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        <ProgramServicesAmt>1162731</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12137</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>666905</TotalAmt>
        <ManagementAndGeneralAmt>666905</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT</Desc>
        <TotalAmt>1281142</TotalAmt>
        <ProgramServicesAmt>1281142</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>70765</TotalAmt>
        <ProgramServicesAmt>70765</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES AND SUBSCRIPTIONS</Desc>
        <TotalAmt>58813</TotalAmt>
        <ProgramServicesAmt>58813</ProgramServicesAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>11585847</TotalAmt>
        <ProgramServicesAmt>10209377</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1376470</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2203895</BOYAmt>
        <EOYAmt>3213651</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1551569</BOYAmt>
        <EOYAmt>1747771</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>249999</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>536916</BOYAmt>
        <EOYAmt>626682</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>17140140</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>4010250</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>14119597</BOYAmt>
        <EOYAmt>13129890</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>81144</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>18803485</BOYAmt>
        <EOYAmt>18967993</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>129681</BOYAmt>
        <EOYAmt>258386</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <EOYAmt>3470657</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>3914261</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>838626</BOYAmt>
        <EOYAmt>770580</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>4882568</BOYAmt>
        <EOYAmt>4499623</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>13920917</BOYAmt>
        <EOYAmt>14468370</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>13920917</BOYAmt>
        <EOYAmt>14468370</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>18803485</BOYAmt>
        <EOYAmt>18967993</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>547453</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>0</FSAuditedInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus3YearsAmt>204635</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>24863</CurrentTaxYearMinus2YearsAmt>
        <TotalAmt>229498</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>9689496</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9382505</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8771914</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8535771</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12101362</CurrentTaxYearAmt>
        <TotalAmt>48481048</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>9689496</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9587140</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8796777</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8535771</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12101362</CurrentTaxYearAmt>
        <TotalAmt>48710546</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>48710546</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>7025</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>403</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>12490</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>30695</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>25293</CurrentTaxYearAmt>
        <TotalAmt>75906</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>7025</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>403</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>12490</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>30695</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>25293</CurrentTaxYearAmt>
        <TotalAmt>75906</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus1YearAmt>1326</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>6645</CurrentTaxYearAmt>
        <TotalAmt>7971</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>9696521</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9587543</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8809267</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8567792</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12133300</CurrentTaxYearAmt>
        <TotalAmt>48794423</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.99840</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.99850</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00160</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00150</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III, Line 12, Explanation of Other Income:</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER OPERATING INCOME - 2023 Amount: $ 1,326. 2024 Amount: $ 6,645.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>250000</OtherCostOrOtherBasisAmt>
        <BookValueAmt>250000</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>2576798</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1050874</DepreciationAmt>
        <BookValueAmt>1525924</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>14242811</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2943986</DepreciationAmt>
        <BookValueAmt>11298825</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>70531</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>15390</DepreciationAmt>
        <BookValueAmt>55141</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>13129890</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO COREWELL HEALTH</Desc>
        <Amt>632954</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>LONG TERM LEASE LIABILITIES</Desc>
        <Amt>137626</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>770580</TotalLiabilityAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION HAS A MANAGEMENT SERVICES AGREEMENT WITH SPECTRUM HEALTH HOSPITALS DBA COREWELL HEALTH GRAND RAPIDS HOSPITALS, A MEMBER ORGANIZATION. SHARED SERVICES ARE ALSO PROVIDED BY COREWELL HEALTH; THE PARENT ORGANIZATION OF SPECTRUM HEALTH HOSPITALS DBA COREWELL HEALTH GRAND RAPIDS HOSPITALS. COREWELL HEALTH PROVIDES PERSONNEL AND SERVICES TO LEAD, MANAGE, AND OPERATE NFAM'S AIR AMBULANCE PROGRAM AND RELATED OPERATIONS AS DIRECTED BY NFAM'S BOARD OF DIRECTORS. SERVICES PROVIDED INCLUDE DIRECT MANAGEMENT OF NFAM'S BUSINESS, FINANCIAL MATTERS, PERSONNEL, AND THE PROVISION OF CLINICAL SERVICES AND COMMUNICATION CENTER SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>MUNSON HEALTHCARE (50%), A MICHIGAN NONPROFIT CORPORATION; SPECTRUM HEALTH HOSPITALS DBA COREWELL HEALTH GRAND RAPIDS HOSPITALS (50%), A MICHIGAN NONPROFIT CORPORATION. BOTH MEMBERS ARE TAX-EXEMPT UNDER INTERNAL REVENUE CODE 501(C)(3).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>THE MEMBERS OF THE ORGANIZATION APPOINT ALL MEMBERS OF THE BOARD OF DIRECTORS, WITH EACH MEMBER ENTITLED TO APPOINT THREE DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>UNLESS OTHERWISE NOTED BELOW, THE MEMBERS OF THE ORGANIZATION HAVE THE RESERVED POWERS SET FORTH BELOW, AND SHALL NOT BE DEEMED AUTHORIZED UNLESS AND UNTIL APPROVED BY THE MEMBERS: - THE DISSOLUTION OF THE CORPORATION; - MERGER OR CONSOLIDATION OF THE CORPORATION; - AN AMENDMENT TO THE ARTICLES OR THESE BYLAWS; - CONVERSION OF THE CORPORATION; - THE SALE, EXCHANGE, LEASE, OR OTHER TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; - APPOINTMENT AND ELECTION OF DIRECTORS; - CHANGE IN NUMBER OF DIRECTORS; - REMOVAL OF ANY DIRECTOR; - ESTABLISHING FROM TIME TO TIME LEVELS OF APPROVAL AUTHORITY FOR THE DIRECTORS OF THE CORPORATION AND APPROVE ANY TRANSACTIONS AND EXPENDITURES EXCEEDING THE ESTABLISHED AUTHORITY FOR THE DIRECTORS; - APPROVAL OF THE MISSION AND VISION STATEMENTS FOR THE CORPORATION AND ENSURING COMPLIANCE WITH THE CORPORATION'S PHILOSOPHY, MISSION, AND VISION; - APPROVAL OF THE STRATEGIC PLAN AND CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; - APPROVAL OF ANNUAL OPERATING AND CAPITAL BUDGETS RECOMMENDED BY THE DIRECTORS; AND - APPROVAL OF ANY MANDATORY CONTRIBUTION OF CAPITAL RECOMMENDED BY THE DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS PREPARED BY COREWELL HEALTH CORPORATE TAX. THE TAX RETURN IS REVIEWED BY THE CORPORATE TAX MANAGER AND THE DIRECTOR OF TAX. IT IS THEN REVIEWED BY THE ORGANIZATION'S TREASURER AND SHARED WITH THE MEMBERS OF THE BOARD OF DIRECTORS. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>1. CONFLICTS OF INTEREST MUST BE DISCLOSED, VIA AN ANNUAL ELECTRONIC DISCLOSURE PROCESS AND VERBALLY AT EACH BOARD AND BOARD COMMITTEE MEETING AS PART OF THE DECLARATION OF CONFLICT OF INTEREST PRIOR TO DISCUSSION OF ANY AGENDA ITEMS. 2. A PERSON HAVING A FINANCIAL INTEREST IN A PROPOSED TRANSACTION OR ARRANGEMENT MAY MAKE A PRESENTATION AT A MEETING OF THE BOARD OR COMMITTEE WHICH IS CONSIDERING THAT TRANSACTION OR ARRANGEMENT, BUT AFTER THAT PRESENTATION HE/SHE SHALL LEAVE THE MEETING BEFORE DISCUSSION AND VOTING ON THAT PROPOSED TRANSACTION OR ARRANGEMENT. THE PERSON HAVING THE FINANCIAL INTEREST SHALL NOT BE COUNTED IN DETERMINING WHETHER A QUORUM IS PRESENT. 3. THE CHAIRPERSON OF THE BOARD OR THE COMMITTEE CHAIR SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE (INCLUDING OUTSIDE ADVISORS) TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND TO ADVISE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST. 4. THE BOARD OR COMMITTEE SHALL EXERCISE DUE DILIGENCE TO DETERMINE WHETHER THE ORGANIZATION CAN, WITH REASONABLE EFFORTS, OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 5. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS AND MEMBERS WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. 6. THE MINUTES OF THE MEETINGS OF THE BOARD AND ALL OF THE ORGANIZATION'S COMMITTEES SHALL SET FORTH: A) THE NAMES OF THE PERSONS WHO DISCLOSED A FINANCIAL INTEREST IN A PROPOSED TRANSACTION OR ARRANGEMENT INVOLVING THE ORGANIZATION OR ANY OF ITS SUBSIDIARIES AND THE NATURE OF THE FINANCIAL INTEREST; AND B) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO SUCH TRANSACTION OR ARRANGEMENT, INCLUDING ANY DISCUSSION OF ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THAT MATTER. THE VOTES OF INDIVIDUAL MEMBERS NEED NOT BE RECORDED UNLESS OTHERWISE DIRECTED BY THE BOARD OF DIRECTORS OR COMMITTEE. 7. THERE IS AN ONGOING REQUIREMENT THAT MEMBERS OF THE BOARD AND BOARD COMMITTEES UPDATE THEIR ANNUAL DISCLOSURE QUESTIONNAIRE AT ANY POINT DURING HIS/HER TENURE ON THE BOARD OF DIRECTORS WHEN A NEW POTENTIAL CONFLICT OF INTEREST ARISES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S ARTICLES OF INCORPORATION HAVE BEEN PROVIDED TO THE STATE OF MICHIGAN AND ARE AVAILABLE TO THE PUBLIC ON THE STATE'S WEBSITE. THE ORGANIZATION'S BYLAWS AND INTERNAL POLICIES ARE GENERALLY NOT MADE AVAILABLE TO THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER PURCHASED SERVICES: Program service expenses 4,759,731. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,759,731. NONCLINICAL PURCHASED SERVICES: Program service expenses 3,221. Management and general expenses 646,850. Fundraising expenses 0. Total expenses 650,071. CLINICAL PURCHASED SERVICES: Program service expenses 129,293. Management and general expenses 0. Fundraising expenses 0. Total expenses 129,293. COLLECTION AGENCY FEES: Program service expenses 10,022. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,022.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>