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      <FeesForServicesLegalGrp>
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      <FeesForServicesAccountingGrp>
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      <FeesForServicesLobbyingGrp>
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      <RoyaltiesGrp>
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      <TravelGrp>
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      <InterestGrp>
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      <PaymentsToAffiliatesGrp>
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      <InsuranceGrp>
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        <FundraisingAmt>63899</FundraisingAmt>
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        <ManagementAndGeneralAmt>39655</ManagementAndGeneralAmt>
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      <ReconcilationRevenueExpnssAmt>-227624</ReconcilationRevenueExpnssAmt>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
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        <CurrentTaxYearMinus2YearsAmt>4980831</CurrentTaxYearMinus2YearsAmt>
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        <CurrentTaxYearAmt>536538</CurrentTaxYearAmt>
        <TotalAmt>11763651</TotalAmt>
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      <SubstantialContributorsTotAmt>6289918</SubstantialContributorsTotAmt>
      <PublicSupportTotal170Amt>5473733</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
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        <CurrentTaxYearMinus3YearsAmt>8366</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3740</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>116392</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>134493</CurrentTaxYearAmt>
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          <AddressLine2>RESTRICTED</AddressLine2>
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          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
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      <TotalRevEtcAuditedFinclStmtAmt>1726528</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>58297</NetUnrealizedGainsInvstAmt>
      <DonatedServicesAndUseFcltsAmt>260793</DonatedServicesAndUseFcltsAmt>
      <OtherRevenueAmt>740282</OtherRevenueAmt>
      <RevenueNotReportedAmt>1059372</RevenueNotReportedAmt>
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      <TotalRevenuePerForm990Amt>667156</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>1895855</TotExpnsEtcAuditedFinclStmtAmt>
      <DonatedServicesUseFcltsAmt>260793</DonatedServicesUseFcltsAmt>
      <OtherExpensesIncludedAmt>740282</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>1001075</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>894780</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>894780</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d: Other revenue amounts included in F/S but not included on form 990</FormAndLineReferenceDesc>
        <ExplanationTxt>Assets Released from Restrictions $735197 Special Events Reclassifications $5085</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d: Other expenses and losses per audited F/S</FormAndLineReferenceDesc>
        <ExplanationTxt>Assets Released From Restrictions $735197 Special Events Exp Reclassifications $5085</ExplanationTxt>
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    <IRS990ScheduleI documentId="IRS990ScheduleI" softwareId="22015553" softwareVersionNum="2022v5.0">
      <GrantRecordsMaintainedInd>true</GrantRecordsMaintainedInd>
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          <BusinessNameLine1Txt>Mark Twain Medical Center</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>768 Mountain Ranch Rd</AddressLine1Txt>
          <CityNm>San Andreas</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>95249</ZIPCd>
        </USAddress>
        <RecipientEIN>680127677</RecipientEIN>
        <IRCSectionDesc>170b1Aiii</IRCSectionDesc>
        <CashGrantAmt>791226</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>Cash Value</ValuationMethodUsedDesc>
        <PurposeOfGrantTxt>Capital Campaigns &amp; General Support</PurposeOfGrantTxt>
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      <Total501c3OrgCnt>1</Total501c3OrgCnt>
      <TotalOtherOrgCnt>0</TotalOtherOrgCnt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Grantmaker's Description of How Grants are Used</FormAndLineReferenceDesc>
        <ExplanationTxt>Grants are used for general support of the Mark Twain Medical Center's mission and in accordance with capital campaign stipulations, if applicable.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleL documentId="IRS990ScheduleL" softwareId="22015553" softwareVersionNum="2022v5.0">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>Charanjit Singh</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Med Ctr Employee</RelationshipDescriptionTxt>
        <TransactionAmt>135032</TransactionAmt>
        <TransactionDesc>Compensated by Rltd Org</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
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          <PersonNm>Substantial Contributor</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Interested Perso</RelationshipDescriptionTxt>
        <TransactionAmt>16900</TransactionAmt>
        <TransactionDesc>Substantial Contribution</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule L, Part V Supplemental Information</FormAndLineReferenceDesc>
        <ExplanationTxt>The officer of the organization is compensated as an officer of the Mark Twain Medical Center (MTMC). Since the Foundation's purpose is to support MTMC, and the officer's compensation exceeded $10,000, these transactions are required to be reported on Schedule L. The MTMC Philanthropy Officer is not a voting member of the Board of Directors.An interested person of the organization was a substantial contributor during the fiscal year (contributor whose contributions both exceed $5000 and is required to be reported on Schedule B). This transaction both impairs the Director's voting independence on the Foundation's Board of Directors and is reportable on the Form 990, Schedule L as a business transaction.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="22015553" softwareVersionNum="2022v5.0">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 1a</FormAndLineReferenceDesc>
        <ExplanationTxt>N/A</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>Presented to the Executive Board at Monthly meeting and signed by both Treasurer and Chief Executive Officer.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization abides by all Dignity Health policies and guidelines as so written.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>Compensation is determined by the human resources department of Mark Twain Medical Center in accordance with comparability data and Dignity Health policies. Please note that all staff services received by the Foundation are donated, as Mark Twain Medical Center staff members donate a portion of their time to the Foundation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>Compensation is determined by the human resources department of Mark Twain Medical Center in accordance with comparability data and Dignity Health policies. Please note that all staff services received by the Foundation are donated, as Mark Twain Medical Center staff members donate a portion of their time to the Foundation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The documents are provided upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>Unrealized Gain/Loss = $58297</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Column D</FormAndLineReferenceDesc>
        <ExplanationTxt>The Foundation has reported fundraising expenses in column D of Part IX. Expenses related to special event activities are reported on Schedule G (during years when special events are held and they meet the threshold to require Schedule G), and are accounted for in the Schedule D reconciliation on page 4.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part V, Lines 1a &amp; 2a</FormAndLineReferenceDesc>
        <ExplanationTxt>Compensation of officers/employees is not paid by the Foundation, as the value of these services is donated by the Mark Twain Medical Center. The Mark Twain Medical Center also pays the Foundation's other expenses, aside from grants and donations. The Foundation and the Mark Twain Medical Center are related organizations, as they have common agents.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 1b</FormAndLineReferenceDesc>
        <ExplanationTxt>An interested person of the organization was a substantial contributor during the fiscal year (contributor whose contributions both exceed $5000 and is required to be reported on Schedule B). This transaction both impairs the Director's voting independence on the Foundation's Board of Directors and is reportable on the Form 990, Schedule L as a business transaction.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990: Part IX Lines 5 &amp; 6; Part VII col. B, E, &amp; F;Part V Ln 1&amp;2a</FormAndLineReferenceDesc>
        <ExplanationTxt>Compensation of Officers and other employees is not paid by the Foundation, as the value of these services (See Schedule R) is donated by Mark Twain Medical Center.</ExplanationTxt>
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          <AddressLine1Txt>768 Mountain Ranch Rd</AddressLine1Txt>
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          <StateAbbreviationCd>CA</StateAbbreviationCd>
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      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
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      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
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      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
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      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
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          <BusinessNameLine1Txt>Mark Twain Medical Center</BusinessNameLine1Txt>
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        <InvolvedAmt>791226</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Cash Value</MethodOfAmountDeterminationTxt>
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      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Mark Twain Medical Center</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>c</TransactionTypeTxt>
        <InvolvedAmt>103554</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Cash Value</MethodOfAmountDeterminationTxt>
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      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Mark Twain Medical Center</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>k</TransactionTypeTxt>
        <InvolvedAmt>43348</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
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      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Mark Twain Medical Center</BusinessNameLine1Txt>
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        <InvolvedAmt>217445</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
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        <FormAndLineReferenceDesc>Part V</FormAndLineReferenceDesc>
        <ExplanationTxt>Transaction types K and O that occurred between the organizations consisted of donated services and space (lease is actually paid by the Medical Center, and only valued for financial statement purposes), which are financial statement reportable items not to be reported on the form 990. Thus they are reconciling items of the Form 990, appearing only on Schedule R and the Schedule D, page 4.</ExplanationTxt>
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  </ReturnData>
</Return>
