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      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART I, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>HOSPITAL SHARED SERVICES ASSOCIATION IS A COOPERATIVE HOSPITAL SERVICES ORGANIZATION PROVIDING PURCHASING SERVICES TO OVER 40 MEMBER HOSPITALS. THIS ORGANIZATION IS NOT A LICENSED HOSPITAL THAT IS REQUIRED TO COMPLETE SCHEDULE H.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION IS MANAGED BY ADVENTIST, A NONPROFIT HOSPITAL SYSTEM.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE DIRECTOR REVIEWS THE FORM 990 PRIOR TO SUBMISSION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF DIRECTORS ARE RESPONSIBLE FOR SETTING THE COMPENSATION FOR THE EXECUTIVE DIRECTOR DURING A BOARD MEETING. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>SHOULD SOMEONE FROM THE PUBLIC ASK FOR GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS, THEY WOULD BE PROVIDED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VIII, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>PREMIER PURCHASING PARTNERS LP ISSUED AN INITIAL PUBLIC OFFERING (IPO) IN SEPTEMBER 2013. AS PART OF ITS GROUP PURCHASING AGREEMENT, HSSA OWNED STOCK IN THE PARTNERSHIP. HSSA'S PARTNERSHIP STOCK WAS CONVERTED TO PUBLICLY TRADED SECURITIES AT THE TIME OF THE PREMIER IPO. AS PART OF THE CONVERSION AGREEMENT, HSSA HAS THE OPTION TO SELL A PORTION OF ITS STOCK IN PREMIER EACH YEAR. HSSA OWNED LESS THAN 1% OF THE OUTSTANDING SHARES OF PREMIER PURCHASING PARTNERS AT THE TIME OF THE IPO. PROCEEDS FROM THE SALE OF THE STOCK ARE DISTRIBUTED TO HSSA'S MEMBER HOSPITALS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>