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        <PersonNm>Adrian Maldonado</PersonNm>
        <TitleTxt>Vice Chairman</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Nicolette Scott OD</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Cynthia Schulz</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>David Sylvan</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>R Terry Krivak</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Ken D Semelsberger</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Brian Monter</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Paul Hinchey MD</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Christine Lobas</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>William H Gary Sr</PersonNm>
        <TitleTxt>Secretary</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Thomas M Wynne</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Wayne E Brassel</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>James F Sheppard</PersonNm>
        <TitleTxt>Treasurer</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Theodoros Teknos MD</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Thomas W Laub</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Brett C Hazard</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Shelley Chornak</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>001.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>4210196</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>1072905</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>546041</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>209</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>true</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Southwest Anesthesia Group Inc</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>18697 Bagley Road</AddressLine1Txt>
            <CityNm>Middleburg Heights</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contract Labor</ServicesDesc>
        <CompensationAmt>15487499</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Healthtrust Inc DBA HSS Systems</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1100 DR Martin L King Jr Blvd</AddressLine1Txt>
            <CityNm>Nashville</CityNm>
            <StateAbbreviationCd>TN</StateAbbreviationCd>
            <ZIPCd>37203</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Revenue Cycle</ServicesDesc>
        <CompensationAmt>9065476</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ABM Healthcare Support Services</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 74008829</AddressLine1Txt>
            <CityNm>Chicago</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>606748829</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contract Labor</ServicesDesc>
        <CompensationAmt>6580873</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>University Hospitals Health Sys</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 78000</AddressLine1Txt>
            <CityNm>Detroit</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>482781887</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Purchased Svc</ServicesDesc>
        <CompensationAmt>6527465</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Qualivis</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 674913</AddressLine1Txt>
            <CityNm>Dallas</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>75267</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contract Labor</ServicesDesc>
        <CompensationAmt>5762269</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>43</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>2156978</RelatedOrganizationsAmt>
      <TotalContributionsAmt>2156978</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient Care</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>423943692</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>423943692</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Rental Income controlled org</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>798975</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>798975</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Program Related investments</Desc>
        <BusinessCd>541990</BusinessCd>
        <TotalRevenueColumnAmt>684120</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>602245</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>81875</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Operating Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1045213</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1045213</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Nursing Home and Lab Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>196915</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>196915</UnrelatedBusinessRevenueAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>14763</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>14763</UnrelatedBusinessRevenueAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>426683678</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>8535903</TotalRevenueColumnAmt>
        <ExclusionAmt>8535903</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>85738</TotalRevenueColumnAmt>
        <ExclusionAmt>85738</ExclusionAmt>
      </IncmFromInvestBondProceedsGrp>
      <GrossRentsGrp>
        <RealAmt>1332350</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>2505759</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>-1173409</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>-1173409</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>146243</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>-1319653</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>97309395</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>88970621</SecuritiesAmt>
        <OtherAmt>27534</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>8338774</SecuritiesAmt>
        <OtherAmt>-27534</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>8311240</TotalRevenueColumnAmt>
        <ExclusionAmt>8311240</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <OtherRevenueMiscGrp>
        <Desc>Tax Levy</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>906662</TotalRevenueColumnAmt>
        <ExclusionAmt>906662</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Fitness Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>3010986</TotalRevenueColumnAmt>
        <ExclusionAmt>3010986</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Cafeteria Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1043987</TotalRevenueColumnAmt>
        <ExclusionAmt>1043987</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>4961635</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>449561763</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>426390125</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>357921</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>20656738</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>3454597</TotalAmt>
        <ManagementAndGeneralAmt>3454597</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>135386148</TotalAmt>
        <ProgramServicesAmt>128024405</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7361743</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>6151988</TotalAmt>
        <ProgramServicesAmt>5640319</ProgramServicesAmt>
        <ManagementAndGeneralAmt>511669</ManagementAndGeneralAmt>
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      <OtherEmployeeBenefitsGrp>
        <TotalAmt>24070458</TotalAmt>
        <ProgramServicesAmt>22068488</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2001970</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>10220169</TotalAmt>
        <ProgramServicesAmt>9370145</ProgramServicesAmt>
        <ManagementAndGeneralAmt>850024</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>725724</TotalAmt>
        <ProgramServicesAmt>46305</ProgramServicesAmt>
        <ManagementAndGeneralAmt>679419</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>440545</TotalAmt>
        <ManagementAndGeneralAmt>440545</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising></FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>874224</TotalAmt>
        <ManagementAndGeneralAmt>874224</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>80223056</TotalAmt>
        <ProgramServicesAmt>65970413</ProgramServicesAmt>
        <ManagementAndGeneralAmt>14252643</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>1447366</TotalAmt>
        <ProgramServicesAmt>607591</ProgramServicesAmt>
        <ManagementAndGeneralAmt>839775</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>8789956</TotalAmt>
        <ProgramServicesAmt>7987275</ProgramServicesAmt>
        <ManagementAndGeneralAmt>802681</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>21996730</TotalAmt>
        <ProgramServicesAmt>16094736</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5901994</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
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      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>11262872</TotalAmt>
        <ProgramServicesAmt>11045694</ProgramServicesAmt>
        <ManagementAndGeneralAmt>217178</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>596699</TotalAmt>
        <ProgramServicesAmt>571335</ProgramServicesAmt>
        <ManagementAndGeneralAmt>25364</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>23030</ProgramServicesAmt>
        <ManagementAndGeneralAmt>107197</ManagementAndGeneralAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>130227</TotalAmt>
        <ProgramServicesAmt>23030</ProgramServicesAmt>
        <ManagementAndGeneralAmt>107197</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>5362121</TotalAmt>
        <ManagementAndGeneralAmt>5362121</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>22235684</TotalAmt>
        <ProgramServicesAmt>21072827</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1162857</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>4512902</TotalAmt>
        <ProgramServicesAmt>414979</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4097923</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Provision for Bad Debt</Desc>
        <TotalAmt>20081893</TotalAmt>
        <ProgramServicesAmt>20081893</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Medical supplies</Desc>
        <TotalAmt>52634156</TotalAmt>
        <ProgramServicesAmt>52634156</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Drug expense</Desc>
        <TotalAmt>31516033</TotalAmt>
        <ProgramServicesAmt>31516033</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Taxes</Desc>
        <TotalAmt>13705008</TotalAmt>
        <ProgramServicesAmt>10563</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13694445</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>2552108</TotalAmt>
        <ProgramServicesAmt>1834563</ProgramServicesAmt>
        <ManagementAndGeneralAmt>717545</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>458370664</TotalAmt>
        <ProgramServicesAmt>395037780</ProgramServicesAmt>
        <ManagementAndGeneralAmt>63463111</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>14076141</BOYAmt>
        <EOYAmt>13782717</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
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        <ExplanationTxt>Representatives from a number of organizations serving Cuyahoga County formed the Cuyahoga County CHNA Steering committee to guide Cuyahoga County community partners through the assessment process. Representing a variety of sectors including academia, education, healthcare, as well as social services agencies, these organizations play key roles in optimizing the communitys health. Multiple Sectors including the general public, were asked through email list servs, social media, and public notices to participate in the process of qualitative data collection. In addition, the Health Center conducted an independent survey utilizing the same questions from the previous needs assessment which was distributed to over 90 thousand individuals utilizing the healthcare portal of the Health Centers electronic platform. The survey was opened up to any participant who had an email address in the portal from June 1, 2022 to September 2022. 3,561 surveys were completed as of 9.6.2022.</ExplanationTxt>
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        <ExplanationTxt>Three health care priorities identified for integration into the Community Health Improvement Planning Process were Behavioral Health, including mental health and drug use and misuse, Accessible and Affordable Healthcare, and Community Conditions made up of access to healthy food and community safety. Elimination structural and racism and enhancing trust will continue to be two overarching areas of focus for work. The Health Centers plan to address these three priorities include increasing system investment in primary and safety net specialty care to support a person and relationship focus for health care. Enhance the value of community- based primary care team approach to avoid inappropriate use of the ER, readmission and institutional care with focus on preventative approach, care management and home health care, through educational opportunities. Provide information on local transportation to local food pantries. Improve community based preventative care through education. Improve health by the continued promotion of healthy eating and increase making nutritious foods. Increase suicide awareness, prevention and peer norm programs, and working with area schools to attract a diverse population of potential employees.</ExplanationTxt>
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            <BusinessNameLine1Txt>The Surgery Center of Southwest General</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>19250 Bagley Rd</AddressLine1Txt>
            <CityNm>Middleburg Hts</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
          <FacilityTxt>Ambulatory Outpatient Surgery</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Brunswick Med Center</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>4065 Center Road</AddressLine1Txt>
            <CityNm>Brunswick</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44212</ZIPCd>
          </USAddress>
          <FacilityTxt>ER and Outpatient Svs</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Big Creek Surgery Center</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>15345 Bagley Road</AddressLine1Txt>
            <CityNm>Middleburg Hts</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
          <FacilityTxt>Ambulatory Outpatient Surgery</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>LifeWorks of Southwest General</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>7390 Old Oak Blvd</AddressLine1Txt>
            <CityNm>Middleburg Hts</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
          <FacilityTxt>Physical Therapy</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Pain Management</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>18780 Bagley Road</AddressLine1Txt>
            <CityNm>Middleburg Hts</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
          <FacilityTxt>Pain Management</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Behavioral Health OP</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>18780 Bagley Road</AddressLine1Txt>
            <CityNm>Middleburg Hts</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
          <FacilityTxt>OP Behavioral Hlth</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Oakview Behavioral Health</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>7265 Old Oak Blvd</AddressLine1Txt>
            <CityNm>Middleburg Hts</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44136</ZIPCd>
          </USAddress>
          <FacilityTxt>IP Mental Health</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Southwest Home Health Services</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>7575 Old Oak Blvd</AddressLine1Txt>
            <CityNm>Middleburg Hts</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
          <FacilityTxt>Home Health Services</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Strongsville Med Center</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>18181 Pearl Road</AddressLine1Txt>
            <CityNm>Strongsville</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44130</ZIPCd>
          </USAddress>
          <FacilityTxt>Outpatient Svc</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>SW Physical Therapy North Royalton</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>5340 Royalton Road</AddressLine1Txt>
            <CityNm>North Royalton</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44133</ZIPCd>
          </USAddress>
          <FacilityTxt>Physical Therapy</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Olmsted Medical Center</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>27076 Bagley Road</AddressLine1Txt>
            <CityNm>Olmsted Township</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44138</ZIPCd>
          </USAddress>
          <FacilityTxt>Outpatient Svc</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Southwest Hospice Services</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>18659 Drake Road</AddressLine1Txt>
            <CityNm>Strongsville</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44136</ZIPCd>
          </USAddress>
          <FacilityTxt>Hospice</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>SW Physical Therapy Hinckley</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>2546 Center Road</AddressLine1Txt>
            <CityNm>Hinckley</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44233</ZIPCd>
          </USAddress>
          <FacilityTxt>Physical Therapy</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>SW Physical Therapy Broadview Heights</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>7000 Town Center Drive Ste 400</AddressLine1Txt>
            <CityNm>Broadview Heights</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44147</ZIPCd>
          </USAddress>
          <FacilityTxt>Physical Therapy</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>SW Physical Therapy North Olmsted</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>23887 Lorain Road</AddressLine1Txt>
            <CityNm>North Olmsted</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44070</ZIPCd>
          </USAddress>
          <FacilityTxt>Physical Therapy</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 3c</FormAndLineReferenceDesc>
        <ExplanationTxt>When a patient does not provide a Financial Assistance Application or supporting documentation, Southwest may utilize other sources of information to make an individual assessment of financial need. Southwest General Health Center may utilize a third-party to conduct an electronic review of patient information to assess financial need. Relief granted using this method will be identified as presumptive financial assistance. The patient will be notified in writing if the discount is less than 100 and will have an opportunity to submit a financial assistance application if the patient believes that he or she may qualify for more assistance. The review utilizes a healthcare industry- recognized predictive model that is based on public record data basis. The models rule based electronic technology is calibrated to the historical approvals for financial assistance under the general application process and is designed to statistically match the hospitals policy. The model considers multiple decision criteria designed to assess each patient to the same standards as defined in this policy. This ensures that Southwest grants assistance only to patients with characteristics similar to the patients who have qualified based on criteria defined in this policy. This predictive model calculates a socio-economic and financial capacity score that includes estimates for income, assets and liquidity. The data returned from this electronic eligibility review will constitute adequate documentation of financial need under this policy.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 6a</FormAndLineReferenceDesc>
        <ExplanationTxt>Community Benefits are reported in the annual report sent to the Board and members of the community.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>A cost-to-charge ratio was used to complete the charity care Line 7a and means-tested government programs Line 7b. The cost- to- charge ratio was derived from Worksheet 2 that accompanies the instructions to this schedule.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>The hospitals accounting records were used to complete the community health improvement services and community benefit operations Line 7e and health professions education Line 7f.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>g Subsidized health services include costs and direct offsetting revenue for the following services Inpatient Mental Health, Geriatric Mental Health, Hospice, and Residential Hospice. The hospitals cost accounting system was used to determine revenue and costs on all services.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>column f. In calculating the percent of total expense reported in column f, the total expense as reported on Form 990 Pt IX, Line 25, column a was reduced by 18,246,428 - the amount of bad debt reported on line 24 a.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>For receivables associated with self-pay patients which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill, Southwest records significant implicit price concessions in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 8</FormAndLineReferenceDesc>
        <ExplanationTxt>Medicare shortfall is considered a community benefit of the Health Center. Medicare shortfall uses Medicare revenue and allowable costs as reported in the Medicare Cost Report less net subsidized health services reported in Part 1 line 7g and health professions education reported in Part 1 line 7f.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 8</FormAndLineReferenceDesc>
        <ExplanationTxt>In addition to traditional Medicare costs reported in Part III line 7, the Health Center incurred an additional 34,346,255 in Medicare Advantage plans shortfall. This shortfall is calculated using charges and costs from a cost accounting system.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III Line 9b</FormAndLineReferenceDesc>
        <ExplanationTxt>Under all circumstances, and in fairness to those patients who are responsible to pay for their services, Southwest will pursue patient accounts through appropriate financial assistance plans for those who are legitimately unable to pay for the care they received. Southwest collections policy contains provisions to be followed for patients who qualify for financial assistance. Southwest utilizes a predictive model to calculate a socio-economic and financial capacity score that includes estimates for income, assets and liquidity. The data returned from this electronic eligibility review will constitute adequate documentation of financial need under this policy. Collection practices for the remaining balances under all circumstances are performed in a professional and compassionate manner, consistent with our mission and values and the Federal Fair Debt Collection Practices Act.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
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      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>true</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>true</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>true</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>William A Young Jr</PersonNm>
        <TitleTxt>President/CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>717489</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>54720</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>24150</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>32505</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>828864</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Martha Bauschka</PersonNm>
        <TitleTxt>VP/CNO</TitleTxt>
        <BaseCompensationFilingOrgAmt>329094</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>31791</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>25427</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>30296</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>15478</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>432086</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Kelly Linson</PersonNm>
        <TitleTxt>Sr. VP/CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>450928</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>40828</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>25995</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>25344</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>12735</NontaxableBenefitsFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Albert Matyas</PersonNm>
        <TitleTxt>VP/Marketing</TitleTxt>
        <BaseCompensationFilingOrgAmt>283178</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>28276</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>15363</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>21898</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>20855</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>369570</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>John Alton MD</PersonNm>
        <TitleTxt>President Medical Staff</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>632577</CompensationBasedOnRltdOrgsAmt>
        <BonusRelatedOrganizationsAmt>17618</BonusRelatedOrganizationsAmt>
        <OtherCompensationRltdOrgsAmt>5652</OtherCompensationRltdOrgsAmt>
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        <TotalCompensationRltdOrgsAmt>711518</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Gregory Rogers MD</PersonNm>
        <TitleTxt>VP Medical Staff</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>369545</CompensationBasedOnRltdOrgsAmt>
        <BonusRelatedOrganizationsAmt>33980</BonusRelatedOrganizationsAmt>
        <OtherCompensationRltdOrgsAmt>13533</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>24569</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>13069</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>454696</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Ferdinand Plecha</PersonNm>
        <TitleTxt>Chief Medical Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>380326</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>38626</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>41626</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>24569</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>3308</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>488455</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Donna Williams</PersonNm>
        <TitleTxt>Physician Assist</TitleTxt>
        <BaseCompensationFilingOrgAmt>254924</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>2179</BonusFilingOrganizationAmount>
        <DeferredCompensationFlngOrgAmt>36122</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>1847</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>295072</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jill Barber</PersonNm>
        <TitleTxt>Dir Managed Care Rev</TitleTxt>
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        <OtherCompensationFilingOrgAmt>558</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>13738</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>26295</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>239130</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Charleen Scott</PersonNm>
        <TitleTxt>Director of Finance</TitleTxt>
        <BaseCompensationFilingOrgAmt>196437</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>741</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>11333</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2291</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>210802</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Linda Brashear</PersonNm>
        <TitleTxt>Physician Advisor</TitleTxt>
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        <DeferredCompensationFlngOrgAmt>9345</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>13756</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>223648</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Michael Waggoner</PersonNm>
        <TitleTxt>Dir of Behavioral Health</TitleTxt>
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        <OtherCompensationFilingOrgAmt>834</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>14925</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>25657</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>239680</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Cheryl OMalley</PersonNm>
        <TitleTxt>Former Chief Transformation Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>200478</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>3659</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>18300</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>13465</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>235902</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Joni Edwards</PersonNm>
        <TitleTxt>VP HR</TitleTxt>
        <BaseCompensationFilingOrgAmt>329598</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>30965</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>14454</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>14719</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>28731</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>418467</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 4a</FormAndLineReferenceDesc>
        <ExplanationTxt>Cheryl O Malley, Severance 200,478.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>William A. Young, Jr. Supplemental nonqualified retirement plan 46,800</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Kelly Linson Supplemental nonqualified retirement plan 25,353</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Ferdinand Plecha Supplemental nonqualified retirement plan 19,084</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Martha Bauschka Supplemental nonqualified retirement plan 13,497</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Albert Matyas Supplemental nonqualified retirement plan 11,649</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Joni Edwards Supplemental nonqualified retirement plan 13,757</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>Bonus and incentive compensation is calculated annually based on performance metrics and goals, but also includes discretion from Board Management.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="990K:1" softwareId="24019898" softwareVersionNum="24.0.1.0">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>County of Medina Ohio</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>346001851</BondIssuerEIN>
        <BondIssuedDt>2021-12-31</BondIssuedDt>
        <IssuePriceAmt>7605000</IssuePriceAmt>
        <PurposeDesc>Paid off 2012 Bonds used to construct outpatient facilities in Medina County</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>City of Middleburg Heights Ohio</BusinessNameLine1Txt>
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        <BondIssuerEIN>346001879</BondIssuerEIN>
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        <BondIssuedDt>2020-08-03</BondIssuedDt>
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        <PurposeDesc>Improvement endoscopy and maternity and new born units, refund 2012 bonds</PurposeDesc>
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        <BondReferenceCd>C</BondReferenceCd>
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        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
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        <BondReferenceCd>D</BondReferenceCd>
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        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <EngageBondCounselResearchInd>false</EngageBondCounselResearchInd>
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        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
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        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <NoRebateDueInd>true</NoRebateDueInd>
        <VariableRateIssueInd>true</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
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        <BondReferenceCd>B</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <NoRebateDueInd>true</NoRebateDueInd>
        <VariableRateIssueInd>true</VariableRateIssueInd>
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        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
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      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <NoRebateDueInd>true</NoRebateDueInd>
        <VariableRateIssueInd>true</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
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        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
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      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
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        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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    <IRS990ScheduleL documentId="990L" softwareId="24019898" softwareVersionNum="24.0.1.0">
      <BusTrInvolveInterestedPrsnGrp>
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          <PersonNm>Cardiovascular Med Assoc</PersonNm>
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        <TransactionAmt>1093913</TransactionAmt>
        <TransactionDesc>Contractor for Health Services</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <BusinessName>
            <BusinessNameLine1Txt>Former President Medical Staff in 2018 Mark Panigutti MD has an interest in</BusinessNameLine1Txt>
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        </NameOfInterested>
        <RelationshipDescriptionTxt>Former Officer/Director</RelationshipDescriptionTxt>
        <TransactionAmt>604796</TransactionAmt>
        <TransactionDesc>Contractor for Health Services</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV Line 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Former President Medical Staff, Michael Deucher M.D. and former Director Trilok Sharma M.D. are shareholders in Cardiovascular Medicine Associates.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Former President Medical Staff in 2018, Mark Panigutti M.D. has an interest in Orthowest LTD.</ExplanationTxt>
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    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="990O" softwareId="24019898" softwareVersionNum="24.0.1.0">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>Southwest Community Health System non profit tax exempt is a voting member. University Hospitals Health System shares in 50 of the net income or loss excluding tax levy receipts of the Health Center under a Partnering Agreement.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Under the partnering agreement referenced in the narrative for Part VI line 6, University Hospitals non profit tax exempt has a 50 representation on the Health Centers board.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>Budget is subject to approval by Southwest Community Health System.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The 990 is reviewed internally by the CEO and CFO. It is presented and reviewed at the Audit Committee of the Board of Trustees Governing Board at their October meeting. The Audit Committee of the Board of Trustees is a joint committee of the Boards of Southwest Community Health System and Southwest General Health Center. The return is distributed electronically to the entire board before filing. Also prior to filing, the entire Board is presented with a review of the highlights and key points of the 990 at their October meeting.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Southwest Community Health System SCHS has a written conflict of interest policy that requires our officers, directors, and key employees to annually disclose potential conflicts of themselves and their family members on a questionnaire distributed by the Compliance Officer. If a designated person discloses in writing a circumstance that falls within the terms and conditions of the SCHS policy, such disclosure shall be reviewed by the Compliance Officer and, as applicable, SCHSs Legal Counsel, senior leadership, and the Governance and Ethics Committee to determine the appropriate course of action. SCHS requires all new physicians to disclose in writing any potential conflicts as part of the onboarding process. SCHS also requires requests for proposals from vendors, suppliers, or contractors to disclose whether the bidder or any of the bidding companys officers or key personnel or their family members have a conflict with SCHS. The Compliance Officer monitors potential conflicts disclosed from year to year and addresses changes in disclosures appropriately such as evaluating whether a disclosed conflicted interest still exists when a designated persons disclosure is inconsistent from their previous conflicts reported on the annual questionnaire. SCHS enforces the conflict of interest policy in various ways on a case by case basis such as requiring a person to abstain from voting, advocating, or participating in decisions involving the conflicted interest or by requiring severing the relationship. The Compliance Officer is responsible for administering the conflict of interest program and documenting all actions required by the policy.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>Southwest has a CEO Oversight Board Committee that annually reviews the CEOs salary. The committee uses an outside consultant to perform a salary survey using data about similarly situated executives in other organizations. Documentation for these decisions are currently kept by Southwest General Health Centers Human Resources department.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>Executive salary actions are reviewed with the CEO Oversight Board Committee. Documentation for these decisions are currently kept by Southwest General Health Centers Human Resources department.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Board of Trustee lists, Mission and Vision statement, and a consolidated financial summary are available on our website at www.swgeneral.com. The 990 is available upon request. Quarterly and annual financial statement disclosure is available to the public at www.dacbond.com and https//emma.msrb.org/. Conflict of interest policy available upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A, Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>William A Young Jr, President and CEO of Southwest General Health Center is also on the Board of Southwest Community Health System and Southwest Community Health Foundation, both related organizations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A, Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>The compensation information for the following individual will also be found on related tax exempt organizations 990 returns. The compensation amounts on those other 990 returns is not additive to the amounts on this 990 return for tax ID 34-0753531. Ferdinand Plecha 34-1652755.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Kelly Linson SVP/Chief Financial Offer also provides time to Southwest Community Health System and Southwest Community Health Foundation, both related organizations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A, Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>The compensation information for the following individual will also be found on related tax exempt organizations 990 returns. The compensation amounts on those other 990 returns is not additive to the amounts on this 990 return for tax ID 34-0753531. William A. Young Jr 34-1455141 34-1455135 34-1652755.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>The compensation information for the following individual will also be found on related tax exempt organizations 990 returns. The compensation amounts on those other 990 returns is not additive to the amounts on this 990 return for tax ID 34-0753531. Kelly Linson 34-1455141 34-1652755.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Program Services Consulting 3,711,661 General admin purchased services 7,926,218 Healthcare purchased services 46,736,565 Repair Service agreements 7,595,969. Management and General Services Consulting 4,842,135 General admin purchased services 9,259,336 Healthcare purchased services 88,657 Repair Service agreements 62,515</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>Changes in the following fund balance accounts Contribution from Foundation 2,357,501 Southwest General Medical Group Equity Elimination -21,787,967. Drawable credited earning due from UHHS 13,812,042 and 782,126</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2c</FormAndLineReferenceDesc>
        <ExplanationTxt>In the course of preparing their audit report, the independent auditors reviewed the organizations financial statements.There were no changes in the audit procedures from the prior year.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part I, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The decrease between prior year and current year is primarily due to rising inflationary costs of employed and contract labor.</ExplanationTxt>
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