﻿<?xml version="1.0" encoding="utf-8"?>
<Return returnVersion="2024v5.0" xmlns="http://www.irs.gov/efile">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2025-10-20T03:10:22Z</ReturnTs>
    <TaxPeriodEndDt>2024-12-31</TaxPeriodEndDt>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2024-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>382168007</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>MIDMICHIGAN HEALTH SERVICES</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>MIDM</BusinessNameControlTxt>
      <PhoneNum>9894225122</PhoneNum>
      <USAddress>
        <AddressLine1Txt>9249 W LAKE CITY RD</AddressLine1Txt>
        <CityNm>HOUGHTON LAKE</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>486299602</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>William Collin</PersonNm>
      <PersonTitleTxt>CFO</PersonTitleTxt>
      <PhoneNum>9894225122</PhoneNum>
      <SignatureDt>2025-10-20</SignatureDt>
    </BusinessOfficerGrp>
    <TaxYr>2024</TaxYr>
    <BuildTS>2025-03-06 01:10:19Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="5">
    <IRS990 documentId="SIMPLE990" documentName="IRS990" referenceDocumentName="IRS990ScheduleO ReasonableCauseExplanation BinaryAttachment">
      <PrincipalOfficerNm>Melissa Dunkle</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>9249 W Lake City Road</AddressLine1Txt>
        <CityNm>Houghton Lake</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>48629</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>23840235</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>www.midmichigan.org/microsites/chs</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1975</FormationYr>
      <LegalDomicileStateCd>MI</LegalDomicileStateCd>
      <ActivityOrMissionDesc>Community Health Center providing health care services to Roscommon, Gladwin and surrounding areas of Michigan, through four clinics and five school-based health centers. MidMichigan Health Services provided services to 17,614 patients through 60,719 medical encounters.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>11</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>11</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>172</TotalEmployeeCnt>
      <TotalVolunteersCnt>0</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>5462391</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>4599722</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>16116165</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>18889391</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>572088</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>135473</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>211398</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>215649</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>22362042</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>23840235</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>13454524</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>13806860</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>8656060</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>10578700</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>22110584</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>24385560</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>251458</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-545325</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>14832612</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>14455313</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>5106561</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>5274587</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>9726051</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>9180726</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>To provide high quality community-oriented, patient-centered health services for all.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>24385560</ExpenseAmt>
      <RevenueAmt>23840235</RevenueAmt>
      <Desc>Community Health Center provides health care services to Roscommon, Gladwin and surrounding counties of Michigan. Located at four clinic sites and five school-based health centers. MidMichigan Health Services provided services to 17,614 patients through 60,719 encounters. MidMichigan Health Services offers imaging services in Houghton Lake. In addition, through an affiliation with My Michigan, on-site laboratory services are offered at the Houghton Lake site. Physical Therapy and Specialty Services are also provided in Houghton Lake by our affiliation agreement. The five school-based health centers offer health care services to students on school campuses, allowing the students to receive services while minimizing the time spent out of the classroom. In keeping with its' mission, the clinic provides high quality healthcare to all patients, regardless of the individual's inability to pay. Through its' 340b drug program, the clinic was able to provide significant discounts on prescriptions filled with our contracted pharmacies.</Desc>
      <ProgSrvcAccomActy2Grp />
      <ProgSrvcAccomActy3Grp />
      <TotalOtherProgSrvcExpenseAmt>24385560</TotalOtherProgSrvcExpenseAmt>
      <TotalProgramServiceExpensesAmt>48771120</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="ScheduleA" referenceDocumentName="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentName="IRS990ScheduleB">false</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd referenceDocumentName="IRS990ScheduleC">false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd referenceDocumentName="IRS990ScheduleC">false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd referenceDocumentName="IRS990ScheduleC">false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd referenceDocumentName="IRS990ScheduleE">false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd referenceDocumentName="IRS990ScheduleF">false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd referenceDocumentName="IRS990ScheduleF">false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd referenceDocumentName="IRS990ScheduleF">false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd referenceDocumentName="IRS990ScheduleG">false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd referenceDocumentName="IRS990ScheduleG">false</FundraisingActivitiesInd>
      <GamingActivitiesInd referenceDocumentName="IRS990ScheduleG">false</GamingActivitiesInd>
      <OperateHospitalInd referenceDocumentName="IRS990ScheduleH">false</OperateHospitalInd>
      <GrantsToOrganizationsInd referenceDocumentName="IRS990ScheduleI">false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd referenceDocumentName="IRS990ScheduleI">false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="ScheduleJ" referenceDocumentName="IRS990ScheduleJ">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd referenceDocumentName="IRS990ScheduleK">false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd referenceDocumentName="IRS990ScheduleL">false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd referenceDocumentName="IRS990ScheduleL">false</PYExcessBenefitTransInd>
      <LoanOutstandingInd referenceDocumentName="IRS990ScheduleL">false</LoanOutstandingInd>
      <GrantToRelatedPersonInd referenceDocumentName="IRS990ScheduleL">false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd referenceDocumentName="IRS990ScheduleL">false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd referenceDocumentName="IRS990ScheduleL">false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd referenceDocumentName="IRS990ScheduleL">false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd referenceDocumentName="IRS990ScheduleM">false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd referenceDocumentName="IRS990ScheduleM">false</DeductibleArtContributionInd>
      <TerminateOperationsInd referenceDocumentName="IRS990ScheduleN">false</TerminateOperationsInd>
      <PartialLiquidationInd referenceDocumentName="IRS990ScheduleN">false</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentName="IRS990ScheduleR">false</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentName="IRS990ScheduleR">false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentName="IRS990ScheduleR">false</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentName="IRS990ScheduleR">false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentName="IRS990ScheduleR">false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>8</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>true</BackupWthldComplianceInd>
      <EmployeeCnt>172</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <Form990TFiledInd>false</Form990TFiledInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>true</PayPremiumsPrsnlBnftCntrctInd>
      <DAFExcessBusinessHoldingsInd>false</DAFExcessBusinessHoldingsInd>
      <TaxableDistributionsInd>false</TaxableDistributionsInd>
      <DistributionToDonorInd>false</DistributionToDonorInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <ExcsTaxSect4951Or4952Or4953Ind>false</ExcsTaxSect4951Or4952Or4953Ind>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>11</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>11</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>true</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>true</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>true</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>MI</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>William Collin</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>9894222138</PhoneNum>
        <USAddress>
          <AddressLine1Txt>9249 W Lake City Road</AddressLine1Txt>
          <CityNm>Houghton Lake</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>48629</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>Edward Stern</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Deborah VanWert</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Dawn LaCasse</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Frederick Roemer</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Gregory Rogers</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jeffrey Fossitt</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Ray Stover</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Shannon Phelps</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Thomas Moreau</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>James Bischoff</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Bryann Cross</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Melissa Dunkle</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>185537</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>17157</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>William Collin</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>200575</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>33361</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Candice Barnum</PersonNm>
        <TitleTxt>Clinical Operations Director</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>113407</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>35954</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jennifer Shamel</PersonNm>
        <TitleTxt>COO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>137519</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>37655</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Allison Hubbard</PersonNm>
        <TitleTxt>Human Resources Director</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>119797</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>4929</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lisa Harrington</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>220374</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>42949</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Robert McMorrow II</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>326891</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>17588</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Kevin Denlinger</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>260563</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>43664</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Roberto Viguilla</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>186846</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>40164</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lyndsy McMorrow</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>267635</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>43271</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Robert McMorrow</PersonNm>
        <TitleTxt>Chief Medical Assistant</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>40000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lyndsy McMorrow</PersonNm>
        <TitleTxt>Chief Medical Assistant</TitleTxt>
        <AverageHoursPerWeekRt>15.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>15000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2074144</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>316692</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>22</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>4m Building Solutions</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 870784</AddressLine1Txt>
            <CityNm>Kansas City</CityNm>
            <StateAbbreviationCd>KS</StateAbbreviationCd>
            <ZIPCd>64187</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Cleaning Service</ServicesDesc>
        <CompensationAmt>248132</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Midland Radiogy</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4005 Orchard Drive</AddressLine1Txt>
            <CityNm>Midland</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>48670</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Imaging</ServicesDesc>
        <CompensationAmt>150742</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>My Michigan-Clare</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4000 Wellness Drive</AddressLine1Txt>
            <CityNm>Midland</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48640</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>EPIC/Pharmacy Staff</ServicesDesc>
        <CompensationAmt>1023780</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>NetExpress</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 391</AddressLine1Txt>
            <CityNm>Coldwater</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49036</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Communication</ServicesDesc>
        <CompensationAmt>107834</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Scribe X Northwest</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 391</AddressLine1Txt>
            <CityNm>Portland</CityNm>
            <StateAbbreviationCd>OR</StateAbbreviationCd>
            <ZIPCd>97205</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Physician Scribe</ServicesDesc>
        <CompensationAmt>131612</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>2</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>4599722</GovernmentGrantsAmt>
      <TotalContributionsAmt>4599722</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Physician Offices`</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>18889391</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>18889391</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp />
      <TotalProgramServiceRevenueAmt>18889391</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>56161</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>56161</RelatedOrExemptFuncIncomeAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp />
      <RoyaltiesRevenueGrp />
      <GrossRentsGrp>
        <RealAmt>213862</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp />
      <RentalIncomeOrLossGrp>
        <RealAmt>213862</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>213862</TotalRevenueColumnAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>79312</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp />
      <GainOrLossGrp>
        <SecuritiesAmt>79312</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>79312</TotalRevenueColumnAmt>
      </NetGainOrLossInvestmentsGrp>
      <OtherRevenueMiscGrp>
        <Desc>Other Revenue (Edward Jones)</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1787</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1787</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>1787</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>23840235</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>18947339</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2390836</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2390836</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>7824514</TotalAmt>
        <ProgramServicesAmt>6636901</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1187613</ManagementAndGeneralAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>354661</TotalAmt>
        <ProgramServicesAmt>230423</ProgramServicesAmt>
        <ManagementAndGeneralAmt>124238</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>2477402</TotalAmt>
        <ProgramServicesAmt>1521813</ProgramServicesAmt>
        <ManagementAndGeneralAmt>955589</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>759447</TotalAmt>
        <ProgramServicesAmt>481926</ProgramServicesAmt>
        <ManagementAndGeneralAmt>277521</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>7585</TotalAmt>
        <ManagementAndGeneralAmt>7585</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>84602</TotalAmt>
        <ProgramServicesAmt>4972</ProgramServicesAmt>
        <ManagementAndGeneralAmt>79630</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <AdvertisingGrp>
        <TotalAmt>68755</TotalAmt>
        <ProgramServicesAmt>6327</ProgramServicesAmt>
        <ManagementAndGeneralAmt>62428</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>5706780</TotalAmt>
        <ProgramServicesAmt>5420298</ProgramServicesAmt>
        <ManagementAndGeneralAmt>286482</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>411944</TotalAmt>
        <ProgramServicesAmt>398008</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13936</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>418258</TotalAmt>
        <ProgramServicesAmt>286945</ProgramServicesAmt>
        <ManagementAndGeneralAmt>131313</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>54210</TotalAmt>
        <ProgramServicesAmt>20220</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33990</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>110825</TotalAmt>
        <ProgramServicesAmt>65394</ProgramServicesAmt>
        <ManagementAndGeneralAmt>45431</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>695752</TotalAmt>
        <ProgramServicesAmt>453917</ProgramServicesAmt>
        <ManagementAndGeneralAmt>241835</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>54778</TotalAmt>
        <ProgramServicesAmt>54060</ProgramServicesAmt>
        <ManagementAndGeneralAmt>718</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Purchased &amp; Contract Services</Desc>
        <TotalAmt>1785750</TotalAmt>
        <ProgramServicesAmt>1705273</ProgramServicesAmt>
        <ManagementAndGeneralAmt>80477</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Equipment &amp; Repair Expense</Desc>
        <TotalAmt>574990</TotalAmt>
        <ProgramServicesAmt>546038</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28952</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>604471</TotalAmt>
        <ProgramServicesAmt>407992</ProgramServicesAmt>
        <ManagementAndGeneralAmt>196479</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>24385560</TotalAmt>
        <ProgramServicesAmt>18240507</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6145053</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>938392</BOYAmt>
        <EOYAmt>747697</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2045222</BOYAmt>
        <EOYAmt>1953799</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>581603</BOYAmt>
        <EOYAmt>1234642</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>2926612</BOYAmt>
        <EOYAmt>2287827</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>791882</BOYAmt>
        <EOYAmt>798822</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>100972</BOYAmt>
        <EOYAmt>379137</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>16146503</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>9110549</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>7432589</BOYAmt>
        <EOYAmt>7035954</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>15340</BOYAmt>
        <EOYAmt>17435</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>0</BOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>0</BOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>14832612</BOYAmt>
        <EOYAmt>14455313</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>2442693</BOYAmt>
        <EOYAmt>2645174</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <GrantsPayableGrp>
        <BOYAmt>0</BOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>773575</BOYAmt>
        <EOYAmt>931777</EOYAmt>
      </DeferredRevenueGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>0</BOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1890293</BOYAmt>
        <EOYAmt>1697636</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>5106561</BOYAmt>
        <EOYAmt>5274587</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>9726051</BOYAmt>
        <EOYAmt>9180726</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <CapStkTrPrinCurrentFundsGrp>
        <BOYAmt>0</BOYAmt>
      </CapStkTrPrinCurrentFundsGrp>
      <PdInCapSrplsLandBldgEqpFundGrp>
        <BOYAmt>0</BOYAmt>
      </PdInCapSrplsLandBldgEqpFundGrp>
      <RtnEarnEndowmentIncmOthFndsGrp>
        <BOYAmt>0</BOYAmt>
      </RtnEarnEndowmentIncmOthFndsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>9726051</BOYAmt>
        <EOYAmt>9180726</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>14832612</BOYAmt>
        <EOYAmt>14455313</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-545325</ReconcilationRevenueExpnssAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>true</AccountantCompileOrReviewInd>
      <AcctCompileOrReviewBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </AcctCompileOrReviewBasisGrp>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="ScheduleA" documentName="IRS990ScheduleA">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <SupportedOrganizationsCnt>0</SupportedOrganizationsCnt>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>7386037</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5805126</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5825024</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5462391</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4599722</CurrentTaxYearAmt>
        <TotalAmt>29078300</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>7386037</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5805126</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5825024</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5462391</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4599722</CurrentTaxYearAmt>
        <TotalAmt>29078300</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>29078300</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>679352</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>523444</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>-807731</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>572088</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>135473</CurrentTaxYearAmt>
        <TotalAmt>1102626</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <TotalSupportAmt>30180926</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>30180926</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.96350</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.94940</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="ScheduleD" documentName="IRS990ScheduleD">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>228191</OtherCostOrOtherBasisAmt>
        <BookValueAmt>228191</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>13451583</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>7134019</DepreciationAmt>
        <BookValueAmt>6317564</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp />
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>2285511</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1821856</DepreciationAmt>
        <BookValueAmt>463655</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>181217</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>154673</DepreciationAmt>
        <BookValueAmt>26544</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>7035954</TotalBookValueLandBuildingsAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="ScheduleJ" documentName="IRS990ScheduleJ">
      <FirstClassOrCharterTravelInd>X</FirstClassOrCharterTravelInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <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>Melissa Dunkle</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>185537</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>17157</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>202694</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Candie Barnum</PersonNm>
        <TitleTxt>Clinical Operations Director</TitleTxt>
        <BaseCompensationFilingOrgAmt>113407</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>35954</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>149361</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>William Collin</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>200575</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>33361</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>233936</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jennifer Shamel</PersonNm>
        <TitleTxt>COO</TitleTxt>
        <BaseCompensationFilingOrgAmt>137519</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>37655</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>175174</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Allison Hubbard</PersonNm>
        <TitleTxt>Human Resources Director</TitleTxt>
        <BaseCompensationFilingOrgAmt>119797</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>4929</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>124726</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lisa Harrington</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <BaseCompensationFilingOrgAmt>220374</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>42949</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>263323</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Robert McMorrow</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <BaseCompensationFilingOrgAmt>326891</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>17588</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>344479</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lyndsy McMorrow</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <BaseCompensationFilingOrgAmt>267635</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>43271</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>310906</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Kevin Denlinger</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <BaseCompensationFilingOrgAmt>260563</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>43664</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>304227</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Robert McMorrow</PersonNm>
        <TitleTxt>Medical Director</TitleTxt>
        <BaseCompensationFilingOrgAmt>40000</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>40000</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lyndsy McMorow</PersonNm>
        <TitleTxt>Medical Director</TitleTxt>
        <BaseCompensationFilingOrgAmt>15000</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>15000</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Roberto Viguilla</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <BaseCompensationFilingOrgAmt>186846</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>40164</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>227010</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="ScheduleO" documentName="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents, conflict of interest policy, and financial statements are made available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Section B, Line 11b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Subsequent to completion, a copy of the 990 is reviewed by the Executive Director and the Executive Committee of the Board of Directors prior to submission to the IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Section B, Line 12c:</FormAndLineReferenceDesc>
        <ExplanationTxt>At the time of initial election, and annually thereafter, each board member shall be asked to complete and file a Disclosure of Certain Interests form. Before discussion of each issue at a Committee or Board Meeting, board members should voluntarily state any conflict of interest they may have. When a conflict of interest is established, members with a conflict may not participate in the discussion or vote on the matter before a body.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Section B, Line 15b:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Directors provide regular annual performance evaluations of the Executive Director in which compensation is determined and approved for the following year. The Executive Director provides annual performance evaluations for other officers and top management officials, while reporting and justifying compensation changes to the Board Executive Committee.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>