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        <TotalAmt>4370</TotalAmt>
        <ProgramServicesAmt>4370</ProgramServicesAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>25476</TotalAmt>
        <ProgramServicesAmt>25476</ProgramServicesAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>80977</TotalAmt>
        <ProgramServicesAmt>80977</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>56370</TotalAmt>
        <ProgramServicesAmt>56370</ProgramServicesAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>219993</TotalAmt>
        <ProgramServicesAmt>219993</ProgramServicesAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>524566</TotalAmt>
        <ProgramServicesAmt>393424</ProgramServicesAmt>
        <ManagementAndGeneralAmt>131142</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>3998</TotalAmt>
        <ProgramServicesAmt>3998</ProgramServicesAmt>
      </TravelGrp>
      <InterestGrp>
        <TotalAmt>56086</TotalAmt>
        <ProgramServicesAmt>56086</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>323446</TotalAmt>
        <ProgramServicesAmt>323446</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>91207</TotalAmt>
        <ProgramServicesAmt>91207</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>CONTRACTED SERVICES</Desc>
        <TotalAmt>133185</TotalAmt>
        <ProgramServicesAmt>133185</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PATIENT CARE</Desc>
        <TotalAmt>9490731</TotalAmt>
        <ProgramServicesAmt>9490731</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DEVELOPMENT DUES</Desc>
        <TotalAmt>107187</TotalAmt>
        <ProgramServicesAmt>107187</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>VOLUNTEER AND COMMUNITY</Desc>
        <TotalAmt>12564</TotalAmt>
        <ProgramServicesAmt>12564</ProgramServicesAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>22943521</TotalAmt>
        <ProgramServicesAmt>22553796</ProgramServicesAmt>
        <ManagementAndGeneralAmt>389725</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>3120224</BOYAmt>
        <EOYAmt>2084298</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>2742061</BOYAmt>
        <EOYAmt>2655300</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>366680</BOYAmt>
        <EOYAmt>157237</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>10615955</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>5666746</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>5188256</BOYAmt>
        <EOYAmt>4949209</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>1551280</BOYAmt>
        <EOYAmt>1805130</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>21884</BOYAmt>
        <EOYAmt>72859</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>12990385</BOYAmt>
        <EOYAmt>11724033</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>2411162</BOYAmt>
        <EOYAmt>2012668</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1144020</BOYAmt>
        <EOYAmt>888719</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>3555182</BOYAmt>
        <EOYAmt>2901387</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>9082129</BOYAmt>
        <EOYAmt>8154067</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>353074</BOYAmt>
        <EOYAmt>668579</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>9435203</BOYAmt>
        <EOYAmt>8822646</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>12990385</BOYAmt>
        <EOYAmt>11724033</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-828875</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>216318</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>16730289</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>17922319</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>16421280</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>21838224</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>21648165</CurrentTaxYearAmt>
        <TotalAmt>94560277</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>16730289</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>17922319</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>16421280</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>21838224</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>21648165</CurrentTaxYearAmt>
        <TotalAmt>94560277</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>94560277</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>52342</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>84167</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>43903</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>144670</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>78598</CurrentTaxYearAmt>
        <TotalAmt>403680</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <TotalSupportAmt>94963957</TotalSupportAmt>
      <PublicSupportCY170Pct>0.99570</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.99540</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>61000</OtherCostOrOtherBasisAmt>
        <BookValueAmt>61000</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>8239933</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>5505023</DepreciationAmt>
        <BookValueAmt>2734910</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>2315022</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>161723</DepreciationAmt>
        <BookValueAmt>2153299</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>4949209</TotalBookValueLandBuildingsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>22330964</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>216318</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>216318</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>22114646</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>22114646</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>22943521</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>22943521</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>22943521</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ">
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANDREA HALE</PersonNm>
        <TitleTxt>CHIEF EXECUTIVE OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>189709</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>5757</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>11574</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>207040</TotalCompensationFilingOrgAmt>
        <CompReportPrior990FilingOrgAmt>169133</CompReportPrior990FilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 990 IS REVIEWED BY THE CEO AND CFO BEFORE IT IS FILED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>EACH BOARD OF TRUSTEE MUST FILL OUT AND SIGN A CONFLICT OF INTEREST FORM WHICH IS REVIEWED ANNUALLY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>CEO executive director top management comp Part VI line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>ANNUAL REVIEWS ARE PERFORMED BY THE BOARD FOR THE CEO AND AN INCREASE MAY BE APPROVED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other officer or key employee compensation Part VI line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>ANNUAL REVIEWS ARE PERFORMED FOR EMPLOYEES AND SUPERVISORS AND AN INCREASE MAY BE APPROVED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>DOCUMENTS ARE MADE AVAILABLE UPON REQUEST IN PERSON AT THE ORGANIZATIONS RAYLAND, OH LOCATION.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>