TY 2022 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(1) ANTOINETTE GRAY...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(2) FRANCES V VAUGHN...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(3) CHERYL SHOPE...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(4) MARIA PETTINGER MD...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(5) FRED PRICE...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(6) PETER HOPSICKER...................................................................... DIRECTOR	1.00 ................. 1.00	X
(7) JAMES A TROHA...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(8) DR MARGARET HALLAHAN...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(9) JOHN D COURSEN...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(10) MICHAEL SABATINI...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(11) A KEITH BLACK...................................................................... DIRECTOR (END 12/31/2022)	1.00 ................. 1.00	X
(12) DAVID HILEMAN...................................................................... DIRECTOR (START 1/1/2023)	1.00 ................. 1.00	X
(13) WILLIAM HOOVER...................................................................... DIRECTOR (START 1/1/2023)	1.00 ................. 1.00	X
(14) DR KARA KIMBERLY...................................................................... DIRECTOR (START 1/1/2023)	1.00 ................. 1.00	X
(15) BUD BOOM...................................................................... DIRECTOR (END 3/13/2023)	1.00 ................. 1.00	X
(16) LINDA DELGROSSO RN...................................................................... DIRECTOR (END 6/8/2023)	1.00 ................. 1.00	X
(17) JOHN STEINBUGL...................................................................... DIRECTOR (END 3/22/2023)	1.00 ................. 1.00	X

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(18) ROBERT SLOSS........................................................................ DIRECTOR (START 12/31/2022)	1.00 .......................1.00	X			0	0
(19) MARK MINOR........................................................................ DIRECTOR (END 12/31/2022)	1.00 .......................1.00	X			0	0
(20) MIRANDA K PERUSO........................................................................ CHAIR	2.00 .......................2.00	X	X		0	0
(21) LESLIE ESTEP........................................................................ SECRETARY (END 12/31/2022)	2.00 .......................2.00	X	X		0	0
(22) TODD LEWIS........................................................................ TREASURER (START 1/1/2023)	2.00 .......................2.00	X	X		0	0
(23) OSCAR JOHNSTON........................................................................ VICE CHAIR	2.00 .......................2.00	X	X		0	0
(24) IVALOU NOUTLON MLT ASCP........................................................................ DIRECTOR	1.00 .......................1.00	X			0	0
(25) JOSEPH MYERS........................................................................ PRESIDENT	40.00 .......................0.00		X		258,960	13,159
(26) JOELLE KAMINSKY........................................................................ DIRECTOR OF PHARMACY	40.00 .......................0.00			X	141,276	7,780
(27) JOHN LEYTHAM........................................................................ DIRECTOR OF PHYSICAL THERAPY	40.00 .......................0.00			X	106,630	21,951
(28) TODD FORTNEY........................................................................ PHARMACIST	40.00 .......................0.00			X	140,009	16,560
(29) MUHAMMAD QAMAR........................................................................ PSYCHIATRIST	40.00 .......................0.00			X	157,874	21,168
(30) DEBORAH FRONTZ........................................................................ RN	40.00 .......................0.00			X	118,419	9,194

(A) Name and business address	(B) Description of services	(C) Compensation
AMN HEALTHCARE INC 2735 COLLECTION CENTER DRIVE CHICAGO,IL606932735	NURSING	968,196
ALLIANCE RECRUITING RESOURCES INC PO BOX 223901 DALLAS,TX752223901	PSYCHIATRY	771,027
CARDIOLOGY ASSOCIATES OF ALTOONA 1321 ELEVENTH AVENUE ALTOONA,PA16601	CARDIOLOGY	433,808
MAXIM HEALTHCARE STAFFING SERVICES INC 12558 COLLECTIONS CENTER DRIVE CHICAGO,IL60693	NURSING	361,257
LOCUMTENENS LLC PO BOX 405547 ATLANTA,GA303845547	NURSING	222,883
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 10

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2022

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2021. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2022

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2021. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2022

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2022

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2022

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2022

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization JC BLAIR MEMORIAL HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 3

Name of organization JC BLAIR MEMORIAL HOSPITAL		Employer identification number 23-1352159

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 4


Name of organization JC BLAIR MEMORIAL HOSPITAL			Employer identification number 23-1352159
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2022)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

8,208

Total. Add lines 1c through 1i ....................................................................................................

8,208

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	OTHER LOBBYING ACTIVITIES: THE HOSPITAL IS A MEMBER OF THE HOSPITAL ASSOCIATION OF PENNSYLVANIA, HOSPITAL COUNCIL OF WESTERN PA ("HAP"), AS SUCH, A PERCENTAGE OF DUES IS EXPENDED ON LOBBYING ACTIVITIES. IT IS ESTIMATED THAT $8,208 OF THE DUES PAID WAS USED BY HAP FOR LOBBYING ACTIVITIES.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	1,705,073	2,126,131	1,876,612	1,876,855	1,806,323
b	Contributions ...
c	Net investment earnings, gains, and losses	107,738	-421,058	249,519	-243	70,532
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	1,812,811	1,705,073	2,126,131	1,876,612	1,876,855

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

95.000 %

Term endowment SchDMd Bullet

5.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	1,141,612		1,141,612
b	Buildings ....	20,686,108	9,863,629	10,822,479
c	Leasehold improvements	3,282,970	1,550,490	1,732,480
d	Equipment ....	14,774,276	13,808,780	965,496
e	Other .....	6,882,952	552,481	6,330,471
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				20,992,538

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)INTERCOMPANY RECIEVABLES				18,015,720
(2)INVESTMENTS IN AFFILIATES				3,251,090
(3)RENT RECEIVABLE				514,429
(4)OTHER ASSETS				491,100
(5)ROU ASSET				142,987
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,415,326

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	4,930,480
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART V, LINE 4:

ENDOWMENT FUNDS: J.C. BLAIR MEMORIAL HOSPITAL HAS RECORDED ON ITS BALANCE SHEET ITS INTEREST IN THE NET ASSETS OF THE J.C. BLAIR MEMORIAL HOSPITAL FOUNDATION. THE AMOUNT IS REPORTED ABOVE AND CATEGORIZED AS A TERM ENDOWMENT. THE FOUNDATION TRANSFERS FUNDS RAISED TO THE HOSPITAL FOR THE PURCHASE OF EQUIPMENT AND BUILDING IMPROVEMENTS. FUNDS RAISED AND NOT YET TRANSFERRED ARE REPORTED AS INTEREST IN NET ASSETS OF THE FOUNDATION.

PART X, LINE 2:

UNCERTAIN TAX POSITIONS: JC BLAIR MEMORIAL HOSPITAL IS INCLUDED IN PENN HIGHLANDS HEALTHCARE'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE FOLLOWING NARRATIVE IS THE FOOTNOTE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS: THE SYSTEM AND ITS SUBSIDIARIES HAVE GENERALLY BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THESE ENTITIES ARE SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE SYSTEM CONSOLIDATES CERTAIN ENTITIES, WHICH ARE ORGANIZED AS CORPORATIONS AND SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. OTHER CONSOLIDATED AFFILIATES HAVE ELECTED TO BE TAXED AS A PARTNERSHIP UNDER PROVISIONS OF THE INTERNAL REVENUE CODE AND A SIMILAR SECTION OF THE STATE INCOME TAX LAW. THEREFORE, TAXABLE INCOME OR LOSS IS REPORTED TO THE INDIVIDUAL MEMBERS FOR INCLUSION IN THEIR RESPECTIVE TAX RETURNS. TO THE EXTENT THAT THE OPERATIONS OF THE PARTNERSHIP ENTITIES ARE RELATED TO THE SYSTEM'S TAX-EXEMPT PURPOSE, ITS INCOME WILL BE EXEMPT FROM INCOME TAXES. THE SYSTEM AND ITS SUBSIDIARIES ACCOUNT FOR UNCERTAIN TAX POSITIONS USING A TWO-STEP APPROACH FOR RECOGNIZING AND MEASURING TAX BENEFITS TAKEN, OR EXPECTED TO BE TAKEN, IN AN UNRELATED BUSINESS ACTIVITY TAX RETURN, AND DISCLOSURES REGARDING UNCERTAINTIES IN TAX POSITIONS. THE SYSTEM'S FOR-PROFIT CORPORATIONS RECOGNIZE DEFERRED TAX ASSETS AND LIABILITIES FOR THE FUTURE TAX IMPACT OF TEMPORARY DIFFERENCES BETWEEN AMOUNTS RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS AND THEIR RESPECTIVE TAX BASES, AND THE FUTURE BENEFIT OF UTILIZING AVAILABLE NET OPERATING LOSSES. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. INCOME TAXES OF THE SYSTEM'S TAX-EXEMPT, FOR-PROFIT AND PARTNERSHIP ENTITIES ARE RECORDED IN ACCRUED EXPENSES ON THE CONSOLIDATED BALANCE SHEET.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,043,001		1,043,001	1.660 %
b	Medicaid (from Worksheet 3, column a) . . . . .	10,749,777	5,849,795	4,899,982	7.800 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	11,792,778	5,849,795	5,942,983	9.460 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	9,088		9,088	0.010 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	2,431,362	1,893,953	537,409	0.860 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	2,440,450	1,893,953	546,497	0.870 %
k	Total. Add lines 7d and 7j .	14,233,228	7,743,748	6,489,480	10.330 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,869,240

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

562,054

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

7,580,624

Enter Medicare allowable costs of care relating to payments on line 5.....

8,019,220

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-438,596

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2022

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	JC BLAIR MEMORIAL HOSPITAL 1225 WARM SPRINGS AVENUE HUNTINGDON,PA16652 WWW.JCBLAIR.ORG 101101	X	X	X	INPATIENT PSYCHIATRY

Schedule H (Form 990) 2022

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	JC BLAIR MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 20

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	JC BLAIR MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	JC BLAIR MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	JC BLAIR MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2022

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
J.C. BLAIR MEMORIAL HOSPITAL	PART V, SECTION B, LINE 5: COMMUNITY INPUT:A COMPREHENSIVE COMMUNITY-WIDE CHNA PROCESS WAS COMPLETED FOR PENN HIGHLANDS HUNTINGDON, PREVIOUSLY JC BLAIR HEALTH SYSTEM. THE 2021 CHNA BROUGHT TOGETHER HOSPITAL AND COMMUNITY PARTNERS TO IDENTIFY AND EVALUATE THE NEEDS OF THE COMMUNITY. HOSPITAL LEADERSHIP WAS INTERESTED IN HEARING FROM KEY COMMUNITY LEADERS TO OBTAIN AN OUTSIDE PERSPECTIVE OF THE HEALTH OF THE COMMUNITY AS WELL AS HELP REACH INPUT FROM UNDERSERVED POPULATIONS. THIS WAS ACCOMPLISHED THROUGH COMMUNITY LEADER INTERVIEWS, PROVIDER SURVEYS, AND PUBLIC COMMENTARY, SELECT QUESTIONS WERE UTILIZED TO SUPPORT THE PENN HIGHLANDS HUNTINGDON CHNA. KEY STAKEHOLDERS IN THE COMMUNITY WERE IDENTIFIED TO GIVE INTERVIEWS OR PUBLIC COMMENTARY. HOSPITAL STAFF DEVELOPED THE INTERVIEW AND SURVEY QUESTIONS. THE INTERVIEWS AND SURVEYS WERE USED TO OBTAIN VITAL INFORMATION ABOUT THE COMMUNITY FROM THE SOCIAL AND HEALTH SERVICES PROVIDERS WHO SERVE THEM. THE SURVEYS WERE ACTIVE FROM DECEMBER 2020 TO FEBRUARY 2021. FEEDBACK FROM 26 COMMUNITY STAKEHOLDERS WAS COLLECTED. THE HOSPITAL IDENTIFIED TARGET STAKEHOLDERS TO BE INTERVIEWED. DEVELOPED THE STAKEHOLDER INTERVIEW GUIDE AND CREATED ALL DATA COLLECTION TOOLS. INTERVIEW QUESTIONS INCLUDED THE FOLLOWING TOPICS: TOP COMMUNITY HEALTH NEEDS, ENVIRONMENTAL FACTORS DRIVING THE NEEDS, EFFORTS CURRENTLY UNDERWAY TO ADDRESS NEEDS AND ADVICE FOR THE HOSPITAL.
J.C. BLAIR MEMORIAL HOSPITAL	PART V, SECTION B, LINE 6A: CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES:- PENN HIGHLANDS BROOKVILLE- PENN HIGHLANDS CLEARFIELD- PENN HIGHLANDS DUBOIS- PENN HIGHLANDS ELK- PENN HIGHLANDS TYRONE SCHEDULE H, PART V, SECTION B, LINE 7AWEBSITE WHERE CHNA IS AVAILABLE:HTTPS://WWW.PHHEALTHCARE.ORG/HEALTH-WELLNESS/CHNA-PLANS-2021SCHEDULE H, PART V, SECTION B, LINE 10AWEBSITE WHERE IMPLEMENTATION STRATEGY IS AVAILABLE:HTTPS://WWW.PHHEALTHCARE.ORG/HEALTH-WELLNESS/CHNA-PLANS-2021
J.C. BLAIR MEMORIAL HOSPITAL	PART V, SECTION B, LINE 11: ADDRESSING IDENTIFIED NEEDS:PENN HIGHLANDS HUNTINGDON DEVELOPED SPECIFIC GOALS AND STRATEGIES FOR THEIR 2021 CHNA IMPLEMENTATION PLAN BASED ON THE IDENTIFIED PRIORITIES. THE HEALTH SYSTEM LEVERAGED ITS STRENGTHS AND RESOURCES AND WORKED COLLABORATIVELY WITH ITS COMMUNITY PARTNERS TO ADDRESS THE IDENTIFIED NEEDS. THE IMPLEMENTATION PLAN INCLUDES MEASURES, STRATEGIES AND GOALS AS TO HOW THE HEALTH SYSTEM ADDRESSES PRIORITY AREAS.PENN HIGHLANDS HUNTINGDON IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITY AND WORKS DILIGENTLY WITH PUBLIC HEALTH AGENCIES AND COMMUNITY ORGANIZATIONS TO IMPLEMENT RELEVANT AND EFFECTIVE STRATEGIES TO ADDRESS THE IDENTIFIED AREAS OF NEED. THE HOSPITAL ROUTINELY EVALUATES PROGRESS AND ADJUSTS THEIR PLAN AS NEEDED TO BEST MEET THE NEEDS OF THE COMMUNITY. WHEREVER POSSIBLE THE HOSPITAL COLLABORATES WITH COMMUNITY AGENCIES TO BUILD ON CORE STRENGTHS AND LEVERAGE COMMUNITY ASSETS. TO STRENGTHEN THE HEALTH AND VITALITY OF THE COMMUNITY, THE FOLLOWING ACTIONS WERE TAKEN:- DEVELOP EFFECTIVE COMMUNICATION STRATEGIES TO SHARE THE RESULTS OF THE CHNA WITH STAFF, PROVIDERS, LEADERSHIP, BOARD, COMMUNITY STAKEHOLDERS AND THE COMMUNITY AT LARGE.- CONTINUE TO WORK WITH COMMUNITY PARTNERS TO IDENTIFY AND LEVERAGE EXISTING COMMUNITY RESOURCES AND IDENTIFY OPPORTUNITIES FOR COLLABORATION.- MAINTAIN ONGOING MEETINGS WITH THE CHNA STEERING COMMITTEE TO EVALUATE PROGRESS MADE TOWARDS THE IMPLEMENTATION PLAN AS WELL AS STRENGTHEN WORKING RELATIONSHIPS AND SYNERGIES AMONG PROVIDERS.- CREATE IMPLEMENTATION STRATEGY TEAMS TO DEVELOP THE CHNA IMPLEMENTATION PLAN WHICH WILL ADDRESS KEY AREAS OF NEED AND PRIORITIES IDENTIFIED DURING THE CHNA PROCESS.- UTILIZE COMMUNITY STAKEHOLDERS AND REGIONAL PARTNERS WHEN POSSIBLE TO HELP ADDRESS IDENTIFIED NEEDS IN THE COMMUNITY.- ROUTINELY EVALUATE THE GOALS AND STRATEGIES OUTLINED IN THE CHNA IMPLEMENTATION PLAN AND ADJUST AS NEEDED TO ENSURE THE NEEDS OF THE COMMUNITY ARE BEING MET.SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16CFINANCIAL ASSISTANCE POLICY APPLICATION FORM AVAILABILITY:FAP, FAP APPLICATION, PLAIN LANGUAGE SUMMARY:HTTPS://WWW.PHHEALTHCARE.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-POLICYSCHEDULE H, PART V, SECTION B, LINE 16ILEP TRANSLATION:THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER THE IRC SECTION 501(R). HOWEVER, THE ORGANIZATION HAS A CONTRACT WITH A TRANSLATIONS SERVICE PROVIDERS.
J.C. BLAIR MEMORIAL HOSPITAL	PART V, SECTION B, LINE 16J: FAP AVAILABILITY:FINANCIAL COUNSELORS DISCUSS THE AVAILABILITY OF DISCOUNTED AND CHARITY CARE INDIVIDUALLY WITH PATIENTS.
J.C. BLAIR MEMORIAL HOSPITAL	PART V, SECTION B, LINE 20E: OTHER EFFORTS:THE BILLING STATEMENT STATES THAT THERE IS A FAP AVAILABLE AND GIVES INFORMATION ON HOW TO CONTACT SOMEONE FOR THE APPLICATION.

Schedule H (Form 990) 2022

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address		Type of Facility (describe)
1	1 - CONVENIENT CARE CENTER 7651 RAYSTOWN SHOPPING CENTER DR HUNTINGDON,PA16652	HEALTH CLINIC LAB & DIAGNOSTIC TESTING
2	2 - 611 MRI 611 UNIVERSITY DRIVE STATE COLLEGE,PA16801	MRI, CT, X-RAY DIGITAL MAMMOGRAPHY CENTER
3	3 - ORBISONIA QUICK LAB 626 WATER ST 1 ORBISONIA,PA17243	LAB
4
5
6
7
8
9
10

Schedule H (Form 990) 2022

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 7:	COSTING METHODOLOGY:THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3.
PART I, LN 7 COL(F):	PERCENT OF TOTAL EXPENSES:THE PERCENT OF TOTAL EXPENSES ON SCHEDULE H, PART I, LINE 7, COLUMN (F), WAS CALCULATED USING TOTAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A).
PART II, COMMUNITY BUILDING ACTIVITIES:	COMMUNITY BUILDING ACTIVITIES:MAJOR RENOVATION OF THE 3RD FLOOR OF THE MAIN HOSPITAL BUILDING TO UPDATE AND INCREASE CAPACITY FOR BEHAVIORAL HEALTH SERVICES AND INFUSION/ONCOLOGY SERVICES. THESE ACTIVITIES HELP THE HOSPITAL MAKE HIGH QUALITY HEALTHCARE ACCESSIBLE TO RESIDENTS OF HUNTINGDON COUNTY.
PART III, LINE 2:	BAD DEBT EXPENSE METHODOLOGY:THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2023. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
PART III, LINE 3:	BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE:THE SYSTEM HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES SUCH AS COPAYS AND DEDUCTIBLES. THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE SYSTEM EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE FOR FINANCIAL REPORTING. LINE 3 REPORTS THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS FROM THE INTERNAL FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU.
PART III, LINE 4:	BAD DEBT EXPENSE FOOTNOTE:THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBE BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:	COMMUNITY BENEFIT:SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.ORGANIZATION USES INFORMATION FROM THE MEDICARE COST REPORT TO COMPUTE THE MEDICARE ALLOWABLE COSTS OF CARE ON LINE 6.
PART III, LINE 9B:	COLLECTION POLICY:IF A PATIENT IS DETERMINED TO BE FINANCIALLY INDIGENT, THE CREDIT DEPARTMENT WILL ASSIST THE PATIENT IN APPLYING FOR OTHER FINANCIAL ASSISTANCE SUCH AS STATE AND FEDERAL PROGRAMS, CIVIC ORGANIZATIONS, REHABILITATION PROGRAMS, RELIGIOUS ORGANIZATIONS, RELATIVES OR FRIENDS. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE, THE HOSPITAL WILL REVIEW THE ACCOUNT FOR A CHARITY ALLOWANCE ONLY ON THE CURRENT ACCOUNT. NO BAD DEBT ACCOUNTS WILL BE INCLUDED IN THIS REVIEW. ALL CHARITY ALLOWANCES MUST BE APPROVED BY THE CHIEF FINANCIAL OFFICER OR DELEGATED REPRESENTATIVE.
PART VI, LINE 2:	NEEDS ASSESSMENT: IN ADDITION TO THE CHNA THAT WAS COMPLETED IN MAY 2021, THE ORGANIZATION RECEIVES INFORMATION FROM COMMUNITY MEMBERS ON THE BOARD AND FROM THE LOCAL AUXILIARY. WE ALSO MEET FROM TIME TO TIME WITH COMMUNITY MEMBERS TO ADDRESS CERTAIN NEEDS AS THEY ARISE. WE ARE ALWAYS OPEN TO LISTENING TO ANY CONCERNS OF COMMUNITY MEMBERS AND/OR ORGANIZATIONS.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:IN ORDER TO BE ELIGIBLE FOR CHARITY CARE, A PATIENT WHO DOES NOT HAVE HEALTH INSURANCE MUST COMPLETE AN APPLICATION FOR MEDICAL ASSISTANCE AND BE DENIED COVERAGE. SUCH PATIENTS, DESIGNATED AS SELF-PAY, ARE OFFERED ASSISTANCE BY OUR SELF-PAY FINANCIAL COUNSELORS. IN COMPLETING APPLICATIONS FOR MEDICAL ASSISTANCE COUNSELORS FOLLOW UP WITH PATIENTS. IF APPLICATIONS ARE NOT COMPLETED OR INFORMATION IS NOT RETURNED THE HOSPITAL ALSO HAS ACCESS TO LIMITED FUNDS (THE INCOME FROM A TRUST WHICH HAS BEEN DESIGNATED TO BE USED FOR CHARITY CARE). APPLICANTS FOR CHARITY CARE ARE SCREENED FOR ELIGIBILITY FOR THIS PROGRAM. IN ADDITION, A RESTRICTED DONATION FROM A COMMUNITY MEMBER HAS PROVIDED FOR PAYMENT FOR HEALTH CARE SERVICES WHICH ARE NOT ELIGIBLE FOR ANY OTHER PROGRAMS OR INSURANCE COVERAGES. A GENEROUS AMOUNT OF $10,000 HAS ALREADY PROVIDED COVERAGE FOR COSTS OF CARE FOR SEVERAL PATIENTS FOR NEEDED SERVICES. PATIENT BROCHURES ARE PROVIDED TO EXPLAIN THE AVAILABILITY OF ASSISTANCE AND CHARITY CARE PROGRAMS. THE FEDERAL POVERTY LEVEL GUIDELINES WITH OUR 250% MULTI PLIER ARE POSTED IN LOCATIONS FREQUENTED BY PATIENTS, SUCH AS THE EMERGENCY DEPARTMENT AND REGISTRATION AREAS. IF A PATIENT IS SELF PAY AT THE TIME OF REGISTRATION, THE REGISTRATION CLERK NOTIFIES A PATIENT FINANCIAL COUNSELOR AND PROVIDES THE PATIENT WITH A FINANCIAL ASSISTANCE PROGRAM LETTER. THE PROGRAM LETTER OFFERS A 20% SELF PAY DISCOUNT PROGRAM AND CHARITY CARE PROGRAM OUTLINE PATIENT COUNSELORS ADVISE AND ASSIST WITH THE APPLICATION PROCESS. TO APPLY FOR CHARITY CARE, THE PATIENT MUST FIRST APPLY FOR MEDICAL ASSISTANCE THIS PROCESS CAN TAKE UP TO 30 DAYS FOR MEDICAL ASSISTANCE APPROVAL OR DENIAL. IF MEDICAL ASSISTANCE COVERAGE IS DENIED, THE PATIENT IS ASKED TO CONTACT THE PATIENT COUNSELOR FOR ASSISTANCE WITH COMPLETING THE CHARITY CARE APPLICATION, OR TO HAVE THE APPLICATION MAILED OUT TO THE PATIENT. ONCE THE PATIENT IS DETERMINED TO BE ELIGIBLE, THE PATIENT IS ISSUED AN IDENTIFICATION CARD, WHICH THEY MAY PRESENT AT FUTURE VISITS TO VALIDATE THEY HAVE BEEN DETERMINED. TO BE ELIGIBLE FOR CHARITY CARE ELIGIBILITY MUST BE RENEWED EVERY SIX MONTHS. THE HOSPITAL IS CURRENTLY DEVELOPING A NEW BROCHURE WHICH DESCRIBES THE CHARITY PROGRAM ALONG WITH OTHER FINANCIAL POLICIES, SUCH AS PROMPT PAYMENT DISCOUNTS AND ELIGIBILITY FOR PAYMENT PLANS AND GRANT FUNDED CARE.
PART VI, LINE 4:	COMMUNITY INFORMATION:PENN HIGHLANDS HUNTINGDON IS THE HEALTHCARE LEADER IN HUNTINGDON COUNTY, SERVING THE COMMUNITY'S HEALTHCARE NEEDS AND STRIVING TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT FOR OVER 100 YEARS. THE HOSPITAL IS THE ONLY HOSPITAL IN RURAL HUNTINGDON COUNTY, SERVING OVER 45,000 COUNTY RESIDENTS SPREAD ACROSS MANY SMALL BOROUGHS AND VILLAGES. THE HOSPITAL'S REGION INCLUDES BEDFORD, BLAIR, HUNTINGDON, JUNIATE AND MIFFLIN COUNTIES. THERE ARE A NUMBER OF AMISH AND MENNONITE SETTLEMENTS IN THE REGION. THE COMMUNITIES IN THE PRIMARY SERVICE AREA ARE HUNTINGDON, SMITHFIELD, MOUNT UNION, ALEXANDRIA, ORBISONIA, PETERSBURG, THREE SPRINGS, MAPLETON DEPOT, JAMES CREEK AND MILL CREEK. A NUMBER OF SMALL COMMUNITIES MAKE UP THE SECONDARY SERVICE AREA. ACCORDING TO THE MOST RECENTLY COMPLETED CHNA, 9.5% OF THE POPULATION LIVES BELOW THE FEDERAL POVERTY LEVEL.
PART VI, LINE 5:	PROMOTION OF COMMUNITY HEALTH:THE GOVERNING BODY IS REPRESENTATIVE OF THE COMMUNITIES IN THE PRIMARY AND SECONDARY SERVICE AREAS OF THE HOSPITAL.PENN HIGHLANDS HUNTINGDON IS A SMALL, RURAL HOSPITAL THAT IS NOT ENGAGED IN RESEARCH, BUT IT DOES ALLOCATE FUNDS ANNUALLY FOR THE UPGRADE OF PATIENT CARE EQUIPMENT AND FOR EXPENDITURES IN TECHNOLOGY OR FACILITIES TO IMPROVE THE SAFETY AND CARE OF PATIENTS RECENT EXAMPLES OF PURCHASES AND UPGRADES ARE A NEW DIGITAL MAMMOGRAPHY SYSTEM, ORTHOPEDIC SURGERY EQUIPMENT, STEREOTACTIC SPECIMEN IMAGING SYSTEM, AND A DIETARY TRAYLINE SYSTEM RECENT TECHNOLOGY INVESTMENTS INCLUDE NURSING DOCUMENTATION, ELECTRONIC MEDICATION ADMINISTRATION RECORD AND BEDSIDE MEDICATION VERIFICATION.
PART VI, LINE 6:	AFFILIATED HEALTH CARE SYSTEM:PENN HIGHLANDS HUNTINGDON IS PART OF PENN HIGHLANDS HEALTHCARE (PHH, SYSTEM). PHH IS A NOT-FOR-PROFIT CORPORATION ORGANIZED TO COORDINATE AND MANAGE THE INTEGRATION OF THE DELIVERY OF HEALTHCARE SERVICES TO THE NORTH CENTRAL PENNSYLVANIA AREA. THE SYSTEM INCLUDES THE CONSOLIDATED FINANCIAL STATEMENTS OF PENN HIGHLANDS HEALTHCARE, PENN HIGHLANDS DUBOIS, PENN HIGHLANDS ELK, PENN HIGHLANDS CLEARFIELD, PENN HIGHLANDS TYRONE, PENN HIGHLANDS MON VALLEY AND PENN HIGHLANDS CONNELLSVILLE.THE PENN HIGHLANDS HUNTINGDON PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS:-PENN HIGHLANDS HUNTINGDON PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT, EMERGENCY CARE SERVICES AND URGENT CARE SERVICES TO FURTHER THE HEALTH AND WELLNESS OF RESIDENTS IN HUNTINGDON, PENNSYLVANIA, AND SURROUNDING AREAS.-PENN HIGHLANDS HUNTINGDON FOUNDATION EARNS REVENUE THROUGH FUNDRAISING TO SUPPORT HEALTH CARE PROGRAMS OF PENN HIGHLANDS HUNTINGDON.THE PENN HIGHLANDS DUBOIS PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS:-DUBOIS REGIONAL MEDICAL CENTER (DRMC) PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO RESIDENTS IN DUBOIS, PENNSYLVANIA, AND SURROUNDING AREAS.-BROOKVILLE HOSPITAL (BROOKVILLE), A CRITICAL ACCESS HOSPITAL IN BROOKVILLE, PENNSYLVANIA. BROOKVILLE EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES.-BROOKVILLE INCLUDES BROOKCARE, A CORPORATION WHOSE PRIMARY BUSINESS IS TO RENT OFFICE SPACE TO PHYSICIANS AND VARIOUS DEPARTMENTS OF BROOKVILLE HOSPITAL.-JEFFCO HEALTH SERVICES, A POST-ACUTE HEALTHCARE SERVICE PROVIDER.-DUBOIS MEDICAL RISK RETENTION GROUP (DMRRG), PROVIDES LIABILITY INSURANCE TO DUBOIS COMPANIES AS WELL AS EMPLOYEE HEALTH INSURANCE FOR THE SYSTEM. DUBOIS IS THE SOLE MEMBER OF THE CLASS A VOTING AND PARTICIPATING CERTIFICATES OF DMRRG.-DUBOIS REGIONAL MEDICAL GROUP (DRMG), PROVIDES PRIMARY CARE AND SPECIALTY PHYSICIAN SERVICES.-WRC SENIOR SERVICES IS A HOUSING, HEALTHCARE, AND RESIDENT SERVICE PROVIDER IN WESTERN PENNSYLVANIA.-WRC PENNSYLVANIA MEMORIAL HOME, A CORPORATION THAT OWNS AND OPERATES A CONTINUING CARE RETIREMENT COMMUNITY.-WRC HEALTH CARE SUPPORTIVE SERVICES, A HOME AND COMMUNITY-BASED SERVICES PROVIDER.-WRC NORTH FORK HEIGHTS, A HOUSING PROJECT FOR LOW-INCOME ELDERLY INDIVIDUALS REGULATED BY THE UNITED STATES DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD).THE PENN HIGHLANDS ELK (ELK) PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS:-ELK REGIONAL HEALTH CENTER (ELK) PROVIDES PRIMARY ACUTE CARE MEDICAL SERVICES AT TWO CAMPUSES, THE ST. MARYS HEALTH CENTER IN ST. MARYS, PENNSYLVANIA, AND THE RIDGWAY HEALTH CENTER IN RIDGWAY, PENNSYLVANIA.-COMMUNITY NURSES, INC. AND SUBSIDIARIES (COMMUNITY NURSES), IS COMPRISED OF COMMUNITY NURSES HOME HEALTH AND HOSPICE, INC., WHICH PROVIDES SKILLED NURSING, PROFESSIONAL HOME HEALTH AND HOSPICE SERVICES, HOME HEALTH AIDE, PHYSICAL THERAPY, SPEECH THERAPY AND OCCUPATIONAL THERAPY; COMMUNITY NURSES HOME HEALTH SUPPORT SERVICES, INC., WHICH PROVIDES VARIOUS NONPROFESSIONAL HOME HEALTH RELATED SUPPORTIVE SERVICES, AND HELPMATES WHICH PROVIDES PRIVATE DUTY HOME COMPANION, RESPITE, PERSONAL CARE AND HOMEMAKER SERVICES.-ELK REGIONAL PROFESSIONAL GROUP, INC., IS COMPRISED OF VARIOUS PHYSICIAN PRACTICES. -ELCO HOUSING, INC., WAS FORMED TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF AND TO CARRY OUT THE PURPOSES OF ELK BY SERVING AS A GENERAL PARTNER IN ELCO GLEN LIMITED PARTNERSHIP, THE PURPOSE OF WHICH IS TO ACQUIRE, CONSTRUCT, PROVIDE AND OPERATE RENTAL HOUSING AND RELATED FACILITIES SUITED TO THE NEEDS AND LIVING REQUIREMENTS OF ELIGIBLE OCCUPANTS AS DETERMINED BY THE FARMERS HOME ADMINISTRATION (FMHA).-ELK VENTURES, LLC (ELK VENTURES), A SINGLE MEMBER LLC OF ELK REGIONAL HEALTH CENTER, WAS FORMED TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF AND TO CARRY OUT THE PURPOSES OF ELK.THE PENN HIGHLANDS CLEARFIELD (CLEARFIELD) PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS:-CLEARFIELD HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN CLEARFIELD COUNTY AND THE SURROUNDING AREAS.-CLEARFIELD MEDICAL ASSOCIATES (CMA), OWNS AND OPERATES THE MEDICAL ARTS BUILDING LOCATED ON CLEARFIELD HOSPITAL'S CAMPUS.-CLEAR-CARE CORPORATION (CLEAR-CARE), PROVIDES MEDICAL EQUIPMENT TO CUSTOMERS.THE PENN HIGHLANDS TYRONE PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS:-TYRONE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE HOSPITAL SERVICES.-TYRONE FOUNDATION WHICH PROVIDES SUPPORT.THE PENN HIGHLANDS MON VALLEY PORTION OF THE PHH SYSTEM INCLUDED THE FOLLOWING ENTITIES AND OPERATIONS:-MON VALE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE HOSPITAL SERVICES.-MONONGAHELA VALLEY HOSPITAL FOUNDATION WHICH PROVIDES SUPPORT.THE PENN HIGHLANDS CONNELLSVILLE PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS:-HIGHLANDS HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE HOSPITAL SERVICES;-HIGHLANDS FOUNDATION WITH PROVIDES SUPPORT.
PART VI, LINE 7, REPORTS FILED WITH STATES	PA

Schedule H (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2022

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JOSEPH MYERS PRESIDENT	(i) (ii)	248,130 ------------- 0	10,000 ------------- 0	830 ------------- 0	10,000 ------------- 0	3,159 ------------- 0	272,119 ------------- 0	0 ------------- 0
2MUHAMMAD QAMAR PSYCHIATRIST	(i) (ii)	156,631 ------------- 0	0 ------------- 0	1,243 ------------- 0	0 ------------- 0	21,168 ------------- 0	179,042 ------------- 0	0 ------------- 0
3TODD FORTNEY PHARMACIST	(i) (ii)	138,318 ------------- 0	1,600 ------------- 0	91 ------------- 0	0 ------------- 0	16,560 ------------- 0	156,569 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 7	THE ORGANIZATION REPORTED AMOUNTS ON SCHEDULE J, PART II, COLUMN B(II) THAT QUALIFY AS NON-FIXED PAYMENTS. WHILE THE AMOUNTS ARE BASED ON CERTAIN PRESET METRICS, THERE IS DISCRETION OVER DECIDING WHETHER TO MAKE THE PAYMENT, AS THE AMOUNTS ARE SUBJECT TO FINAL APPROVAL. THE AMOUNT PAID TO THE PRESIDENT IS APPROVED BY THE BOARD, WHILE THE AMOUNT PAID TO THE PHARMACIST IS APPROVED BY THE PRESIDENT.

Schedule J (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Return Reference	Explanation
PART 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:	VISION - TO BE A MODEL OF EXCELLENCE FOR THE PROVISION OF A COMPREHENSIVE RANGE OF HEALTHCARE AND WELLNESS SERVICES DESIGNED TO CONTINUALLY IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR THE RESIDENTS OF HUNTINGDON COUNTY AND NEARBY COMMUNITIES.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:	THE HOSPITAL CONTRIBUTED A GREAT DEAL IN COMMUNITY BENEFIT PROGRAMS THAT INCLUDED THOUSANDS OF HOURS OF VOLUNTEER SERVICE PROVIDING FREE EDUCATION AND SCREENING PROGRAMS, MENTORING FUTURE HEALTH CARE PROFESSIONALS, PROVIDING LEADERSHIP SERVICE TO COMMUNITY ORGANIZATIONS, AND CONTRIBUTING FINANCIAL AND IN-KIND SUPPORT TO A NUMBER OF LOCAL INITIATIVES. THESE PROGRAMS INCLUDED: FREE DIABETES SELF-MANAGEMENT CLASSES, FREE BREAST-FEEDING EDUCATION AND CONSULTING FOR NEW MOTHERS, FREE NEWBORN SAFETY KITS, FREE YEAR ROUND EDUCATIONAL PROGRAMS ON NUTRITION, HEART HEALTH, BREAST HEALTH, ETC., FREE OSTEOPOROSIS SCREENINGS, PARTICIPATION IN NUMEROUS HEALTH FAIRS THROUGHOUT THE COUNTY, AND ANNUAL WELLNESS CHECK COMPREHENSIVE BLOOD SCREENINGS. OUR COMMUNITY BENEFIT PROGRAMS ARE ALL FOCUSED ON THE GOALS, STRATEGIES, AND ACTION PLANS OUTLINED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN.
FORM 990, PART VI, SECTION A, LINE 4	PENN HIGHLANDS HUNTINGDON REVISED ITS BYLAWS IN OCTOBER 2022 AND HAS MADE SEVERAL SIGNIFICANT CHANGES TO ITS BYLAWS, AS DEFINED BY THE IRS INSTRUCTIONS. THESE CHANGES ARE SUMMARIZED BELOW: BOARD OF DIRECTORS: THE NUMBER OF DIRECTORS HAS BEEN ADJUSTED FROM A MINIMUM OF 12 AND A MAXIMUM OF 19 TO NO MORE THAN 16, INCLUDING ACTIVE MEDICAL STAFF MEMBERS. 2 MEMBERS OF THE MEDICAL STAFF IN GOOD STANDING, THE CHIEF OF STAFF, THE VICE CHIEF OF STAFF, AND A MEMBER OF THE PHHD AUXILIARY WERE REMOVED AS EX-OFFICIO DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 6	MEMBERS: EFFECTIVE JUNE 1, 2019, PENN HIGHLANDS HEALTHCARE EXECUTED AN ACQUISITION WITH J.C. BLAIR HOSPITAL AND RELATED ENTITIES. AS PART OF THE AGREEMENT, PENN HIGHLANDS HEALTHCARE BECAME THE SOLE MEMBER OF J.C. BLAIR MEMORIAL HOSPITAL AND RELATED ENTITIES. IN ITS CAPACITY AS SOLE MEMBER OF J.C. BLAIR MEMORIAL HOSPITAL, PENN HIGHLANDS HEALTHCARE HAS THE RIGHT TO, AMONG OTHER THINGS, APPOINT TRUSTEES, APPROVE MAJOR EXPENDITURES, AND APPROVE LONG-TERM BORROWING.
FORM 990, PART VI, SECTION A, LINE 7A	SEE LINE 6 NARRATIVE ABOVE.
FORM 990, PART VI, SECTION A, LINE 7B	SEE LINE 6 NARRATIVE ABOVE.
FORM 990, PART VI, SECTION A, LINE 8B	THE GOVERNING BODY HAS NOT AUTHORIZED ANY COMMITTEES TO ACT ON ITS BEHALF.
FORM 990, PART VI, SECTION B, LINE 11B	990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE DRAFT FORM 990 IS REVIEWED BY THE CFO AND THE CONTROLLER OF PENN HIGHLANDS HEALTHCARE SYSTEM. AFTER ALL SUGGESTED CHANGES FROM THE CFO AND CONTROLLER ARE MADE, THE UPDATED DRAFT FORM 990 IS PROVIDED FOR REVIEW TO THE FULL BOARD. ANY QUESTIONS OR COMMENTS FROM THE BOARD ARE ADDRESSED BEFORE FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY: PENN HIGHLANDS HEALTHCARE, INC. (PHH), MAINTAINS A CONFLICT OF INTEREST POLICY WHICH APPLIES TO ALL SUBSIDIARIES. THE CONFLICT OF INTEREST POLICY APPLIES TO BOARD MEMBERS, OFFICERS, EXECUTIVE EMPLOYEES, AND ANY OTHER MANAGER OR SUPERVISOR EXERCISING SUBSTANTIAL INFLUENCE OVER OPERATIONS. EACH COVERED PERSON WILL PROMPTLY AND FULLY DISCLOSE ALL MATERIAL FACTS OF EVERY ACTUAL OR POTENTIAL DUAL INTEREST EXISTING AT THE TIME WHEN HE/SHE BECOMES A COVERED PERSON, AND ANNUALLY THROUGH EACH PHH SYSTEM ENTITY'S DISCLOSURE STATEMENT, WHICH REQUESTS DISCLOSURE OF RELATIONSHIPS, INVESTMENTS, AND TRANSACTIONS THAT MAY LEAD TO AN ACTUAL CONFLICT OF INTEREST. ALL COMPLETED DISCLOSURE STATEMENTS WILL BE PROVIDED TO THE PHH GOVERNANCE/NOMINATING COMMITTEE. THIS COMMITTEE, IN CONSULTATION WITH THE CHAIRPERSON OR VICE CHAIRPERSON OF EACH PHH SYSTEM ENTITY'S BOARD, SHALL EVALUATE THE COMPLETED DISCLOSURE STATEMENTS AND DETERMINE IF THERE ARE ANY CONFLICTS THAT ARE SO PERVASIVE AS TO RENDER ANY COVERED PERSON INELIGIBLE FOR SERVICE. THE CHAIRPERSON OF EACH PHH SYSTEM ENTITY'S BOARD WILL DISCLOSE TO THE FULL BOARD OF SAID PHH SYSTEM ENTITY ALL DUAL INTERESTS REPORTED TO HIM OR HER UNDER THE POLICY AND WILL ALSO MAKE THE DISCLOSURE STATEMENTS OF ALL COVERED PERSONS AVAILABLE TO DIRECTORS AT ANY TIME DURING THE YEAR. IF A POTENTIAL DUAL INTEREST ARISES AS A RESULT OF A CONTEMPLATED PHH SYSTEM ENTITY BOARD (OR COMMITTEE) ACTION, THE CHAIRPERSON OF SAID PHH SYSTEM ENTITY'S BOARD OR THE INTERESTED PERSON SHALL, OR ANY OTHER DIRECTOR MAY, RAISE THE QUESTION OF THE INTERESTED PERSON'S DUAL INTEREST. THE DISINTERESTED MEMBERS OF THE PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE) WILL EVALUATE THE DISCLOSURES AND THE MATERIAL FACTS RELATING TO THE TRANSACTION, ARRANGEMENT, OR POLICY GIVING RISE TO THE DUAL INTEREST TO DETERMINE WHETHER THEY INVOLVE ACTUAL CONFLICTS OF INTEREST AND MAY ATTEMPT TO DEVELOP ALTERNATIVES TO REMOVE THE CONFLICT FROM THE TRANSACTION, ARRANGEMENT, OR POLICY. A COVERED PERSON WHO HAS A DUAL INTEREST SHALL NOT BE PRESENT FOR OR SHALL LEAVE ANY PORTION OF A MEETING AT WHICH A PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE) IS VOTING TO DETERMINE WHETHER A CONFLICT EXISTS, BUT MAY BE PRESENT PRIOR TO THE VOTE TO MAKE A PRESENTATION TO SAID BOARD (OR COMMITTEE), TO DISCLOSE ADDITIONAL FACTS, OR TO RESPOND TO QUESTIONS. IF A PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE DETERMINES THAT AN ACTUAL CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON SHALL BE SO ADVISED AND THE CHAIRPERSON OF A PHH SYSTEM ENTITY'S BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE OR DIRECT MANAGEMENT TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, IF THIS HAS NOT ALREADY BEEN DONE. ANY INTERESTED PERSON WHO HAS AN ACTUAL CONFLICT OF INTEREST WITH RESPECT TO THE TRANSACTION OR ARRANGEMENT DOES NOT PARTICIPATE IN AND IS NOT PRESENT FOR THE VOTE REGARDING ANY SUCH TRANSACTION OR ARRANGEMENT. IF AN INDIVIDUAL WHOSE COMPANY OR EMPLOYER HAS A BUSINESS RELATIONSHIP WITH A PHH SYSTEM ENTITY, BUT THE INDIVIDUAL DOES NOT HAVE AN ACTUAL CONFLICT OF INTEREST WITH RESPECT TO THIS BUSINESS RELATIONSHIP, THE INDIVIDUAL MAY NONETHELESS VOLUNTARILY RECUSE HIM/HERSELF FROM VOTING ON ANY MATTERS RELATED TO THE RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 15A	OFFICER COMPENSATION: COMPENSATION FOR THE CEO WAS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS BASED ON SALARY MARKET DATA. IF THE EXECUTIVE IS ELIGIBLE FOR A PERFORMANCE BONUS, THE CRITERIA FOR DETERMINATION OF THE BONUS IS DEVELOPED BY ESTABLISHING OBJECTIVES AND MEASUREMENTS THAT WILL INDICATE THE DEGREE TO WHICH OBJECTIVES HAVE BEEN ACCOMPLISHED. APPROVAL IS DOCUMENTED VIA COMMITTEE MINUTES. FORM 990, PART VI, SECTION B, LINE 15B: THERE WERE NO OTHER OFFICERS OR KEY EMPLOYEES COMPENSATED, THEREFORE, PART VI, LINE 15B IS ANSWERED "NO" IN ACCORDANCE WITH THE IRS INSTRUCTIONS.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENT AVAILABILITY: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	OTHER FEES: PROGRAM SERVICE EXPENSES 8,485,856. MANAGEMENT AND GENERAL EXPENSES 737,900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,223,756.
FORM 990, PART XI, LINE 9:	OTHER CHANGES IN NET ASSETS 5,007,359.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

JC BLAIR MEMORIAL HOSPITAL

Employer identification number

23-1352159

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)PENN HIGHLANDS HEALTHCARE PO BOX 447 DUBOIS,PA15801 32-0345810	MGMT SERVICES	PA	501(C)(3)	LINE 7	N/A		No
(2)DUBOIS REGIONAL MEDICAL CENTER 100 HOSPITAL AVENUE DUBOIS,PA15801 25-1490707	HOSPITAL	PA	501(C)(3)	3	PHH	Yes
(3)ELCO HOUSING 759 JOHNSONBURG ROAD ST MARYS,PA15857 25-1639115	HOUSING	PA	501(C)(3)	12 A I	PHH	Yes
(4)ELK REGIONAL PROFESSIONAL GROUP INC 763 JOHNSONBURG ROAD ST MARYS,PA15857 25-1875183	HEALTHCARE	PA	501(C)(3)	3	PHH	Yes
(5)COMMUNITY NURSES HOME HEALTH & HOSPICE 757 JOHNSONBURG ROAD ST MARYS,PA15857 25-0996070	HEALTHCARE	PA	501(C)(3)	10	CNI	Yes
(6)COMMUNITY NURSES INC 757 JOHNSONBURG ROAD STE 200 ST MARYS,PA15857 25-1623598	HEALTHCARE	PA	501(C)(3)	10	PHH	Yes
(7)COMMUNITY NURSES HOME SUPPORT SERVICES 757 JOHNSONBURG ROAD ST MARYS,PA15857 25-1623601	HEALTHCARE	PA	501(C)(3)	10	CNI	Yes
(8)DRMC EMPLOYEE BENEFITS PLAN TRUST 100 HOSPITAL AVENUE DUBOIS,PA15810 25-6332829	DRMC EMP BENE	PA	501(C)(9)		DRMC	Yes
(9)JEFFCO HEALTH SERVICES INC 417 ROUTE 28 BROOKVILLE,PA15825 25-1505478	HEALTHCARE	PA	501(C)(3)	10	BROOKVILLE	Yes
(10)JC BLAIR MEMORIAL HOSPITAL FOUNDATION 935 14TH STREET HUNTINGDON,PA16652 25-1881377	SUPPORT HOSP	PA	501(C)(3)	12 A I	PHH	Yes
(11)DRMC WORKERS COMPENSATION TRUST PO BOX 447 DUBOIS,PA15801 25-1741497	SUPPORT HOSP	PA	501(C)(3)	12 B II	DRMC	Yes
(12)HELPMATES INC 757 JOHNSONBURG RD ST MARYS,PA15857 25-1555968	HEALTHCARE	PA	501(C)(3)	10	CNI	Yes
(13)PENN HIGHLANDS TYRONE 187 HOSPITAL DRIVE TYRONE,PA16686 23-1440116	HOSPITAL	PA	501(C)(3)	3	PHH	Yes
(14)TYRONE REGIONAL HEALTH NETWORK FOUNDATIO 187 HOSPITAL DRIVE TYRONE,PA16686 81-4504606	SUPPORT	PA	501(C)(3)	12 A I	PH TYRONE	Yes
(15)HIGHLANDS HOSPITAL 401 EAST MURPHY AVENUE CONNELSVILLE,PA15425 25-1494705	HOSPITAL	PA	501(C)(3)	3	PHH	Yes
(16)HIGHLANDS HOSPITAL FOUNDATION 401 EAST MURPHY AVENUE CONNELSVILLE,PA15425 84-3713870	SUPPORT HOSP	PA	501(C)(3)	12 A I	PHH	Yes
(17)WRC HEALTH CARE SUPPORT SERVICES 985 ROUTE 28 BROOKVILLE,PA15825 25-1601734	HEALTHCARE	PA	501(C)(3)	10	WRC SR SRVCS	Yes
(18)WRC SENIOR SERVICES 985 ROUTE 28 BROOKVILLE,PA15825 25-1552925	HEALTHCARE	PA	501(C)(3)	10	DRMC	Yes
(19)WRC NORTH FORK HEIGHTS 985 ROUTE 28 BROOKVILLE,PA15825 25-1684846	HEALTHCARE	PA	501(C)(3)	10	WRC SR SRVCS	Yes
(20)WRC PENNSYLVANIA MEMORIAL HOME 985 ROUTE 28 BROOKVILLE,PA15825 25-0718600	HEALTHCARE	PA	501(C)(3)	10	WRC SR SRVCS	Yes
(21)MONONGAHELA VALLEY HOSPITAL FOUNDATION 1163 COUNTRY CLUB ROAD MONONGAHELA,PA15063 82-5336533	FUNDRAISING	PA	501(C)(3)	12 B II	PHH	Yes
(22)MONONGAHELA VALLEY HOSPITAL INC 1163 COUNTRY CLUB ROAD MONONGAHELA,PA15063 23-7218917	HOSPITAL	PA	501(C)(3)	3	PHH	Yes
(23)CLEARFIELD EMS 713 W FRONT ST CLEARFIELD,PA16830 25-1672659	EMS SERVICE	PA	501(C)(3)	10	PHH	Yes
(24)BROOKVILLE HOSPITAL 100 HOSPITAL RD BROOKVILLE,PA15825 25-0984595	HOSPITAL	PA	501(C)(3)	3	DRMC	Yes
(25)ELK REGIONAL HEALTH CENTER 763 JOHNSONBURG RD ST MARYS,PA15857 25-0585280	HOSPITAL	PA	501(C)(3)	3	PHH	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) JC BLAIR MEDICAL SERVICES INC 1225 WARM SPRINGS AVENUE HUNTINGDON,PA16652 25-1881378	HEALTH CARE	PA	PHH	C					No
(2) BENNETTS VALLEY PHARMACY PO BOX 112 ST MARYS,PA15857 25-1601794	PHARMACY	PA	N/A	S					No
(3) E NICHOLSON PHARMACY 265 ALLEGHENY BLVD BROOKVILLE,PA15825 47-3117408	PHARMACY	PA	N/A	S					No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) JC BLAIR MEMORIAL HOSPITAL FOUNDATION	C	67,008	COST
(2) PENN HIGHLANDS HEALTHCARE INC	M	9,912,697	COST
(3) PENN HIGHLANDS HEALTHCARE INC	O	951,900	COST
(4) PENN HIGHLANDS HEALTHCARE INC	Q	1,900,800	COST
(5) PENN HIGHLANDS HEALTHCARE INC	S	7,665,760	COST
(6) DUBOIS REGIONAL MEDICAL CENTER	S	4,108,259	COST

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: HEALTHCARE PROVIDER - NOT-FOR-PROFIT ACUTE CARE HOSPITAL
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	445
6	Total number of volunteers (estimate if necessary) .............	6	75
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	882,283
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,836,156	594,548
9	Program service revenue (Part VIII, line 2g) .........	55,788,211	57,676,246
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	207,352	127,169
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	588,993	208,764
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	59,420,712	58,606,727
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	24,292,232	25,801,973
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	31,020,359	37,009,492
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	55,312,591	62,811,465
19	Revenue less expenses. Subtract line 18 from line 12.......	4,108,121	-4,204,738
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	87,016,603	64,585,589
21	Total liabilities (Part X, line 26).............	47,454,143	23,485,507
22	Net assets or fund balances. Subtract line 21 from line 20.....	39,562,460	41,100,082

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 58,328,754 including grants of $ ) (Revenue $ 56,793,963 )
	J.C. BLAIR MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE SERVICES, AND URGENT CARE SERVICES TO FURTHER THE HEALTH AND WELLNESS OF HUNTINGDON, PENNSYLVANIA AND SURROUNDING COMMUNITIES IN HUNTINGDON COUNTY, PENNSYLVANIA. IN FISCAL YEAR 2023, CHARITY CARE SERVICES AMOUNTED TO APPROXIMATELY $562,000. PATIENTS RECEIVE MEDICALLY NECESSARY SERVICES REGARDLESS OF ABILITY TO PAY. SEE SCHEDULE O FOR ADDITIONAL DETAIL.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses58,328,754

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	923,168	0	89,812

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	67,008
e	Government grants (contributions)		1e	431,651

f	All other contributions, gifts, grants, and similar amounts not included above		1f	95,889

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		594,548

		Business Code
2a	NET PATIENT REVENUE	621110	56,293,946	56,293,946
b	MEAL & UTILITY CONTRACT SRVCS	810000	1,115,656	233,373	882,283
c	CAFETERIA REVENUE	621500	151,746	151,746
d	HPSA/PCIP/HSIP INCENTIVE PMT	621110	104,876	104,876
e	OTHER REVENUE	900099	10,022	10,022
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		57,676,246

3 Investment income (including dividends, interest, and othersimilar amounts) ......			74,992			74,992
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,876,959	6a
b	Less: rental expenses		1,668,195	6b
c	Rental income or (loss)		208,764	6c
d	Net rental income or (loss).......			208,764			208,764
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		5,292,653	7a
b	Less: cost or other basis and sales expenses		5,240,476	7b
c	Gain or (loss)		52,177	7c
d	Net gain or (loss).........			52,177			52,177
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			58,606,727	56,793,963	882,283	335,933

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	275,621		275,621
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	21,173,511	19,479,630	1,693,881
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	340,425	313,191	27,234
9	Other employee benefits .......	2,058,446	1,893,770	164,676
10	Payroll taxes ...........	1,953,970	1,797,652	156,318
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	90,439		90,439
c	Accounting ...........
d	Lobbying ...........	8,208		8,208
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	9,223,756	8,485,856	737,900
12	Advertising and promotion ....
13	Office expenses .......	1,161,243	1,068,344	92,899
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	2,655,510	2,434,059	221,451
17	Travel ............	165,676	152,422	13,254
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	1,477,189	1,359,014	118,175
23	Insurance ...
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL AND DRUGS	11,194,283	11,194,283
b	ASSESSMENT EXPENSE	9,912,697	9,119,681	793,016
c	REPAIR AND MAINTENANCE	1,120,491	1,030,852	89,639
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	62,811,465	58,328,754	4,482,711	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,279	1	2,300
2	Savings and temporary cash investments .........			73,647	2	991,178
3	Pledges and grants receivable, net ......			106,129	3
4	Accounts receivable, net .............			7,184,069	4	14,025,593
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			999,532	8	765,189
9	Prepaid expenses and deferred charges ......			303,794	9	146,684
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	46,767,918
b	Less: accumulated depreciation	10b	25,775,380	16,776,293	10c	20,992,538
11	Investments—publicly traded securities .			4,408,538	11	5,246,781
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			57,160,322	15	22,415,326
16	Total assets. Add lines 1 through 15 (must equal line 33)...			87,016,603	16	64,585,589

17	Accounts payable and accrued expenses .....	6,367,422	17	5,370,504
18	Grants payable ...		18
19	Deferred revenue .........	634,112	19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	15,184,523	23	13,184,523
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	25,268,086	25	4,930,480
26	Total liabilities. Add lines 17 through 25..	47,454,143	26	23,485,507

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	37,062,081	27	39,147,170
28	Net assets with donor restrictions ...........	2,500,379	28	1,952,912
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	39,562,460	32	41,100,082
33	Total liabilities and net assets/fund balances ........	87,016,603	33	64,585,589