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      <Form990PartVIISectionAGrp>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JOSHUA JONES MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>THOMAS DUQUIN MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <KeyEmployeeInd>X</KeyEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT ABLOVE MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JOSEPH KUECHLE MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <KeyEmployeeInd>X</KeyEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>3626</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>SCOTT NODZO MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>K KEELY BOYLE MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MATTHEW DIPAOLA MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ANDREW STEGEMANN MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <KeyEmployeeInd>X</KeyEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>16619</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JAMES FARRELL MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <KeyEmployeeInd>X</KeyEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20122</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROSS COLE MD</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20203</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ERIK FREELAND DO</PersonNm>
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        <OtherCompensationAmt>19793</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>SUSAN DAOUST MD</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>GEOFFREY BERNAS MD</PersonNm>
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        <OtherCompensationAmt>72646</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>GEORGE BOUCHER MD</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MEGAN ZISKE MD</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>CLAY DELPRINCE MD</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20203</OtherCompensationAmt>
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      <TotalReportableCompFromOrgAmt>21247743</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
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      <IndivRcvdGreaterThan100KCnt>52</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
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      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
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      <TotalContributionsAmt>56007</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>FEE FOR SERVICE</Desc>
        <BusinessCd>621110</BusinessCd>
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      <ProgramServiceRevenueGrp>
        <Desc>OTHER CONTRACTUAL REVENUE</Desc>
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        <RelatedOrExemptFuncIncomeAmt>6595425</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>GRADUATE MEDICAL EDUCATION REVENU</Desc>
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        <RelatedOrExemptFuncIncomeAmt>2458578</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>SALARY SUPPORT</Desc>
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        <RelatedOrExemptFuncIncomeAmt>605213</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
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      <OtherRevenueMiscGrp>
        <Desc>LOSS ON INVESTMENT IN LLC</Desc>
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        <RelatedOrExemptFuncIncomeAmt>-23532</RelatedOrExemptFuncIncomeAmt>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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      <FeesForServicesAccountingGrp>
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        <ProgramServicesAmt>3862</ProgramServicesAmt>
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      <AdvertisingGrp>
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        <ProgramServicesAmt>699858</ProgramServicesAmt>
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        <ProgramServicesAmt>925798</ProgramServicesAmt>
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        <ProgramServicesAmt>167075</ProgramServicesAmt>
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        <ProgramServicesAmt>320190</ProgramServicesAmt>
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        <ProgramServicesAmt>1378376</ProgramServicesAmt>
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        <ProgramServicesAmt>3421186</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>CHIEF ADMINISTRATIVE OF</Desc>
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        <ProgramServicesAmt>2408116</ProgramServicesAmt>
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      <OtherExpensesGrp>
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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>1607277</ProgramServicesAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>69044617</ProgramServicesAmt>
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        <EOYAmt>145369</EOYAmt>
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        <EOYAmt>3677990</EOYAmt>
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        <EOYAmt>9583257</EOYAmt>
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        <EOYAmt>403475</EOYAmt>
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        <EOYAmt>57972405</EOYAmt>
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        <EOYAmt>219165</EOYAmt>
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        <EOYAmt>4686822</EOYAmt>
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        <EOYAmt>48301723</EOYAmt>
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        <EOYAmt>9670682</EOYAmt>
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        <EOYAmt>57972405</EOYAmt>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
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      <FSAuditedBasisGrp>
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    <IRS990ScheduleA documentId="RetDoc1039100001">
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        <CurrentTaxYearMinus3YearsAmt>2128278</CurrentTaxYearMinus3YearsAmt>
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        <CurrentTaxYearMinus1YearAmt>56214</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>56007</CurrentTaxYearAmt>
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        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>69000</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>3626</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>304626</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CLAY DELPRINCE MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>273950</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>20203</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>294153</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL ROGERS</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>239797</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>30502</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>8349</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>278648</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL RAUH MD</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <BaseCompensationFilingOrgAmt>245000</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>10400</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>3626</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>259026</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MEGAN ZISKE MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>238991</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>8084</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>247075</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>LESLIE BISSON MD</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <BaseCompensationFilingOrgAmt>174746</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>69000</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>2959</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>246705</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I; LINE 5;</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL OFFICERS AND DIRECTORS ARE PHYSICIANS OF THE PRACTICE PLAN WHO ARE PAID ON A PRODUCTION BASIS BASED ON THEIR INDIVIDUAL PRACTICE'S REVENUE LESS DIRECT EXPENSES AND LESS AN ALLOCATION OF OVERHEAD COSTS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <LoansBtwnOrgInterestedPrsnGrp>
        <PersonNm>ANDREW STEGEMANNE</PersonNm>
        <RelationshipWithOrgTxt>MEMBER OF BOARD OF DIRECTORS</RelationshipWithOrgTxt>
        <LoanPurposeTxt>PERSONAL</LoanPurposeTxt>
        <LoanFromOrganizationInd>X</LoanFromOrganizationInd>
        <OriginalPrincipalAmt>100000</OriginalPrincipalAmt>
        <BalanceDueAmt>89629</BalanceDueAmt>
        <DefaultInd>0</DefaultInd>
        <BoardOrCommitteeApprovalInd>1</BoardOrCommitteeApprovalInd>
        <WrittenAgreementInd>1</WrittenAgreementInd>
      </LoansBtwnOrgInterestedPrsnGrp>
      <LoansBtwnOrgInterestedPrsnGrp>
        <PersonNm>ROSS COLE</PersonNm>
        <RelationshipWithOrgTxt>MEMBER OF BOARD OF DIRECTORS</RelationshipWithOrgTxt>
        <LoanPurposeTxt>PERSONAL</LoanPurposeTxt>
        <LoanFromOrganizationInd>X</LoanFromOrganizationInd>
        <OriginalPrincipalAmt>100000</OriginalPrincipalAmt>
        <BalanceDueAmt>89629</BalanceDueAmt>
        <DefaultInd>0</DefaultInd>
        <BoardOrCommitteeApprovalInd>1</BoardOrCommitteeApprovalInd>
        <WrittenAgreementInd>1</WrittenAgreementInd>
      </LoansBtwnOrgInterestedPrsnGrp>
      <TotalBalanceDueAmt>179258</TotalBalanceDueAmt>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <BusinessName>
            <BusinessNameLine1Txt>AMHERST HEALTH CARE CENTER LLC</BusinessNameLine1Txt>
          </BusinessName>
        </NameOfInterested>
        <RelationshipDescriptionTxt>MEMBERS OF THE ORGANIZATION'S BOARD ARE 49% OWNERS IN THE INTERESTED ENTITY</RelationshipDescriptionTxt>
        <TransactionAmt>918488</TransactionAmt>
        <TransactionDesc>ORGANIZATION RENTS SPACE FROM THE AMHERST HEALTH CARE CENTER, LLC</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <BusinessName>
            <BusinessNameLine1Txt>4225 AIRPORT LLC</BusinessNameLine1Txt>
          </BusinessName>
        </NameOfInterested>
        <RelationshipDescriptionTxt>ORGANIZATION HOLDS A 50% OWNERSHIP INTEREST</RelationshipDescriptionTxt>
        <TransactionAmt>384005</TransactionAmt>
        <TransactionDesc>ORGANIZATION RENTS SPACE FROM 4225 AIRPORT LLC</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION HAS MEMBERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION HAS MEMBERS THAT MAY ELECT OTHER MEMBERS TO THE GOVERNING BOARD.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>CERTAIN DECISIONS MADE BY THE BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF MEMBERSHIP AND/OR THE STATE UNIVERSITY OF NEW YORK (SUNY) AT BUFFALO.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>A COPY OF FORM 990 WAS GIVEN TO EACH BOARD MEMBER FOR REVIEW BEFORE THE 990 WAS FILED. THIS WAS DONE VIA A BOARD MEETING AND EMAIL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION REQUIRES DISCLOSURE OF ANY CONFLICTS OF INTEREST ON AN ANNUAL BASIS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE COMPENSATION IS GOVERNED BY ARTICLE XVI OF THE STATE UNIVERSITY OF NEW YORK. THE BOARD OF DIRECTORS AND THE PLAN ADMINISTRATOR MEET ANNUALLY TO DETERMINE COMPENSATION. CURRENT SALARY DATA, EXECUTIVE SURVEYS, AND MARKETPLACE COMPARISONS ARE CONSIDERED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>UB ASSOCIATES INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>77 GOODELL STREET</AddressLine1Txt>
          <CityNm>BUFFALO</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14203</ZIPCd>
        </USAddress>
        <EIN>161559460</EIN>
        <PrimaryActivitiesTxt>PROVIDE ADMIN SUPPORT TO SUNY BUFFALO MEDICAL SCHOOL PRACTICE PLANS</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 11</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>STATE OF NEW YORK</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>ONE COMMERCE PLAZA 99 WASHINGTON AV</AddressLine1Txt>
          <CityNm>ALBANY</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>12231</ZIPCd>
        </USAddress>
        <EIN>146013200</EIN>
        <PrimaryActivitiesTxt>GOVERNMENT</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(1)</ExemptCodeSectionTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>UB FAMILY MEDICINE INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>77 GOODELL STREET</AddressLine1Txt>
          <CityNm>BUFFALO</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14203</ZIPCd>
        </USAddress>
        <EIN>161280696</EIN>
        <PrimaryActivitiesTxt>PROVIDES MEDICAL SERVICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 11</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>HARLEM ROAD LEASING LLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>4225 GENESEE ST</AddressLine1Txt>
          <CityNm>CHEEKTOWAGA</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14225</ZIPCd>
        </USAddress>
        <EIN>205588135</EIN>
        <PrimaryActivitiesTxt>PROVIDES MEDICAL EQUIPMENT TO THE ORGANIZATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <DisproportionateAllocationsInd>0</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>0</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.50000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>AMHERST HEALTH CENTER LLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>4508 MAIN ST</AddressLine1Txt>
          <CityNm>SNYDER</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14226</ZIPCd>
        </USAddress>
        <EIN>202869821</EIN>
        <PrimaryActivitiesTxt>RENTS FACILITIES TO THE ORGANIZATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <DisproportionateAllocationsInd>0</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>0</GeneralOrManagingPartnerInd>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>4225 AIRPORT LLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>4225 GENESEE ST</AddressLine1Txt>
          <CityNm>CHEEKTOWAGA</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14225</ZIPCd>
        </USAddress>
        <EIN>811657514</EIN>
        <PrimaryActivitiesTxt>RENTS FACILITIES TO THE ORGANIZATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DisproportionateAllocationsInd>0</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>0</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.50000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>1</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>1</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>1</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>1</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>HARLEM ROAD LEASING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>K</TransactionTypeTxt>
        <MethodOfAmountDeterminationTxt>MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>AMHERST HEALTH CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>K</TransactionTypeTxt>
        <InvolvedAmt>918488</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>STATE OF NEW YORK</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>P</TransactionTypeTxt>
        <InvolvedAmt>2408116</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>STATE OF NEW YORK</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>E</TransactionTypeTxt>
        <InvolvedAmt>205492</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>STATE OF NEW YORK</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>K</TransactionTypeTxt>
        <InvolvedAmt>29399</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>4225 AIRPORT LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>K</TransactionTypeTxt>
        <InvolvedAmt>384005</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>