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        <Desc>REVERSAL OF ACCRUALS</Desc>
        <BusinessCd>621910</BusinessCd>
        <TotalRevenueColumnAmt>115113</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>115113</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>ACCTG ADJUSTMENTS</Desc>
        <BusinessCd>621910</BusinessCd>
        <TotalRevenueColumnAmt>13857</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>13857</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>CME REIMBURSEMENT</Desc>
        <BusinessCd>621910</BusinessCd>
        <TotalRevenueColumnAmt>13000</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>13000</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>11848</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>11848</RelatedOrExemptFuncIncomeAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>153818</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>10903505</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>9752370</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>101678</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>358006</TotalAmt>
        <ProgramServicesAmt>130142</ProgramServicesAmt>
        <ManagementAndGeneralAmt>227864</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>7090728</TotalAmt>
        <ProgramServicesAmt>6525880</ProgramServicesAmt>
        <ManagementAndGeneralAmt>564848</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>84014</TotalAmt>
        <ProgramServicesAmt>71018</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12996</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1120735</TotalAmt>
        <ProgramServicesAmt>1023112</ProgramServicesAmt>
        <ManagementAndGeneralAmt>97623</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>602146</TotalAmt>
        <ProgramServicesAmt>543514</ProgramServicesAmt>
        <ManagementAndGeneralAmt>58632</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>9612</TotalAmt>
        <ManagementAndGeneralAmt>9612</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>48985</TotalAmt>
        <ManagementAndGeneralAmt>48985</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>758</TotalAmt>
        <ManagementAndGeneralAmt>758</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>278082</TotalAmt>
        <ProgramServicesAmt>47228</ProgramServicesAmt>
        <ManagementAndGeneralAmt>230854</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>36204</TotalAmt>
        <ProgramServicesAmt>36204</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>30930</TotalAmt>
        <ProgramServicesAmt>15465</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15465</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>132702</TotalAmt>
        <ProgramServicesAmt>76547</ProgramServicesAmt>
        <ManagementAndGeneralAmt>56155</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>141948</TotalAmt>
        <ProgramServicesAmt>79678</ProgramServicesAmt>
        <ManagementAndGeneralAmt>62270</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>3848</TotalAmt>
        <ManagementAndGeneralAmt>3848</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>63873</TotalAmt>
        <ManagementAndGeneralAmt>63873</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>247034</TotalAmt>
        <ProgramServicesAmt>147292</ProgramServicesAmt>
        <ManagementAndGeneralAmt>99742</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>546999</TotalAmt>
        <ProgramServicesAmt>439282</ProgramServicesAmt>
        <ManagementAndGeneralAmt>107717</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>288980</TotalAmt>
        <ProgramServicesAmt>288980</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RANSOMEWARE ATTACK</Desc>
        <TotalAmt>258774</TotalAmt>
        <ManagementAndGeneralAmt>258774</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>VEHICLEEQUIP MAINTENANCE</Desc>
        <TotalAmt>139560</TotalAmt>
        <ProgramServicesAmt>139560</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>COMMUNICATIONS</Desc>
        <TotalAmt>110397</TotalAmt>
        <ProgramServicesAmt>105370</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5027</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>269031</TotalAmt>
        <ProgramServicesAmt>136278</ProgramServicesAmt>
        <ManagementAndGeneralAmt>132753</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>11863346</TotalAmt>
        <ProgramServicesAmt>9805550</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2057796</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>661564</BOYAmt>
        <EOYAmt>73305</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>137283</BOYAmt>
        <EOYAmt>4356</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <EOYAmt>21092</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1593121</BOYAmt>
        <EOYAmt>1367116</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>97099</BOYAmt>
        <EOYAmt>37455</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>170199</BOYAmt>
        <EOYAmt>486579</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>6027343</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>2643731</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3610849</BOYAmt>
        <EOYAmt>3383612</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>265261</BOYAmt>
        <EOYAmt>19067</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <EOYAmt>-1274015</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>21476</BOYAmt>
        <EOYAmt>16740</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>428306</BOYAmt>
        <EOYAmt>509356</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>6985158</BOYAmt>
        <EOYAmt>4644663</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1244227</BOYAmt>
        <EOYAmt>1249876</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>8673</BOYAmt>
        <EOYAmt>143086</EOYAmt>
      </DeferredRevenueGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1411523</BOYAmt>
        <EOYAmt>1167260</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>477717</BOYAmt>
        <EOYAmt>488555</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>3142140</BOYAmt>
        <EOYAmt>3048777</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>3771428</BOYAmt>
        <EOYAmt>1525082</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>71590</BOYAmt>
        <EOYAmt>70804</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>3843018</BOYAmt>
        <EOYAmt>1595886</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>6985158</BOYAmt>
        <EOYAmt>4644663</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-959841</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>1668</NetUnrlzdGainsLossesInvstAmt>
      <PriorPeriodAdjustmentsAmt>-1308367</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>19408</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolAndSepBasisFinclStmtInd>X</ConsolAndSepBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>1418717</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2363650</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1189936</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1596232</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1049457</CurrentTaxYearAmt>
        <TotalAmt>7617992</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>7015340</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>7408299</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8586911</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8773313</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>9833271</CurrentTaxYearAmt>
        <TotalAmt>41617134</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <GovtFurnSrvcFcltsVl509Grp>
        <CurrentTaxYearMinus4YearsAmt>56196</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>56196</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>56196</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>56196</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>56196</CurrentTaxYearAmt>
        <TotalAmt>280980</TotalAmt>
      </GovtFurnSrvcFcltsVl509Grp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>8490253</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9828145</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9833043</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10425741</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10938924</CurrentTaxYearAmt>
        <TotalAmt>49516106</TotalAmt>
      </Total509Grp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>49516106</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>58990</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>46602</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>50204</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>27366</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3302</CurrentTaxYearAmt>
        <TotalAmt>186464</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>58990</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>46602</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>50204</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>27366</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3302</CurrentTaxYearAmt>
        <TotalAmt>186464</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <NetIncomeFromOtherUBIGrp>
        <CurrentTaxYearMinus2YearsAmt>200</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>68783</CurrentTaxYearMinus1YearAmt>
        <TotalAmt>68983</TotalAmt>
      </NetIncomeFromOtherUBIGrp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>8549243</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9874747</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9883447</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10521890</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10942226</CurrentTaxYearAmt>
        <TotalAmt>49771553</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.99490</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.99350</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00000</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.01000</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>71590</BeginningYearBalanceAmt>
        <ContributionsAmt>2018</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>2244</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>4000</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>1048</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>70804</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>71779</BeginningYearBalanceAmt>
        <ContributionsAmt>1984</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>3189</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>3993</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>1369</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>71590</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>76640</BeginningYearBalanceAmt>
        <ContributionsAmt>3301</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>-4493</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>2291</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>1378</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>71779</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>91232</BeginningYearBalanceAmt>
        <ContributionsAmt>3331</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>2088</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>17800</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>2211</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>76640</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>83732</BeginningYearBalanceAmt>
        <ContributionsAmt>10124</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>3091</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>5157</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>558</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>91232</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <PrmnntEndowmentBalanceEOYPct>1.00000</PrmnntEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>false</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>false</EndowmentsHeldRelatedOrgInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>675000</OtherCostOrOtherBasisAmt>
        <BookValueAmt>675000</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>3486272</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1184311</DepreciationAmt>
        <BookValueAmt>2301961</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1843676</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1445405</DepreciationAmt>
        <BookValueAmt>398271</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>22395</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>14015</DepreciationAmt>
        <BookValueAmt>8380</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>3383612</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>IRC SEC 457 NONQUALIFIED PLAN</Desc>
        <BookValueAmt>405099</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>BENEVOLENT FUND</Desc>
        <BookValueAmt>68304</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INTEREST RATE SWAP AGREEMENT</Desc>
        <BookValueAmt>35953</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>509356</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>IRC SEC 457 NONQUALIFIED PLAN</Desc>
        <Amt>405099</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>REFUNDABLE ADVANCES</Desc>
        <Amt>75283</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>SECURITY DEPOSIT</Desc>
        <Amt>8173</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>488555</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>10980805</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>1668</NetUnrealizedGainsInvstAmt>
      <DonatedServicesAndUseFcltsAmt>56196</DonatedServicesAndUseFcltsAmt>
      <OtherRevenueAmt>38867</OtherRevenueAmt>
      <RevenueNotReportedAmt>96731</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>10884074</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>758</InvestmentExpensesNotIncldAmt>
      <OtherRevenuesNotIncludedAmt>18673</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>19431</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>10903505</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>11918784</TotExpnsEtcAuditedFinclStmtAmt>
      <DonatedServicesUseFcltsAmt>56196</DonatedServicesUseFcltsAmt>
      <ExpensesNotReportedAmt>56196</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>11862588</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>758</InvestmentExpensesNotIncld2Amt>
      <ExpensesNotRptFinclStmtAmt>758</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>11863346</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d-Other revenue included on Sch D but not on 990</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN VALUE OF INVESTMENT IN SUBSIDIARY $29,352CHNAGE IN VALUE OF INTEREST RATE SWAP 9,515TOTAL $38,867</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b-Other revenue not included on Sch D but on 990</FormAndLineReferenceDesc>
        <ExplanationTxt>REALIZED GAIN ON SALE OF SECURITIES $18,673</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ">
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TIMOTHY P EGAN</PersonNm>
        <TitleTxt>EXECUTIVE DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>240365</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>4926</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>43432</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>288723</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>FRANK DESCHINO</PersonNm>
        <TitleTxt>DEPUTY CHIEF OF OPERATIONS</TitleTxt>
        <BaseCompensationFilingOrgAmt>216694</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>4282</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>1000</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>221976</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RICHARD GREER</PersonNm>
        <TitleTxt>PARAMEDIC</TitleTxt>
        <BaseCompensationFilingOrgAmt>178845</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>2209</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>41747</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>222801</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ALLEN SCHILDGEN</PersonNm>
        <TitleTxt>PARAMEDIC</TitleTxt>
        <BaseCompensationFilingOrgAmt>153312</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>2048</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>155360</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, LINE 11B - ORGANIZATIONS PROCESS TO REVIEW FORM 990 EACH MEMBER OF THE BOARD OF DIRECTORS AND FINANCE COMMITTEE IS PROVIDED A COPY OF FORM 990 FOR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, LNE 12C- ENFORCEMENT OF CONFLICTS POLICY ANNUAL STATEMENT COMPLETED AND SIGNED BY DESIGNATED PARTIES</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>CEO executive director top management comp Part VI line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, LINE 15A - COMPENSATION PROCESS FOR TOP OFFICIAL THE BOARD OF DIRECTORS PERFORMS A REVIEW OF THE COMPENSATION TO BE PAID THE EXECUTIVE DIRECTOR. THE REVIEW PROCESS INCLUDES AVAILABLE COMPARABLE ENTITY DATA, EMPLOYMENT LONGEVITY, RESPONSIBILITIES AND ACCOMPLISHMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other officer or key employee compensation Part VI line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, LINE 15B - COMPENSATION PROCESS FOR OFFICERS THE EXECUTIVE DIRECTOR REVIEWS THE COMPENSATION OF KEY EMPLOYEES ANNUALLY TAKING INTO CONSIDERATION AVAILABLE COMPARABLE ENTITY DATA, EMPLOYMENT LONGEVITY, RESPONSIBILITIES AND ACCOMPLISHMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, LINE 19- GOVERNING DOCUMENTS DISCLOSURE EXPELANATION GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Explanation of other changes in net assets or fund balances Part XI line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS EXPLANATION CHANGE IN VALUE OF INTEREST RATE SWAP $ 9,515 CHANGE IN BENEVOLENT FUND ( 786) CHANGE IN VALUE OF INVESTMENT IN SUBSIDIARY 29,352 REALIZED LOSS ON SALE OF SECURITIES (18,673) TOTAL $19,408</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IX response or note to any line in Part IX</FormAndLineReferenceDesc>
        <ExplanationTxt>PART IX, LINE 11G - FEES FOR SERVICES - OTHER OUTSIDE BOOKKEEPING AND ACCOUNTING $149,469 PAYROLL PROCESSING FEES 58,665 MEDICAL DIRECTOR FEES $23,000 EMERGENCY SERVICES PERSONNEL COVERAGE 13,663 PENSION CONSULTING 12,000 TRAINING SERVICES 10,565 PENSION ADMINISTRATION 7,720 VALUATION SERVICES 3,000</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="IRS990ScheduleR">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>NONE</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <DirectControllingNACd>N/A</DirectControllingNACd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>ROCKLAND MOBILE CARE INC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>17 SQUADRON BLVD</AddressLine1Txt>
          <CityNm>NEW CITY</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>10956</ZIPCd>
        </USAddress>
        <EIN>134034435</EIN>
        <PrimaryActivitiesTxt>AMBULANCE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ROCKLAND PARAMEDIC SERVICES INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C Corp</EntityTypeTxt>
        <ShareOfTotalIncomeAmt>7751</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>3744</ShareOfEOYAssetsAmt>
        <OwnershipPct>1.00000</OwnershipPct>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>RMC AUTOMOTIVE INC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>17 SQUADRON BLVD</AddressLine1Txt>
          <CityNm>NEW CITY</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>10956</ZIPCd>
        </USAddress>
        <EIN>271651799</EIN>
        <PrimaryActivitiesTxt>VEHICLE REPAIR</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ROCKLAND PARAMEDIC SERVICES INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C Corp</EntityTypeTxt>
        <OwnershipPct>1.00000</OwnershipPct>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>ADVANTAGE PRACTICE MANAGEMENT INC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>17 SQUADRON BLVD</AddressLine1Txt>
          <CityNm>NEW CITY</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>10956</ZIPCd>
        </USAddress>
        <EIN>371776021</EIN>
        <PrimaryActivitiesTxt>BILLING SERVICE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>ROCKLAND MOBILE CARE INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C Corp</EntityTypeTxt>
        <OwnershipPct>1.00000</OwnershipPct>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <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>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>