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      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>68762</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>0</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>68762</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>68762</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>68762</RelatedOrExemptFuncIncomeAmt>
      </NetGainOrLossInvestmentsGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>6196966</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>5645505</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>3594234</TotalAmt>
        <ProgramServicesAmt>2970100</ProgramServicesAmt>
        <ManagementAndGeneralAmt>624134</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>403774</TotalAmt>
        <ProgramServicesAmt>396484</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7290</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>286799</TotalAmt>
        <ProgramServicesAmt>286799</ProgramServicesAmt>
      </PayrollTaxesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>60702</TotalAmt>
        <ProgramServicesAmt>12450</ProgramServicesAmt>
        <ManagementAndGeneralAmt>48252</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>40392</TotalAmt>
        <ProgramServicesAmt>17312</ProgramServicesAmt>
        <ManagementAndGeneralAmt>23080</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>39866</TotalAmt>
        <ProgramServicesAmt>24769</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15097</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>116940</TotalAmt>
        <ProgramServicesAmt>110340</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6600</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>2513</TotalAmt>
        <ProgramServicesAmt>2152</ProgramServicesAmt>
        <ManagementAndGeneralAmt>361</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>69403</TotalAmt>
        <ProgramServicesAmt>69403</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>113105</TotalAmt>
        <ProgramServicesAmt>113105</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>CONTRACT LABOR</Desc>
        <TotalAmt>293444</TotalAmt>
        <ProgramServicesAmt>293444</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MEDICATIONS</Desc>
        <TotalAmt>217399</TotalAmt>
        <ProgramServicesAmt>217399</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DURABLE MEDICAL EQUIPME</Desc>
        <TotalAmt>150844</TotalAmt>
        <ProgramServicesAmt>150844</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MILEAGE</Desc>
        <TotalAmt>133952</TotalAmt>
        <ProgramServicesAmt>116562</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17390</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>653114</TotalAmt>
        <ProgramServicesAmt>520377</ProgramServicesAmt>
        <ManagementAndGeneralAmt>130769</ManagementAndGeneralAmt>
        <FundraisingAmt>1968</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>6176481</TotalAmt>
        <ProgramServicesAmt>5301540</ProgramServicesAmt>
        <ManagementAndGeneralAmt>872973</ManagementAndGeneralAmt>
        <FundraisingAmt>1968</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>964315</BOYAmt>
        <EOYAmt>1102644</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <EOYAmt>39799</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>755659</BOYAmt>
        <EOYAmt>644354</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>43802</BOYAmt>
        <EOYAmt>81162</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <LandBldgEquipCostOrOtherBssAmt>2386355</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>1518562</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>1088586</BOYAmt>
        <EOYAmt>867793</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>4942103</BOYAmt>
        <EOYAmt>5505987</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>41455</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>7794465</BOYAmt>
        <EOYAmt>8283194</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>721140</BOYAmt>
        <EOYAmt>828233</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>721140</BOYAmt>
        <EOYAmt>828233</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>7073325</BOYAmt>
        <EOYAmt>7373707</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <EOYAmt>81254</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>7073325</BOYAmt>
        <EOYAmt>7454961</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>7794465</BOYAmt>
        <EOYAmt>8283194</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>20485</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>361148</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>0</FSAuditedInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>195251</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>223547</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>297829</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>197715</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>551461</CurrentTaxYearAmt>
        <TotalAmt>1465803</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>195251</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>223547</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>297829</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>197715</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>551461</CurrentTaxYearAmt>
        <TotalAmt>1465803</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>1465803</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>100362</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>150230</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>142051</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>100259</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>190992</CurrentTaxYearAmt>
        <TotalAmt>683894</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <TotalSupportAmt>2149697</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>16353433</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.68190</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.65400</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>151581</OtherCostOrOtherBasisAmt>
        <BookValueAmt>151581</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>644376</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>412760</DepreciationAmt>
        <BookValueAmt>231616</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>673261</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>330418</DepreciationAmt>
        <BookValueAmt>342843</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>917137</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>775384</DepreciationAmt>
        <BookValueAmt>141753</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>867793</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>Mutual funds</Desc>
        <BookValueAmt>5312400</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <OtherSecuritiesGrp>
        <Desc>ST US Government</Desc>
        <BookValueAmt>193587</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>5505987</TotalBookValueSecuritiesAmt>
      <TotalRevEtcAuditedFinclStmtAmt>6196966</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>361148</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>361148</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>5835818</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>5835818</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>6176478</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>6176478</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>6176478</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The board of directors shall select a qualified individual to review the form 990 prior to filing the individual will report any comment and/or concerns to the board of directors. A copy of the organization's final form 990 (including required schedules), as ultimately filed with the IRS, was provided to each voting member of the organization's governing body and officers in attendance at the meeting prior to its filing for board approval.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Upon employment and at the beginning of board service, and annuallythereafter, all officers, directors, trustees, and key employees must readthe conflict of interest policy and sign a conflict of interest form.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>The executive committee of the board of directors has a process by whichthey annually review the CEO's compensation and benefit package. The CEOuses a compensation philosophy based on salary ranges derived from marketcomparable studies to set the other key employees' salaries.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Governing documents, financial statements, conflict of interest policy are available upon request. Requests should be made to the executive director.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPUTER EXPENSE: Program service expenses 80,980. Management and general expenses 29,593. Fundraising expenses 0. Total expenses 110,573. CLINICAL SUPPLIES: Program service expenses 105,690. Management and general expenses 0. Fundraising expenses 0. Total expenses 105,690. AMBULANCE: Program service expenses 89,510. Management and general expenses 0. Fundraising expenses 0. Total expenses 89,510. TELEPHONE &amp; UTILITIES: Program service expenses 49,595. Management and general expenses 26,348. Fundraising expenses 0. Total expenses 75,943. MISCELLANEOUS: Program service expenses 35,722. Management and general expenses 18,608. Fundraising expenses 0. Total expenses 54,330. LINEN: Program service expenses 40,179. Management and general expenses 0. Fundraising expenses 0. Total expenses 40,179. INVESTMENT EXENSE: Program service expenses 0. Management and general expenses 39,052. Fundraising expenses 0. Total expenses 39,052. REPAIRS &amp; MAINTENANCE: Program service expenses 29,016. Management and general expenses 3,228. Fundraising expenses 0. Total expenses 32,244. DUES &amp; SUBSCRIPTIONS: Program service expenses 21,395. Management and general expenses 8,175. Fundraising expenses 0. Total expenses 29,570. IMAGING &amp; LABORATORY: Program service expenses 18,904. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,904. COPIER EXPENSE: Program service expenses 16,346. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,346. DIET &amp; NUTRITION: Program service expenses 14,063. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,063. CONTINUING EDUCATION: Program service expenses 10,062. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,062. POSTAGE: Program service expenses 8,652. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,652. PRINTING: Program service expenses 0. Management and general expenses 5,218. Fundraising expenses 0. Total expenses 5,218. FUNDRAISING: Program service expenses 0. Management and general expenses 0. Fundraising expenses 1,968. Total expenses 1,968. BANK SERVICE CHARGES: Program service expenses 0. Management and general expenses 547. Fundraising expenses 0. Total expenses 547. BIO HAZARDOUS WASTE: Program service expenses 263. Management and general expenses 0. Fundraising expenses 0. Total expenses 263.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>