﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile" returnVersion="2022v5.0">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2024-08-12T11:27:47-05:00</ReturnTs>
    <TaxPeriodEndDt>2023-09-30</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>010494526</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>Baker Newman &amp; Noyes</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>PO Box 507</AddressLine1Txt>
        <CityNm>Portland</CityNm>
        <StateAbbreviationCd>ME</StateAbbreviationCd>
        <ZIPCd>04112</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2022-10-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>042103583</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>VALL</BusinessNameControlTxt>
      <PhoneNum>4135342567</PhoneNum>
      <USAddress>
        <AddressLine1Txt>20 Hospital Drive</AddressLine1Txt>
        <CityNm>Holyoke</CityNm>
        <StateAbbreviationCd>MA</StateAbbreviationCd>
        <ZIPCd>010406604</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>Dean Vitarisi</PersonNm>
      <PersonTitleTxt>Treasurer &amp; CFO</PersonTitleTxt>
      <PhoneNum>4135342567</PhoneNum>
      <SignatureDt>2024-08-08</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>0</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>Connor Smart</PreparerPersonNm>
      <PTIN>P02285543</PTIN>
      <PhoneNum>2078792100</PhoneNum>
      <PreparationDt>2024-08-08</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2022</TaxYr>
    <BuildTS>2024-08-08 14:25:15Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="8">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <PrincipalOfficerNm>Spiridon E Hatiras</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>20 Hospital Drive</AddressLine1Txt>
        <CityNm>Holyoke</CityNm>
        <StateAbbreviationCd>MA</StateAbbreviationCd>
        <ZIPCd>010406604</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>4708266</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>N/A</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1984</FormationYr>
      <LegalDomicileStateCd>MA</LegalDomicileStateCd>
      <ActivityOrMissionDesc>To support the advancement in knowledge and practice of medicine, surgery, nursing, and all other subjects related to healthcare.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>11</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>8</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>17</TotalEmployeeCnt>
      <TotalVolunteersCnt>25</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>90768</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>63435</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>3974953</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>3955534</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>347764</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>401891</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>-6595</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>-29419</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>4406890</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>4391441</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>54610</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>26535</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>4048775</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>4478886</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>97011</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>360256</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>597513</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>4463641</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>5102934</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>-56751</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-711493</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>10691393</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>11370864</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>958212</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>1013325</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>9733181</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>10357539</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>To support the advancement in knowledge and practice of medicine, surgery, nursing, and all other subjects related to healthcare.</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>4306757</ExpenseAmt>
      <GrantAmt>26535</GrantAmt>
      <RevenueAmt>3923632</RevenueAmt>
      <Desc>To support the advancement in knowledge and practice of medicine, surgery, nursing, and all other subjects related to healthcare. Valley Health Systems, Inc. accomplishes its mission by managing, operating and providing management counsel and advice in connection with the provision of medical or healthcare and services ancillary to Holyoke Medical Center, Inc. and its affiliates.</Desc>
      <TotalProgramServiceExpensesAmt>4306757</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc1039100001">1</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1234500001">1</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>0</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>0</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>0</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc1040000001">0</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc1040000001">0</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc1040000001">0</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc1040000001">0</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>1</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc1040000001">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc1040000001">1</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc1040000001">1</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc1040000001">1</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc1040000001">1</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc1040000001">1</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">1</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>0</SchoolOperatingInd>
      <ForeignOfficeInd>0</ForeignOfficeInd>
      <ForeignActivitiesInd>0</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>0</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>0</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>0</FundraisingActivitiesInd>
      <GamingActivitiesInd>0</GamingActivitiesInd>
      <OperateHospitalInd>0</OperateHospitalInd>
      <GrantsToOrganizationsInd referenceDocumentId="RetDoc1041900001">1</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd referenceDocumentId="RetDoc1041900001">0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc1042400001">1</ScheduleJRequiredInd>
      <TaxExemptBondsInd>0</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>0</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>0</PYExcessBenefitTransInd>
      <LoanOutstandingInd>0</LoanOutstandingInd>
      <GrantToRelatedPersonInd>0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>0</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>0</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>0</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>0</DeductibleArtContributionInd>
      <TerminateOperationsInd>0</TerminateOperationsInd>
      <PartialLiquidationInd>0</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentId="RetDoc1043400001">0</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="RetDoc1043400001">1</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>1</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentId="RetDoc1043400001">1</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentId="RetDoc1043400001">0</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="RetDoc1043400001">0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>1</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>17</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>1</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>0</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>0</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>0</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>0</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>0</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>0</PayPremiumsPrsnlBnftCntrctInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>0</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>0</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>11</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>8</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>1</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>0</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>0</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>0</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>1</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>1</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>1</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>1</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>1</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>1</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>1</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>1</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>1</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>MA</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>Dean Vitarisi</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>4135342567</PhoneNum>
        <USAddress>
          <AddressLine1Txt>20 Hospital Drive</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>010406604</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>Garry Bombardier MD</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>50.50</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>230276</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>14602</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Spiridon E Hatiras</PersonNm>
        <TitleTxt>President &amp; CEO, Clerk</TitleTxt>
        <AverageHoursPerWeekRt>2.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>47.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>907453</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>73368</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Dean Vitarisi</PersonNm>
        <TitleTxt>Treasurer &amp; CFO</TitleTxt>
        <AverageHoursPerWeekRt>2.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>45.50</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>338192</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>25084</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Donald Graham</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Matthew Mainville</PersonNm>
        <TitleTxt>Director (start 5/2023)</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Marge Mantoni</PersonNm>
        <TitleTxt>Director (start 2/2023)</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Mary Jo Maydew</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.50</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Idelia Smith</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Michael Sullivan</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jeff Hayden</PersonNm>
        <TitleTxt>Chair</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Eileen O'Leary Sullivan</PersonNm>
        <TitleTxt>Vice Chair</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Carl Cameron</PersonNm>
        <TitleTxt>VP, Operations</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>3.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>470369</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>47179</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Beverly Fein</PersonNm>
        <TitleTxt>VP, Chief HR Officer</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>277494</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>28629</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Avadhoot S Gokhale</PersonNm>
        <TitleTxt>VP, Quality/CQO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>306588</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>39163</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Marcel Moniz</PersonNm>
        <TitleTxt>VP, Ambulatory Operations</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>180714</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>15831</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Richard T O'Connor</PersonNm>
        <TitleTxt>Director of Legal Affairs</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>156238</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>1512</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2637048</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>230276</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>245368</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>13</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Fidelity Investments</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 770001</AddressLine1Txt>
            <CityNm>Cincinnati</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45277</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Investment Advisory Services</ServicesDesc>
        <CompensationAmt>120697</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>1</CntrctRcvdGreaterThan100KCnt>
      <AllOtherContributionsAmt>63435</AllOtherContributionsAmt>
      <TotalContributionsAmt>63435</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Affiliate Admin Fees</Desc>
        <BusinessCd>561000</BusinessCd>
        <TotalRevenueColumnAmt>3955534</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3955534</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>3955534</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>388179</TotalRevenueColumnAmt>
        <ExclusionAmt>388179</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>176261</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>162549</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>13712</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>13712</TotalRevenueColumnAmt>
        <ExclusionAmt>13712</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>2652</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>169</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>2483</TotalRevenueColumnAmt>
        <ExclusionAmt>2483</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GrossSalesOfInventoryAmt>122205</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>154107</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>-31902</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>-31902</RelatedOrExemptFuncIncomeAmt>
      </NetIncomeOrLossGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>4391441</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3923632</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>404374</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>26535</TotalAmt>
        <ProgramServicesAmt>26535</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1344097</TotalAmt>
        <ProgramServicesAmt>1180869</ProgramServicesAmt>
        <ManagementAndGeneralAmt>163228</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>2646733</TotalAmt>
        <ProgramServicesAmt>2256480</ProgramServicesAmt>
        <ManagementAndGeneralAmt>311907</ManagementAndGeneralAmt>
        <FundraisingAmt>78346</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>20692</TotalAmt>
        <ProgramServicesAmt>17767</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2456</ManagementAndGeneralAmt>
        <FundraisingAmt>469</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>235828</TotalAmt>
        <ProgramServicesAmt>202255</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27957</ManagementAndGeneralAmt>
        <FundraisingAmt>5616</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>231536</TotalAmt>
        <ProgramServicesAmt>197396</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27286</ManagementAndGeneralAmt>
        <FundraisingAmt>6854</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>39696</TotalAmt>
        <ManagementAndGeneralAmt>39696</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>120697</TotalAmt>
        <ManagementAndGeneralAmt>120697</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>26080</TotalAmt>
        <ProgramServicesAmt>26080</ProgramServicesAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>6403</TotalAmt>
        <ManagementAndGeneralAmt>814</ManagementAndGeneralAmt>
        <FundraisingAmt>5589</FundraisingAmt>
      </OfficeExpensesGrp>
      <TravelGrp>
        <TotalAmt>1252</TotalAmt>
        <ProgramServicesAmt>1115</ProgramServicesAmt>
        <FundraisingAmt>137</FundraisingAmt>
      </TravelGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>5125</TotalAmt>
        <ManagementAndGeneralAmt>5125</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <OtherExpensesGrp>
        <Desc>Provision for Bad Debts</Desc>
        <TotalAmt>398260</TotalAmt>
        <ProgramServicesAmt>398260</ProgramServicesAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>5102934</TotalAmt>
        <ProgramServicesAmt>4306757</ProgramServicesAmt>
        <ManagementAndGeneralAmt>699166</ManagementAndGeneralAmt>
        <FundraisingAmt>97011</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>59110</BOYAmt>
        <EOYAmt>78804</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>522374</BOYAmt>
        <EOYAmt>549163</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>61200</BOYAmt>
        <EOYAmt>40000</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>11700</BOYAmt>
        <EOYAmt>9784</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>3748</BOYAmt>
        <EOYAmt>3200</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>65000</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>38440</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>31685</BOYAmt>
        <EOYAmt>26560</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>5707960</BOYAmt>
        <EOYAmt>6189283</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>1829054</BOYAmt>
        <EOYAmt>1966460</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>1066693</BOYAmt>
        <EOYAmt>1066693</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>1397869</BOYAmt>
        <EOYAmt>1440917</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>10691393</BOYAmt>
        <EOYAmt>11370864</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>703292</BOYAmt>
        <EOYAmt>784734</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>254920</BOYAmt>
        <EOYAmt>228591</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>958212</BOYAmt>
        <EOYAmt>1013325</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>4552724</BOYAmt>
        <EOYAmt>5543498</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>5180457</BOYAmt>
        <EOYAmt>4814041</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>9733181</BOYAmt>
        <EOYAmt>10357539</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>10691393</BOYAmt>
        <EOYAmt>11370864</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-711493</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>287574</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>1048277</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>1</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>255160</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>194648</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>228893</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>90768</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>63435</CurrentTaxYearAmt>
        <TotalAmt>832904</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>255160</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>194648</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>228893</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>90768</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>63435</CurrentTaxYearAmt>
        <TotalAmt>832904</TotalAmt>
      </TotalCalendarYear170Grp>
      <SubstantialContributorsTotAmt>160626</SubstantialContributorsTotAmt>
      <PublicSupportTotal170Amt>672278</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>254227</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>223896</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>291281</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>324779</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>388179</CurrentTaxYearAmt>
        <TotalAmt>1482362</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <UnrelatedBusinessNetIncm170Grp>
        <CurrentTaxYearMinus4YearsAmt>900</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>2469</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3096</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>2483</CurrentTaxYearAmt>
        <TotalAmt>8948</TotalAmt>
      </UnrelatedBusinessNetIncm170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>110242</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>61357</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>55385</CurrentTaxYearMinus2YearsAmt>
        <TotalAmt>226984</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>2551198</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>20684466</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.26350</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.36010</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsPY170Ind>X</ThirtyThrPctSuprtTestsPY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>2688295</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>202390</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>61561</OtherExpendituresAmt>
        <EndYearBalanceAmt>2829124</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>2891090</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>-83789</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>119006</OtherExpendituresAmt>
        <EndYearBalanceAmt>2688295</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>2671370</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>417132</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>197412</OtherExpendituresAmt>
        <EndYearBalanceAmt>2891090</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>2670827</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>45823</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>45280</OtherExpendituresAmt>
        <EndYearBalanceAmt>2671370</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>2620090</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>177547</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>126810</OtherExpendituresAmt>
        <EndYearBalanceAmt>2670827</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <BoardDesignatedBalanceEOYPct>0.00000</BoardDesignatedBalanceEOYPct>
      <PrmnntEndowmentBalanceEOYPct>0.25690</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.74310</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>0</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>0</EndowmentsHeldRelatedOrgInd>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>51433</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>30967</DepreciationAmt>
        <BookValueAmt>20466</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>13567</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>7473</DepreciationAmt>
        <BookValueAmt>6094</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>26560</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>Investments in Perpetual Trusts</Desc>
        <BookValueAmt>1966460</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>1966460</TotalBookValueSecuritiesAmt>
      <InvstProgramRelatedOrgGrp>
        <Desc>Investments in Affiliated Companies</Desc>
        <BookValueAmt>1066693</BookValueAmt>
        <MethodValuationCd>C</MethodValuationCd>
      </InvstProgramRelatedOrgGrp>
      <TotalBookValueProgramRltdAmt>1066693</TotalBookValueProgramRltdAmt>
      <OtherAssetsOrgGrp>
        <Desc>Cash Surrender Life Insurance</Desc>
        <BookValueAmt>1433633</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Due From Affilates</Desc>
        <BookValueAmt>7284</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>1440917</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Due to Affiliates</Desc>
        <Amt>228591</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>228591</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>4824336</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>287574</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>300256</OtherRevenueAmt>
      <RevenueNotReportedAmt>587830</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>4236506</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>120697</InvestmentExpensesNotIncldAmt>
      <OtherRevenuesNotIncludedAmt>34238</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>154935</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>4391441</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>5109978</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>154276</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>154276</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>4955702</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>120697</InvestmentExpensesNotIncld2Amt>
      <OtherExpensesNotIncludedAmt>26535</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>147232</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>5102934</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part V, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The intended use of the endowment funds at Valley Health Systems, Inc. is to provide a predictable, stable, and consistent stream of earnings for the Organization.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization and the member organizations are exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board (FASB), assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The Organization has evaluated the position taken on its filed tax returns. The Organization has concluded no uncertain income tax positions exist at September 30, 2023. The Organization's tax years from 2021 through 2023 are open and subject to examination.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Coffee/Gift Shop Expenses 154,107. Fundraising Expenses 169. Change in Beneficial Interest in Perpetual Trusts 145,980.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Adjustment for Assets Transferred and Used in Operations 34,238.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Coffee/Gift Shop Expenses 154,107. Fundraising Expenses 169.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Adjustment for Assets Transferred and Used in Operations 26,535.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Holyoke Medical Center</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>575 Beech Street</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>010402223</ZIPCd>
        </USAddress>
        <RecipientEIN>222520073</RecipientEIN>
        <IRCSectionDesc>501(c)(3)</IRCSectionDesc>
        <CashGrantAmt>26535</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Funding for hospital and healthcare services.</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>1</Total501c3OrgCnt>
      <TotalOtherOrgCnt>0</TotalOtherOrgCnt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization may from time to time award sponsorships and grants to various 501(c)(3) public charities or municipalities. In particular, the Organization regularly provides grants to Holyoke Medical Center, Inc., a related organization of which the Organization is the sole member and shares similar board members and officers.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>1</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Spiridon E Hatiras</PersonNm>
        <TitleTxt>President &amp; CEO, Clerk</TitleTxt>
        <BaseCompensationFilingOrgAmt>907453</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>51770</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>21598</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>980821</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Carl Cameron</PersonNm>
        <TitleTxt>VP, Operations</TitleTxt>
        <BaseCompensationFilingOrgAmt>470369</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>29019</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>18160</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>517548</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Dean Vitarisi</PersonNm>
        <TitleTxt>Treasurer &amp; CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>338192</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>25084</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>363276</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Avadhoot S Gokhale</PersonNm>
        <TitleTxt>VP, Quality/CQO</TitleTxt>
        <BaseCompensationFilingOrgAmt>306588</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>21049</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>18114</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>345751</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Beverly Fein</PersonNm>
        <TitleTxt>VP, Chief HR Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>277494</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>18896</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>9733</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>306123</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Garry Bombardier MD</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>230276</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>2274</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>12328</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>244878</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Marcel Moniz</PersonNm>
        <TitleTxt>VP, Ambulatory Operations</TitleTxt>
        <BaseCompensationFilingOrgAmt>180714</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>2029</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>13802</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>196545</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Richard T O'Connor</PersonNm>
        <TitleTxt>Director of Legal Affairs</TitleTxt>
        <BaseCompensationFilingOrgAmt>156238</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>1512</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>157750</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Holyoke Medical Center adopted a 457(f) non-qualified deferred compensation plan that became effective as of July 1, 2017. The Plan allows for eligible individuals and employees of the Medical Center to receive benefits under the Plan until the attainment of age 65. Non-elective contributions made for a Plan participant are tracked and will vest separately based on anniversaries of participants' employment. Each contribution will be 0% vested until the participant reaches the end of their second year of employment after each contribution. Each contribution will become 100% vested as of the last day of the 2nd year of a participant's employment, if the participant is still employed on that date. Only eligible employees are participants in the plan, and the plan does not allow for employee elective deferrals or employer matches. For the 2022 Tax Year, the following listed individuals received 457(f) contributions under the plan: Spiros Hatiras, $48,870; Carl Cameron, $28,000; Beverly Fein, $16,351; and Avadhoot S. Gokhale, $18,207.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Certain officers and directors of Valley Health Systems, Inc. are employed by a related tax-exempt organization which has common officers and/or directors. By virtue of this arrangement, certain individuals listed in Form 990, Part VII have a business relationship with one another.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>A copy of Valley Health Systems, Inc.'s Form 990 was provided to each voting member of the governing body prior to its filing with the Internal Revenue Service. The Form 990 was prepared with the assistance of an independent public accounting firm and thoroughly reviewed by the Senior Vice President of Finance and CFO and key financial staff of the Hospital prior to distibuting it to the governing body for review.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The conflict of interest policy is monitored and enforced as part of the Valley Health Systems, Inc. System and is reviewed annually by the System's conflict of interest committee. Valley Health Systems, Inc. board members, officers, and key employees complete and sign a conflict of interest questionnaire annually. All signed questionnaires are then submitted to the committeed for review and monitoring.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The compensation committee of the Valley Health Systems, Inc. utilizes a market compensation survey to recommend to the Board the approval of its determination of the appropriate compensation of the Chief Executive Officer. During that process, the Committee also reviews the compensation levels of other senior management and key employees of the System. These individuals are not members of the compensation committee and do not participate in this process. The CEO, as a member of the Board of VHS, does not participate in the approval process of that officer's compensation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents, conflict of interest policy, and financial statements of Valley Health Systems and Affiliates, which includes supplemental information of the filing entity, are available to the public upon request at the Organization's administrative office at 575 Beech Street, Holyoke, MA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Equity Contributions from Affiliates 2,758,000. Change in Beneficial Interest of Perpetual Trusts 145,980. Net Adjustment for Assets Transferred and Used in Operations -7,703. Equity Contributions to Affiliates -1,848,000.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2c:</FormAndLineReferenceDesc>
        <ExplanationTxt>The audit process has not changed from the prior year.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Community Health Foundation of Western Massachusetts Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>575 Beech Street</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01040</ZIPCd>
        </USAddress>
        <EIN>222568962</EIN>
        <PrimaryActivitiesTxt>Raise &amp; Invest Funds for Affiliates</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Holyoke Medical Center Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>575 Beech Street</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01040</ZIPCd>
        </USAddress>
        <EIN>222520073</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Holyoke Visiting Nurse Association Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>575 Beech Street</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01040</ZIPCd>
        </USAddress>
        <EIN>042104310</EIN>
        <PrimaryActivitiesTxt>Home Healthcare</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>MassWest Services Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>575 Beech Street</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01040</ZIPCd>
        </USAddress>
        <EIN>222515964</EIN>
        <PrimaryActivitiesTxt>Healthcare</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12b, II</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>River Valley Counseling Center Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>187 High Street</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01040</ZIPCd>
        </USAddress>
        <EIN>042174657</EIN>
        <PrimaryActivitiesTxt>Outpatient Mental Health</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>H-C Management Services Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>20 Hospital Drive</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01040</ZIPCd>
        </USAddress>
        <EIN>222515981</EIN>
        <PrimaryActivitiesTxt>Supporting Organization</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12b, II</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Western Mass Physician Associates Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>15 Hospital Drive</AddressLine1Txt>
          <CityNm>Holyoke</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01040</ZIPCd>
        </USAddress>
        <EIN>043202198</EIN>
        <PrimaryActivitiesTxt>Medical Care Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>MassWest Services Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>William Skinner TUA-Holyoke Hospital Trust</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>PO Box 1802</AddressLine1Txt>
          <CityNm>Providence</CityNm>
          <StateAbbreviationCd>RI</StateAbbreviationCd>
          <ZIPCd>029011802</ZIPCd>
        </USAddress>
        <EIN>046035855</EIN>
        <PrimaryActivitiesTxt>Grantmaking</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>4947(a)(1)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>PF</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Valley Health Systems Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>1</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>1</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>1</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>1</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>1</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Holyoke Medical Center</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>B</TransactionTypeTxt>
        <InvolvedAmt>26535</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Masswest Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>D</TransactionTypeTxt>
        <InvolvedAmt>7284</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Holyoke Medical Center</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>E</TransactionTypeTxt>
        <InvolvedAmt>21915</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Holyoke Medical Center</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>2964252</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Western Mass Physician Associates Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>284999</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>River Valley Counseling Center Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>501072</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Holyoke Visiting Nurse Association Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>182600</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Masswest Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>7284</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Holyoke Medical Center</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>M</TransactionTypeTxt>
        <InvolvedAmt>183970</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Masswest Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>R</TransactionTypeTxt>
        <InvolvedAmt>1848000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Holyoke Medical Center</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>S</TransactionTypeTxt>
        <InvolvedAmt>2758000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual Per Books</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>