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      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
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      <TotalCalendarYear170Grp>
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      <SubstantialContributorsTotAmt>2831664</SubstantialContributorsTotAmt>
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        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>19191</CurrentTaxYearMinus1YearAmt>
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        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
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    </IRS990ScheduleB>
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      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART V, LINE 4 - INTENDED USES FOR ENDOWMENT FUNDS</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ENDOWMENT FUND WILL BE COMPOSED OF ENDOWMENT GIFTS WHERE SPECIFIED BY THE DONOR FOR THIS PURPOSE AS WELL AS OTHER GIFTS AND INVESTMENT EARNINGS AS DIRECTED TO THE FUND BY THE BOARD OF DIRECTORS. THEREFORE, THE ENDOWMENT FUND WILL CONTAIN CONTRIBUTIONS AND OTHER INCOME WHICH, IN THE TRUE SENSE OF THE HOSPITAL AUDIT GUIDE (PUBLISHED BY THE AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS), DO NOT QUALIFY AS PURE ENDOWMENT. THIS DOES NOT, HOWEVER, CONFLICT WITH THE INTENT OF THE FUND AND DOES NOT COMPROMISE FORMAL ACCOUNTING RESPONSIBILITIES. INTEREST EARNINGS FROM THE ENDOWMENT FUND WILL BE MADE AVAILABLE ON A REGULAR BASIS FOR DISCRETIONARY USE BY THE BOARD OF DIRECTORS IN SUPPORT OF THE APPALACHIAN REGIONAL HEALTHCARE SYSTEM OR AS ADDITIONS TO THE ENDOWMENT FUND (5% OR TOTAL EARNINGS, WHICH IS LESS).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X - FIN 48 FOOTNOTE</FormAndLineReferenceDesc>
        <ExplanationTxt>ARHS AND ITS BLENDED COMPONENT UNITS ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN CONSIDERED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE SYSTEM HAS DETERMINED IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2024.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
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      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
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      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHARLES MANTOOTH</PersonNm>
        <TitleTxt>TRUSTEE/CEO</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>598227</CompensationBasedOnRltdOrgsAmt>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>15950</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
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        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>18882</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>658292</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RICK CASSADY</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>341061</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>5000</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>10318</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>9900</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>34885</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>401164</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ROBERT HUDSPETH</PersonNm>
        <TitleTxt>TRUSTEE/SVP DEVELOP</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>226698</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>17725</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>7178</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>251601</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FILING ORGANIZATION RELIES ON THE METHODS USED BY ARHS, THE PARENT COMPANY, TO ESTABLISH COMPENSATION FOR ALL OFFICERS. NONE OF THE OFFICERS OR BOARD MEMBERS ARE COMPENSATED BY THE FILING ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 4 - SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS</FormAndLineReferenceDesc>
        <ExplanationTxt>SEVERANCE NONQUALIFIED EQUITY-BASED CHARLES MANTOOTH 0 11,250 0 ROBERT HUDSPETH 0 7,193 0</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleM documentId="IRS990ScheduleM">
      <WorksOfArtGrp />
      <ArtHistoricalTreasuresGrp />
      <ArtFractionalInterestGrp />
      <BooksAndPublicationsGrp />
      <ClothingAndHouseholdGoodsGrp />
      <CarsAndOtherVehiclesGrp />
      <BoatsAndPlanesGrp />
      <IntellectualPropertyGrp />
      <SecuritiesPubliclyTradedGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>3</ContributionCnt>
        <NoncashContributionsRptF990Amt>1025111</NoncashContributionsRptF990Amt>
      </SecuritiesPubliclyTradedGrp>
      <SecuritiesCloselyHeldStockGrp />
      <SecurPrtnrshpTrustIntrstsGrp />
      <SecuritiesMiscellaneousGrp />
      <QualifiedContribHistStructGrp />
      <QualifiedContribOtherGrp />
      <RealEstateResidentialGrp />
      <RealEstateCommercialGrp />
      <RealEstateOtherGrp />
      <CollectiblesGrp />
      <FoodInventoryGrp />
      <DrugsAndMedicalSuppliesGrp />
      <TaxidermyGrp />
      <HistoricalArtifactsGrp />
      <ScientificSpecimensGrp />
      <ArchaeologicalArtifactsGrp />
      <AnyPropertyThatMustBeHeldInd>false</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>false</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>false</ThirdPartiesUsedInd>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 - ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES</FormAndLineReferenceDesc>
        <ExplanationTxt>WORK WITH APPALACHIAN REGIONAL HEALTHCARE SYSTEM (ARHS) TO SUPPORT HEALTHCARE IN THE SURROUNDING REGION OF WESTERN NORTH CAROLINA. OUR MISSION WILL BE ACHIEVED BY 1) EXPANDING AND PRESERVING ESSENTIAL PATIENT SERVICES THROUGH PHILANTHROPY; 2) EQUIPPING CAREGIVERS WITH UNIQUE RESOURCES AND LEADING EDGE TECHNOLOGIES; 3) HELPING CREATE A HEALTHIER COMMUNITY FOR THE COUNTIES WE SERVE; AND 4) COOPERATING WITH OTHER COMMUNITY ORGANIZATIONS WHO SHARE THE ARHS MISSION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 6 - CLASSES OF MEMBERS OR STOCKHOLDERS</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SOLE MEMBER OF THE FOUNDATION IS APPALACHIAN REGIONAL HEALTHCARE SYSTEM, INC. (ARHS).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 7A - ELECTION OF MEMBERS AND THEIR RIGHTS</FormAndLineReferenceDesc>
        <ExplanationTxt>ARHS BOARD OF TRUSTEES APPOINTS 12 OF THE 13 MEMBERS OF THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 11B - ORGANIZATION'S PROCESS TO REVIEW FORM 990</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SYSTEM CONTROLLER AND THE CFO REVIEW THE 990 PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. THE RETURN IS MADE AVAILABLE TO THE BOARD OF TRUSTEES UPON COMPLETION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 12C - ENFORCEMENT OF CONFLICTS POLICY</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY AND APPLIES TO ALL EMPLOYEES, OFFICERS AND BOARD MEMBERS. SHOULD A CONFLICT EXIST, THE INDIVIDUAL IS RECUSED FROM DISCUSSION AND DECISION-MAKING PROCESS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 19 - GOVERNING DOCUMENTS DISCLOSURE EXPLANATION</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="IRS990ScheduleR">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>APPALACHIAN REGIONAL BEHAVIORAL HLT</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>432 HOSPITAL DRIVE</AddressLine1Txt>
          <CityNm>LINVILLE</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28646</ZIPCd>
        </USAddress>
        <EIN>851313265</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ARHS</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>WATAUGA MEDICAL CENTER INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>336 DEERFIELD RD</AddressLine1Txt>
          <CityNm>BOONE</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28607</ZIPCd>
        </USAddress>
        <EIN>560510824</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ARHS</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>APPALACHIAN REGIONAL MEDICAL ASSOCI</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>PO BOX 2600</AddressLine1Txt>
          <CityNm>BOONE</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28607</ZIPCd>
        </USAddress>
        <EIN>205775130</EIN>
        <PrimaryActivitiesTxt>PHYSICIANS</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>11</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ARHS</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>CHARLES A CANNON JR MEMORIAL HOSP</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>434 HOSPITAL DRIVE</AddressLine1Txt>
          <CityNm>LINVILLE</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28646</ZIPCd>
        </USAddress>
        <EIN>560529974</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ARHS</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>ARHS PROPERTIES INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>336 DEERFIELD RD</AddressLine1Txt>
          <CityNm>BOONE</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28607</ZIPCd>
        </USAddress>
        <EIN>203470765</EIN>
        <PrimaryActivitiesTxt>PROPERTY</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>12B</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ARHS</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>APPALACHIAN REGIONAL HEALTHCARE SYS</BusinessNameLine1Txt>
        </DisregardedEntityName>
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          <AddressLine1Txt>PO BOX 2600</AddressLine1Txt>
          <CityNm>BOONE</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28607</ZIPCd>
        </USAddress>
        <EIN>201067022</EIN>
        <PrimaryActivitiesTxt>PARENT</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>12B</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>true</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>