIOR SERVICES INCLUDING RETIREMENT COMMUNITIES, SKILLED NURSING FACILITIES, CONVALESCENT AND SHORT-TERM REHABILITATION, HOME HEALTH AND HOSPICE. THE LOCAL HOSPITAL HAS A VOLUNTEER COMMUNITY BOARD, AND RMG AND RIVERSIDE LLH EACH HAVE THEIR OWN VOLUNTEER, COMMUNITY BOARD AS WELL. ALL THOSE BOARDS REPORT UP TO THE RIVERSIDE HEALTH SYSTEM BOARD. EACH AREA WORKS CLOSELY ON CLINICAL AND QUALITY ISSUES FOR THEIR AREA (SUCH AS HACS IN ACUTE CARE, PREVENTATIVE CARE IN RMG AND LENGTH OF STAY IN HOSPICE). STAFF AND PHYSICIANS WORK ACROSS THE AREAS TO PROVIDE THE BEST CARE FOR THE PATIENTS AND RESIDENTS. ADDITIONALLY, THE HOSPITAL IN NEWPORT NEWS SERVES AS A TERTIARY FACILITY WITH A LEVEL 2 TRAUMA CENTER, A CERTIFIED COMPREHENSIVE STROKE CENTER, A CARDIAC CATH LAB, RADIOSURGERY, AND OTHER ACUTE SERVICES NOT AVAILABLE IN THE SMALLER MARKETS. THE MISSION ACROSS ALL OF RIVERSIDE HEALTH SYSTEM IS TO CARE FOR OTHERS AS WE WOULD CARE FOR THOSE WE LOVE. THIS SIMPLE MISSION UNIFIED THE TEAM ACROSS THE COMMUNITIES OF SOUTHEASTERN VIRGINIA. SERVICES ARE FOCUSED IN FIVE MAIN MARKETS, EACH HAVING AN ACUTE CARE HOSPITAL AS WELL AS OTHER SERVICES ACROSS THE CONTINUUM OF CARE. EACH HOSPITAL HAS A COMMUNITY-BASED BOARD OF DIRECTORS. RIVERSIDE MEDICAL GROUP AND RIVERSIDE'S LIFELONG HEALTH DIVISION ALSO HAVE COMMUNITY-BASED BOARDS. THESE BOARDS ALL REPORT UP THROUGH THE RIVERSIDE HEALTH SYSTEM BOARD OF DIRECTORS. PROMOTING THE HEALTH OF THE COMMUNITIES. RIVERSIDE SERVES IS DONE AT ALL LEVELS AND IN ALL PARTS OF THE ORGANIZATIONS. RIVERSIDE WORKS TO KNOW THE INDIVIDUAL SERVICE AREAS TO BEST UNDERSTAND HOW TO PROMOTE HEALTHY COMMUNITIES AT THE LOCAL LEVEL. THIS MAY BE THROUGH RECRUITING HEALTH CARE PROVIDERS TO ENSURE THERE ARE ENOUGH PRIMARY CARE OR SPECIALTY PROVIDERS TO CARE FOR THE POPULATION. IT MAY BE IN PROVIDING INNOVATIVE SERVICES TO HELP INDIVIDUALS AGE IN THE PLACE OF THEIR CHOOSING OR THROUGH VARIOUS IN-HOME TECHNOLOGIES. OR IT MAY BE IN PROVIDING COMMUNITY EDUCATION IN HOW TO MAINTAIN AN ACTIVE LIFESTYLE TO HELP PREVENT OBESITY-RELATED DISEASES. INDIVIDUAL HOSPITALS WORK WITH THE LOCAL COMMUNITIES TO DETERMINE WHAT SERVICES ARE NEEDED, OR WHAT LOCAL PROGRAMS NEED TO BE SUPPORTED - WHETHER THROUGH FINANCIAL OR IN- KIND SUPPORT OR THROUGH PROGRAM DEVELOPMENT. EXAMPLES OF THIS INCLUDE: ORGANIZING COMMUNITY LECTURES TO PROMOTE HEALTH; SUPPORTING THE TRAINING OF FIRST RESPONDERS IN HOW TO BEST CARE FOR PATIENTS WITH DEMENTIA OR A BEHAVIORAL HEALTH CRISIS; WORKING WITH LOCAL TRANSIT AUTHORITIES TO ENSURE BUS ROUTES WORK FOR PATIENTS NEEDING TO GO BETWEEN HOSPITALS AND CLINICS; AND ESTABLISHING A CLINIC AT A LOCAL SCHOOL FOR AT-RISK STUDENTS IN NEWPORT NEWS. FROM A HEALTH SYSTEM PERSPECTIVE, RIVERSIDE IS ALSO WORKING TO CONTRIBUTE TO LONG-TERM CHANGES IN HEALTH CARE THROUGH RESEARCH AND EDUCATION. RIVERSIDE CONTINUES TO TRAIN HEALTH CARE PROFESSIONALS, FROM NURSING ASSISTANTS TO PHYSICIANS. RIVERSIDE'S COLLEGE OF HEALTH CAREERS TRAINS A VARIETY OF STUDENTS IN MULTIPLE PROGRAMS INCLUDING: NURSING, NURSING ASSISTANTS, RADIOLOGIC TECHNOLOGISTS, SURGICAL TECHNOLOGISTS AND PHYSICAL THERAPY ASSISTANTS. RIVERSIDE ALSO MAINTAINS A MEDICAL RESIDENCY PROGRAM TO TRAIN NEW PHYSICIANS. ADDITIONALLY, STUDENTS FROM PROGRAMS OUTSIDE OF THE RIVERSIDE PROGRAMS DO MANY ROTATIONS THROUGH RIVERSIDE'S FACILITIES TO LEARN HOW TO BEST CARE FOR PATIENTS. IN THE AREA OF RESEARCH, RIVERSIDE PROGRAMS CONTINUE TO EXPAND. RESEARCH VARIES FROM STUDIES CONDUCTED BY THE STUDENTS AND FACULTY TO OUR EXTENSIVE CLINICAL TRIAL RESEARCH PROGRAMS GIVING PATIENTS ACCESS TO THE LATEST TRIALS. RIVERSIDE HAS THE BENEFIT OF BEING ABLE TO SERVE AT BOTH A CORPORATE AND LOCAL LEVEL. THE COMMUNITY BASED HOSPITALS ALLOW CONNECTIONS AT A LOCAL LEVEL TO BUILD RELATIONSHIPS AND DEVELOP UNIQUE, CREATIVE AND TAILORED SOLUTIONS TO LOCAL PROBLEMS. AT THE SAME TIME, THE BROADER HEALTH SYSTEM HAS THE ABILITY TO LEVERAGE COMBINED RESOURCES TO IMPACT BROADER ISSUES THROUGH THE PROMOTION OF RESEARCH AND EDUCATION FOR LONG-TERM ADVANCEMENTS IN HEALTH CARE.</ExplanationTxt>
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        <ExplanationTxt>VA</ExplanationTxt>
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        <USAddress>
          <AddressLine1Txt>524 J Clyde Morris Boulevard</AddressLine1Txt>
          <CityNm>Newport News</CityNm>
          <StateAbbreviationCd>VA</StateAbbreviationCd>
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          <AddressLine1Txt>PO BOX 13619</AddressLine1Txt>
          <CityNm>Richmond</CityNm>
          <StateAbbreviationCd>VA</StateAbbreviationCd>
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        <PurposeOfGrantTxt>Sponsorship</PurposeOfGrantTxt>
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          <BusinessNameLine1Txt>Virginia Peninsula Chamber Of Commerce</BusinessNameLine1Txt>
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          <AddressLine2Txt>Suite 110</AddressLine2Txt>
          <CityNm>Newport News</CityNm>
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          <CityNm>Williamsburg</CityNm>
          <StateAbbreviationCd>VA</StateAbbreviationCd>
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        <NontaxableBenefitsRltdOrgsAmt>54222</NontaxableBenefitsRltdOrgsAmt>
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        <TotalCompensationRltdOrgsAmt>458024</TotalCompensationRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>Lisa Shannon</BusinessNameLine1Txt>
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        <TitleTxt>Associate Vice President Risk Management</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>211063</CompensationBasedOnRltdOrgsAmt>
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        <BonusRelatedOrganizationsAmt>37620</BonusRelatedOrganizationsAmt>
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        <OtherCompensationRltdOrgsAmt>11079</OtherCompensationRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>20762</NontaxableBenefitsRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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          <BusinessNameLine1Txt>Toiya Sosa</BusinessNameLine1Txt>
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        <TitleTxt>Associate Vice President/Chief Diversity Officer</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>161530</CompensationBasedOnRltdOrgsAmt>
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        <TitleTxt>RN Nursing Director Surgical Services</TitleTxt>
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          <BusinessNameLine1Txt>JASON VILLAFLOR</BusinessNameLine1Txt>
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        <TitleTxt>AVP LLHARS</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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          <BusinessNameLine1Txt>Lanell Williams</BusinessNameLine1Txt>
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        <TitleTxt>RN Assistant Chief Nursing Officer WRH/DHW/SMH</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>154257</CompensationBasedOnRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>KRISTEN BRAM WITT</BusinessNameLine1Txt>
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        <CompensationBasedOnRltdOrgsAmt>175173</CompensationBasedOnRltdOrgsAmt>
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        <BonusRelatedOrganizationsAmt>30656</BonusRelatedOrganizationsAmt>
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        <CompensationBasedOnRltdOrgsAmt>129667</CompensationBasedOnRltdOrgsAmt>
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        <BusinessName>
          <BusinessNameLine1Txt>Michelle Wooten</BusinessNameLine1Txt>
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        <TitleTxt>Chief Nursing Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>194874</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>Romney Andersen</BusinessNameLine1Txt>
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        <TitleTxt>Physician Specialty</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
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        <BusinessName>
          <BusinessNameLine1Txt>Anthony Farah</BusinessNameLine1Txt>
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        <TitleTxt>Physician Specialty</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
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          <BusinessNameLine1Txt>John Lamm</BusinessNameLine1Txt>
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        <TitleTxt>Physician Specialty</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>1304821</CompensationBasedOnRltdOrgsAmt>
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          <BusinessNameLine1Txt>Matthew Reed</BusinessNameLine1Txt>
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        <TitleTxt>Physician Specialty</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>186407</CompensationBasedOnRltdOrgsAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4a Severance or change-of-control payment</FormAndLineReferenceDesc>
        <ExplanationTxt>SEVERANCE PAYMENT ESTHER DESIMINI $154,585</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan</FormAndLineReferenceDesc>
        <ExplanationTxt>ADRIA VANHOOZIER $34,647 CHARLES O FRAZIER $59,203 CHRISTOPHER P STOLLE $56,006 CYNTHIA WILLIAMS $37,518 DELVIN ERICSON PEEKS $23,253 EDWARD G HECKLER $38,219 EILEEN A VARNSON $32,724 FRANKYE T MYERS $43,313 JASON KILGORE $28,341 JASON O HOUSER $55,125 JESSE R GOODRICH $41,302 JOHN PAUL PETERMAN $41,250 LISA B SALSBERRY $27,542 MICHAEL DOUCETTE $51,501 MICHAEL J DACEY $206,850 MICHAEL SEIJI OSHIKI $72,188 NICOLAS CHUQUIN $26,126 ROSS M YOUNGER $57,201 SADIE J THURMAN $28,193 SALLY A RYAN $37,021 SALLY E HARTMAN $61,347 SHELLY JOHNSON $28,750 STACEY L JOHNSON $28,125 THERESA D SIEVERS $42,900 THOMAS M KAYROUZ $78,101 THOMAS TAGHON $55,000 WALTER WILLIAM AUSTIN $86,504 WILLIAM BURNS DOWNEY $220,584 --------------------------- TOTAL $1,598,834 RIVERSIDE HAS ESTABLISHED THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO PROVIDE RETIREMENT BENEFITS TO CERTAIN EXECUTIVE EMPLOYEES TO SUPPLEMENT THE RETIREMENT BENEFITS TO BE RECEIVED FROM RIVERSIDE AND SOCIAL SECURITY. ALTHOUGH THE EMPLOYEE IS FULLY VESTED IN THESE FUNDS, HE/SHE WILL NOT HAVE THE RIGHT TO WITHDRAW THESE FUNDS UNTIL THE LATER OF THE EMPLOYEE REACHING AGE 62 OR SEPARATION FROM SERVICE WITH RIVERSIDE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION COMMITTEE OF THE PARENT CORPORATION, RIVERSIDE HEALTHCARE ASSOCIATION, INC. REVIEWS AND APPROVES THE COMPENSATION FOR TOP MANAGEMENT USING INDEPENDENT CONSULTANTS AND SURVEYS.</ExplanationTxt>
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      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <BusinessName>
            <BusinessNameLine1Txt>S JOHNSON</BusinessNameLine1Txt>
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        </NameOfInterested>
        <RelationshipDescriptionTxt>SEE PART V</RelationshipDescriptionTxt>
        <TransactionAmt>78665</TransactionAmt>
        <TransactionDesc>EMPLOYMENT</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule L, Part IV, Column (b) SHELLY JOHNSON</FormAndLineReferenceDesc>
        <ExplanationTxt>FAMILY MEMBERS OF SHELLY JOHNSON ARE EMPLOYED BY RIVERSIDE MIDDLE PENINSULA HOSPITAL, INC.</ExplanationTxt>
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    <IRS990ScheduleM documentId="IRS990ScheduleM" softwareId="23017437" softwareVersionNum="2023v5.1">
      <SecuritiesPubliclyTradedGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>6</ContributionCnt>
        <NoncashContributionsRptF990Amt>79864</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>Market value</MethodOfDeterminingRevenuesTxt>
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      <Form8283ReceivedCnt>0</Form8283ReceivedCnt>
      <AnyPropertyThatMustBeHeldInd>false</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>true</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>false</ThirdPartiesUsedInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule M, Part I Explanations of reporting method for number of contributions</FormAndLineReferenceDesc>
        <ExplanationTxt>Securities - Publicly traded - The number reported on Part I, Column B represents the number of contributors.</ExplanationTxt>
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    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="23017437" softwareVersionNum="2023v5.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part I, Line 3 PART I, LINES 3 AND 4/PART VI LINES 1A AND 1B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE NUMBER OF VOTING MEMBERS AND INDEPENDENT VOTING MEMBERS REPORTED IN PART I LINE 3 AND 4/PART VI LINES 1A AND 1B IS HIGHER THAN THE TOTAL COUNT OF BOARD MEMBERS REPORTED IN PART VII AS SEVERAL OF THE BOARD MEMBERS SIT ON SEVERAL OF THE ENTITIES INCLUDED WITHIN THE GROUP RETURN BUT HAVE ONLY BEEN LISTED ONCE.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part V, Line 3a PART V, LINE 3A</FormAndLineReferenceDesc>
        <ExplanationTxt>RIVERSIDE HOSPITAL, INC. EIN 52-1245746, A SUBORDINATE COMPANY, HAD UNRELATED BUSINESS INCOME GREATER THAN $1,000 AND 990-T WAS FILED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15 PART VI, SECTION B, LINE 15 A&amp;B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE RIVERSIDE HEALTHCARE ASSOCIATION, INC. BOARD OF DIRECTORS COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION FOR TOP MANAGEMENT USING INDEPENDENT CONSULTANTS AND SURVEYS. THE REVIEW OF THE DATA PROVIDED BY THE INDEPENDENT CONSULTANTS FOR 2023 TOP MANAGEMENT SALARIES WAS CONDUCTED BY THE COMPENSATION COMMITTEE ON NOVEMBER 1, 2022.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION IS A GROUP OF NOT FOR PROFIT CORPORATIONS WITH A SINGLE MEMBER. THE MEMBER HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE, INCLUDING ELECTING MEMBERS OF THE GOVERNING BODY AND TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>MEMBERS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>SIGNIFICANT ITEMS SUCH AS MERGER, AMENDMENT OF CHARTER DOCUMENTS, AND APPOINTMENT OF BOARD MEMBERS REQUIRES THE APPROVAL OF THE MEMBER CORPORATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>ON BEHALF OF THE ORGANIZATION'S GOVERNING BODY, THE RIVERSIDE HEALTHCARE ASSOCIATION, INC. BOARD OF DIRECTORS COMPENSATION COMMITTEE REVIEWS THE FORM 990. THE ENTIRE FORM 990 WAS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM BEFORE FILING AND IS PROVIDED TO THE RIVERSIDE HEALTHCARE ASSOCIATION, INC. BOARD OF DIRECTORS FOR REVIEW.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL BOARD MEMBERS, OFFICERS, DIRECTORS AND KEY EMPLOYEES COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. A REPORT OF POTENTIAL CONFLICTS OF INTEREST IS REVIEWED BY THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER CONSULTS WITH THE RIVERSIDE HEALTH SYSTEM CEO REGARDING IDENTIFIED CONFLICTS OF INTEREST AS NECESSARY. IF A CONFLICT PRESENTS, BOARD MEMBERS ARE REQUIRED BY THE BY-LAWS, TO DISCLOSE THE CONFLICT TO THE FULL BOARD AND RECUSE THEMSELVES FROM VOTING ON A CASE BY CASE BASIS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BLAKE, DWAYNE B ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-VICE CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BRAUER, WILLIAM L ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BURNETT, JAMES C, CPA ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-CHAIRMAN, AverageHours: 0.500; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-CHAIRMAN, AverageHours: 0.500; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BYRD, THOMAS ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Services, Inc., Title: HCS-VICE CHAIRMAN, AverageHours: 0.300; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Management Services, Inc., Title: RMS-VICE CHAIRMAN, AverageHours: 0.400; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A DACEY, MICHAEL J, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Retirement Services, Inc., Title: RRS-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.500; IndividualTrusteeOrDirectorOfficer Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-Board Member/PRESIDENT/CEO, RHS, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-Board Member/PRESIDENT/CEO, RHS, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Hospital Inc, Title: RRMC-Board Member/PRESIDENT/CEO, RHS, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Healthcare Services, Inc., Title: HCS-Board Member/PREDIDENT/CEO, RHS, AverageHours: 0.300; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Physician Services, Inc., Title: RMG-PRESIDENT/CEO, RHS, AverageHours: 1.000; Officer Organization Name: Patriots Colony, Inc., Title: PAT-PRESIDENT/CEO, RHS, AverageHours: 1.000; Officer Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Sanders Common, LTD., Title: SANN-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-Board Member/PRESIDENT/CEO, RHS, AverageHours: 0.500; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Management Services, Inc., Title: RMS-Board Member/PRESIDENT/CEO, RHS/President/EVP, AverageHours: 30.400; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A DOWNEY, WILLIAM BURNS ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Executive Vice Chairman, RHS Board, AverageHours: 38.000; Officer Organization Name: Patriots Colony, Inc., Title: PAT-EXEC VICE CHAIRMAN &amp; SPECIAL ADVISORY, RHS, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A GOODSON, GEORGE ROYDEN, III ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A HAYWOOD, BARBARA S ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Sanders Common, LTD., Title: SANN-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Retirement Services, Inc., Title: RRS-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-VICE CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A JONES, HAROLD D ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A JONES, DAVID F, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-CHAIRMAN/Physician Specialty, AverageHours: 38.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A KIDD, QUENTIN, PHD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-VICE CHAIRMAN, AverageHours: 0.500; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-VICE CHAIRMAN, AverageHours: 0.500; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MORGAN, GABRIEL A ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-CHAIRMAN, AverageHours: 0.400; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Healthcare Services, Inc., Title: HCS-CHAIRMAN, AverageHours: 0.300; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A RANDOLPH, CARRINGTON F ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-VICE CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SHERLOCK, DANIEL J ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SMITH, CHARLENE E ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-VICE CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SMITH, CONWAY W , III ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Sanders Common, LTD., Title: SANN-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Retirement Services, Inc., Title: RRS-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-CHAIRMAN, AverageHours: 0.100; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Taghon, Thomas ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-Hospital Chief Medical Officer/VP, AverageHours: 39.000; Officer Organization Name: Riverside Physician Services, Inc., Title: RMG-Board Member/Hospital Chief Medical Officer/VP, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A THRASH, NEHEMIAH, JR ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-VICE CHAIRMAN/Physician Specialty, AverageHours: 40.000; IndividualTrusteeOrDirectorOfficer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Abbitt, Stephen M ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A ADOLPHI, CELIA L ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A AINSLEY, KRYSTAL E, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Primary Care, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A ALEWYNSE, JOYCE JARRETT ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A AMBLER, VIRGINIA M ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Anderson, Betsy C ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A AUSTIN, WANDA M ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BARRY, PATRICIA P, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BATES, JARED L ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Patriots Colony, Inc., Title: PAT-VICE CHAIRMAN, AverageHours: 1.000; IndividualTrusteeOrDirectorOfficer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BAYLOUS, JAMES, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-MED STAFF PRESIDENT/BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Billings, Justin A ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Hospitalist, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BROWN, PATRICIA G ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BURGESS, SCOTT ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Specialty, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A CHASE, MICHAEL T ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A CLEMONS, WALTER R, PHD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A COURTER, ROBERT J, JR ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A DAVIS, ROBERT T ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A DENT, MONILLA ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RRMC-BOARD MEMBER/Physician Primary Care, AverageHours: 38.500; Organization Name: Riverside Hospital Inc, Title: RRMC-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A ELOFSON, FREDRICK N ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A EMORY, THERESA, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Exton, Keith J ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A FLANAGAN, SHAWN A ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A FOWLER, CALEB L ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A GARGIULO, FAYE P ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Harrell, Eric ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A HICKMAN, SUSANNA B ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Hill, Andrew T ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A HOWARD, HALL RENFRO, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A HUNT, ELIZABETH DAWN, DMD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A JORDAN, EUGENE M, ESQ ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A LARKIN, TIMOTHY P, II ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Primary Care, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A LINTZENICH, CATHERINE R ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Specialty, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MASSEY, WILLIAM S ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MCALLISTER, WILLIAM H, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Specialty, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MCCORRY, JAMES W, DO ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Emergency Room RRMC, AverageHours: 20.900; IndividualTrusteeOrDirector Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-CMO, RDHW, AverageHours: 1.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MEREDITH, CAROL U ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MINTER, CHARLES G ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MOREHOUSE, THOMAS F, III ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A MOSS, CARRIE R, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER/Physician Specialty, AverageHours: 1.000; IndividualTrusteeOrDirector Organization Name: Riverside Physician Services, Inc., Title: RDHW-BOARD MEMBER/Physician Specialty, AverageHours: 39.000;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A NAGEL, DOUGLAS E ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A POOLE, ALFRED JOE, III ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A REED, SCOTT F, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Specialty, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Roots, Keith D ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Ross, Phyllis ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SAUNDERS, RONALD LEE ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SCHURSKY, MELVIN D, JR, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Physician Specialty, AverageHours: 39.000; IndividualTrusteeOrDirector Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-CMO, RWRH, AverageHours: 1.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SHEILD, CONWAY HOWARD, III ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SILVASY, STEPHEN, JR ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Smith, Dawn R ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SMITH, KIRBY H ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SPAIN, STEVE ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-BOARD MEMBER, AverageHours: 0.500; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A STONE, ERIC M ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Stone, Eric B ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-Board Member/FORMER RRMC VP CLINICAL OPERATIONS/Physician Primary Care, AverageHours: 31.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A STOWELL, PHILIP G ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A THOMPSON, TERESA K, NP ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Nurse Practitioner, AverageHours: 32.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A TILLER, BROOKE ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Tomlin, Dana W ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A TOWLER, APRIL P ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-BOARD MEMBER/Nurse Practitioner, AverageHours: 40.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A TREOLO, PAUL ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A VERSER, JOSEPH F ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Patrick Henry Hospital, Inc., Title: LLH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Sanders Common, LTD., Title: SANN-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector Organization Name: Riverside Retirement Services, Inc., Title: RRS-BOARD MEMBER, AverageHours: 0.100; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A WEST, CHARVALLA ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A WHITE, JOHN T, III ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-BOARD MEMBER, AverageHours: 1.000; IndividualTrusteeOrDirector</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A DESIMINI, ESTHER M ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc.(Former), Title: FORMER RWRH-PRESIDENT, RWRH/Hospital President/VP, AverageHours: 0.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Spiller, James ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc(Former), Title: RRMC-FORMER RRMC INTERIM VP/CMO/Physician Specialty, AverageHours: 0.000; Officer Organization Name: Riverside Physician Services, Inc.(Former), Title: RRMC-FORMER RRMC INTERIM VP/CMO/Physician Specialty, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A AUSTIN, WALTER WILLIAM, JR ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-EVP, CFO &amp; TREASURER, AverageHours: 1.000; Officer Organization Name: Riverside Hospital Inc, Title: RRMC-EVP, CFO &amp; TREASURER, AverageHours: 1.000; Officer Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-EVP, CFO &amp; TREASURER, AverageHours: 1.000; Officer Organization Name: Riverside Healthcare Services, Inc., Title: HCS-EVP, CFO &amp; TREASURER, AverageHours: 0.300; Officer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-EVP, CFO &amp; TREASURER, AverageHours: 1.000; Officer Organization Name: Riverside Retirement Services, Inc., Title: RRS-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer Organization Name: Patriots Colony, Inc., Title: PAT-EVP, CFO &amp; TREASURER, AverageHours: 1.000; Officer Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer Organization Name: Riverside Management Services, Inc., Title: RMS-EVP, CFO &amp; TREASURER, AverageHours: 30.400; Officer Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-EVP, CFO &amp; TREASURER, AverageHours: 0.500; Officer Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-EVP, CFO &amp; TREASURER, AverageHours: 0.500; Officer Organization Name: Sanders Common, LTD., Title: SANN-EVP, CFO &amp; TREASURER, AverageHours: 0.100; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Chuquin, Nicolas ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Hospital President/VP, AverageHours: 0.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Doucette, Michael ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Support Services/VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A FRAZIER, CHARLES O ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-VP MD, AverageHours: 1.000; Officer Organization Name: Riverside Management Services, Inc., Title: RMS-Chief Medical Information &amp; Innovation Officer/SVP, AverageHours: 39.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A GOODRICH, JESSE R ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A HARTMAN, SALLY E ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-SENIOR VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A HECKLER, EDWARD G ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer Organization Name: Patriots Colony, Inc., Title: PAT-VP, LIFELONG HEALTH, AverageHours: 1.000; Officer Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer Organization Name: Riverside Healthcare Services, Inc., Title: HCS-President Lifelong Health/SVP, AverageHours: 38.000; Officer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer Organization Name: Riverside Retirement Services, Inc., Title: RRS-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer Organization Name: Sanders Common, LTD., Title: SANN-VP, LIFELONG HEALTH, AverageHours: 0.100; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A HOUSER, JASON O ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Riverside Physician Services, Inc., Title: RMG-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 1.000; Officer Organization Name: Riverside Healthcare Services, Inc., Title: HCS-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.300; Officer Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 1.000; Officer Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.500; Officer Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.500; Officer Organization Name: Riverside Management Services, Inc., Title: RMS-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 30.400; Officer Organization Name: Riverside Retirement Services, Inc., Title: RRS-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Sanders Common, LTD., Title: SANN-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 0.100; Officer Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 1.000; Officer Organization Name: Riverside Hospital Inc, Title: RRMC-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 1.000; Officer Organization Name: Patriots Colony, Inc., Title: PAT-GENERAL COUNSEL/SECRETARY, RHS, AverageHours: 1.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Johnson, Shelly ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-Hospital President/VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Johnson, Stacey L ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-Hospital President/VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A KAYROUZ, THOMAS M ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Chief Clinical Operations Officer /EVP, AverageHours: 39.000; Officer Organization Name: Riverside Physician Services, Inc., Title: RMG-PRESIDENT CMO RMG, AverageHours: 1.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A KILGORE, JASON ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-VP RESULTS MGT AND ANALYTICS, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Macalino, Jessica ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Hospital President/VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Myers, Frankye T ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-Chief Nursing Officer/SVP, AverageHours: 0.100; Officer Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-Chief Nursing Officer/SVP, AverageHours: 1.000; Officer Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-Chief Nursing Officer/SVP, AverageHours: 0.500; Officer Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-Chief Nursing Officer/SVP, AverageHours: 0.100; Officer Organization Name: Riverside Hospital Inc, Title: RRMC-Chief Nursing Officer/SVP, AverageHours: 1.000; Officer Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-Chief Nursing Officer/SVP, AverageHours: 0.100; Officer Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-Chief Nursing Officer/SVP, AverageHours: 0.500; Officer Organization Name: Patriots Colony, Inc., Title: PAT-Chief Nursing Officer/SVP, AverageHours: 1.000; Officer Organization Name: Riverside Retirement Services, Inc., Title: RRS-Chief Nursing Officer/SVP, AverageHours: 0.100; Officer Organization Name: Patrick Henry Hospital, Inc., Title: LLH-Chief Nursing Officer/SVP, AverageHours: 0.100; Officer Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-Chief Nursing Officer/SVP, AverageHours: 0.100; Officer Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-Chief Nursing Officer/SVP, AverageHours: 0.100; Officer Organization Name: Riverside Physician Services, Inc., Title: RMG-Chief Nursing Officer/SVP, AverageHours: 1.000; Officer Organization Name: Riverside Management Services, Inc., Title: RMS-Chief Nursing Officer/SVP, AverageHours: 32.500; Officer Organization Name: Riverside Healthcare Services, Inc., Title: HCS-Chief Nursing Officer/SVP, AverageHours: 0.300; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Oshiki, Michael Seiji ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-Hospital President/SVP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Peeks, Delvin ERICSON ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Enterprise Resource &amp; Workforce Analytics/VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A PETERMAN, JOHN PAUL ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-COO, RRMC, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A RYAN, SALLY A ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-VP/COO, RMG, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SALSBERRY, LISA B ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Officer Corp Audit &amp; Comp/Priv, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SIEVERS, THERESA D ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-SENIOR VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A STOLLE, CHRISTOPHER P, MD ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Medical Affairs/VP, AverageHours: 39.000; Officer Organization Name: Riverside Hospital Inc, Title: RRMC-VP MEDICAL AFFAIRS, AverageHours: 1.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A THURMAN, SADIE J ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-VP CNO, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A VANHOOZIER, ADRIA NICOLE ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-PRESIDENT, RDHW, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A VARNSON, EILEEN A ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A WILLIAMS, CYNTHIA ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: RRMC-VP, AverageHours: 40.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A YOUNGER, ROSS M ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Chief Information Officer/ SVP, AverageHours: 39.000; Officer Organization Name: Riverside Hospital Inc, Title: RRMC-SENIOR VP, AverageHours: 1.000; Officer</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A CONVERSE, JOSEPH ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc.(Former), Title: FORMER RDHW-MEDICAL STAFF PRESIDENT/Physician Specialty, AverageHours: 13.200; KeyEmployee Organization Name: Doctors Hospital of Williamsburg(Former), Title: FORMER RDHW-MEDICAL STAFF PRESIDENT/Physician Specialty, AverageHours: 0.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A ADINARO, JOSEPH T, IV ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-MEDICAL STAFF PRESIDENT/Physician Specialty, AverageHours: 1.000; KeyEmployee Organization Name: Riverside Physician Services, Inc., Title: RDHW-MEDICAL STAFF PRESIDENT/Physician Specialty, AverageHours: 39.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Ange, Cheryl ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-Specialty Care Senior Director, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Atkins, Margaret ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Chief Nursing Information Officer, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A BAYLY, JULIE MITCHELL ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Services, Inc., Title: Executive Director LLH Facilities, AverageHours: 39.000; KeyEmployee Organization Name: Patriots Colony, Inc., Title: PAT-EXECUTIVE DIRECTOR, AverageHours: 1.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Cook, Jaime ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Total Rewards &amp; Leave Management System Director, AverageHours: 0.400; KeyEmployee Organization Name: Riverside Hospital Inc, Title: Total Rewards &amp; Leave Management System Director, AverageHours: 39.600; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Cooper, Kelly ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RMG-Primary Care Senior Director, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Culbert, Douglas ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Service Line, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Emons, Timothy ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: RMS-Associate Vice President Corporate Controller, AverageHours: 0.400; KeyEmployee Organization Name: Riverside Hospital Inc, Title: Associate Vice President Corporate Controller, AverageHours: 39.600; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Gardner, Laura ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Support Operations, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Gossage, Mary ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Service Line, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Guthrie, Winfred ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: Associate Vice President IS Business Systems &amp; Operational Support, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Guzik, Stacy ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Services, Inc., Title: Administrator LLH PCAW/WF/TGWF, AverageHours: 39.900; KeyEmployee Organization Name: Patrick Henry Hospital, Inc., Title: LLH-Administrator LLH PCAW/WF/TGWF, AverageHours: 0.100; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Healy, Kimberly ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President/Surgery and Anesthesia Services, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Holmes, Gail ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: General Ledger Accounting Director, AverageHours: 39.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Inabinet, David ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Chief Information Security Officer, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A James, Yvonne ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-Finance and Operations Director, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Keesee, Michael ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Clinical &amp; Revenue Systems, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Kirby, Lisa ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patriots Colony, Inc., Title: PAT-Executive Director Nursing Homes LLH, AverageHours: 1.000; KeyEmployee Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-Executive Director Nursing Homes LLH, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Healthcare Services, Inc., Title: Executive Director Nursing Homes LLH, AverageHours: 38.600; KeyEmployee Organization Name: Sanders Common, LTD., Title: SANN-Executive Director Nursing Homes LLH, AverageHours: 0.100; KeyEmployee Organization Name: Patrick Henry Hospital, Inc., Title: LLH-Executive Director Nursing Homes LLH, AverageHours: 0.100; KeyEmployee Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-Executive Director Nursing Homes LLH, AverageHours: 0.100; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Labonte, Barbara ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-Associate Vice President Budget Tax &amp; Reimbursement, AverageHours: 1.000; KeyEmployee Organization Name: Riverside Hospital Inc, Title: Associate Vice President Budget Tax &amp; Reimbursement, AverageHours: 34.800; KeyEmployee Organization Name: Riverside Management Services, Inc., Title: RMS-Associate Vice President Budget Tax &amp; Reimbursement, AverageHours: 0.400; KeyEmployee Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-Associate Vice President Budget Tax &amp; Reimbursement, AverageHours: 0.500; KeyEmployee Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-Associate Vice President Budget Tax &amp; Reimbursement, AverageHours: 1.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Luke, Adam ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Service Line, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Mckee, Linda ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President Service Line, AverageHours: 39.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Miller, Braden ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: Associate Vice President Chief Finance Officer RMG, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Morillo, Christine ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Patrick Henry Hospital, Inc., Title: LLH-Administrator LLH PCAW/WF/TGWF, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Healthcare Services, Inc., Title: Administrator LLH PCAW/WF/TGWF, AverageHours: 39.900; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A NELSON, LINWOOD SHAWN ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Sanders Common, LTD., Title: SANN-CFO LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-CFO LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-CFO LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-Associate Vice President Chief Finance Officer LLH, AverageHours: 0.500; KeyEmployee Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-CFO LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Retirement Services, Inc., Title: RRS-CFO LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Hospital Inc, Title: Associate Vice President Chief Finance Officer LLH, AverageHours: 37.500; KeyEmployee Organization Name: Patrick Henry Hospital, Inc., Title: LLH-CFO LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-CFO LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-CFO LLHARS, AverageHours: 0.100; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Olatunji, Olukemi ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Pharmacy Senior Director, AverageHours: 39.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Rath, Mark ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: Associate Vice President Support Operations, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Schoenherr, Brenda ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Services, Inc., Title: HCS-Regional Director of Homecare Operations, AverageHours: 39.200; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A SENSENIG, JEFF T ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Physician Services, Inc., Title: RWRH-MEDICAL STAFF PRESIDENT/Physician Admin, AverageHours: 34.800; KeyEmployee Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-MEDICAL STAFF PRESIDENT/Physician Admin, AverageHours: 1.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Shannon, Lisa ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Services, Inc., Title: Associate Vice President Risk Management, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Sosa, Toiya ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Management Services, Inc., Title: Associate Vice President/Chief Diversity Officer, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Thomas, Mitzi ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-RN Nursing Director Surgical Services, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A VILLAFLOR, JASON ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Francis N. Sanders Nursing Home, Inc., Title: SAN-AVP LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Retirement Services, Inc., Title: RRS-AVP LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Healthcare Services, Inc., Title: Associate Vice President LLH, AverageHours: 38.000; KeyEmployee Organization Name: Rehabilitation Institute of Virginia, Inc., Title: RRI-AVP LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Center for Excellence in Aging and Geriatric Health, Title: CEAGH-AVP LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Convalescent Centers, Inc., Title: RCC-AVP LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Patrick Henry Hospital, Inc., Title: LLH-AVP LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Sanders Common, LTD., Title: SANN-AVP LLHARS, AverageHours: 0.100; KeyEmployee Organization Name: Riverside Wellness and Fitness Centers, Inc., Title: RWFC-AVP LLHARS, AverageHours: 0.100; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Williams, Lanell ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Middle Peninsula Hospital, Inc., Title: RWRH-RN Assistant Chief Nursing Officer WRH/DHW/SMH, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A WITT, KRISTEN BRAM ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Hospital Inc, Title: Associate Vice President/Chief Philanthropy Officer, AverageHours: 39.000; KeyEmployee Organization Name: Riverside Healthcare Foundation, Inc., Title: RHCF-EXECUTIVE DIRECTOR, AverageHours: 0.500; KeyEmployee Organization Name: Riverside Health System Foundation, Inc., Title: RHSF-EXECUTIVE DIRECTOR, AverageHours: 0.500; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Woodard, Mark ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Riverside Healthcare Services, Inc., Title: Administrator, AverageHours: 39.900; KeyEmployee Organization Name: Patrick Henry Hospital, Inc., Title: LLH-Administrator, AverageHours: 0.100; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Wooten, Michelle ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
        <ExplanationTxt>Organization Name: Doctors Hospital of Williamsburg, Title: RDHW-Chief Nursing Officer, AverageHours: 40.000; KeyEmployee</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A Andersen, Romney ADDITIONAL POSITIONS HELD</FormAndLineReferenceDesc>
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