﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2024v5.0">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2026-02-23T14:30:12-05:00</ReturnTs>
    <TaxPeriodEndDt>2025-04-30</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>382963463</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>QUAST JANKE &amp; CO CPA'S PC</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>1010 N JOHNSON</AddressLine1Txt>
        <CityNm>BAY CITY</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>48708</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2024-05-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>382170985</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>ALCONA CITIZENS FOR HEALTH INC</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>ALCO</BusinessNameControlTxt>
      <PhoneNum>9897363020</PhoneNum>
      <USAddress>
        <AddressLine1Txt>1035 W WASHINGTON AVE</AddressLine1Txt>
        <CityNm>ALPENA</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>49707</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>NANCY SPENCER</PersonNm>
      <PersonTitleTxt>CEO</PersonTitleTxt>
      <PhoneNum>9897363020</PhoneNum>
      <SignatureDt>2026-02-23</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>true</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>ROBERT E FRISKE CPA</PreparerPersonNm>
      <PTIN>P01083831</PTIN>
      <PhoneNum>9898924549</PhoneNum>
      <PreparationDt>2026-02-23</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2024</TaxYr>
    <BuildTS>2025-03-06 01:10:19Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="7">
    <IRS990 documentId="RetDoc2" referenceDocumentId="RetDoc6">
      <DoingBusinessAsName>
        <BusinessNameLine1Txt>ALCONA HEALTH CENTER</BusinessNameLine1Txt>
      </DoingBusinessAsName>
      <PrincipalOfficerNm>NANCY SPENCER</PrincipalOfficerNm>
      <GrossReceiptsAmt>58683162</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>WWW.ALCONAHEALTHCENTERS.ORG</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1978</FormationYr>
      <LegalDomicileStateCd>MI</LegalDomicileStateCd>
      <ActivityOrMissionDesc>MISSION STATEMENT: TO PROVIDE PATIENT-CENTERED, QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. VISION STATEMENT: TO BE THE LEAD PROVIDER OF INNOVTIVE, QUALITY HEALTHCARE SERVICES.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>11</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>11</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>438</TotalEmployeeCnt>
      <TotalVolunteersCnt>11</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <PYContributionsGrantsAmt>9016716</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>9515930</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>41131630</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>48551828</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>189598</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>530381</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>162491</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>85023</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>50500435</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>58683162</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>29736386</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>31731012</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>18793720</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>22395207</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>48530106</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>54126219</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>1970329</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>4556943</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>34785077</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>39869370</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>12048131</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>12504920</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>22736946</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>27364450</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <MissionDesc>MISSION STATEMENT: TO PROVIDE PATIENT-CENTERED, QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. VISION STATEMENT: TO BE THE LEAD PROVIDER OF INNOVTIVE, QUALITY HEALTHCARE SERVICES.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>22255009</ExpenseAmt>
      <RevenueAmt>25212110</RevenueAmt>
      <Desc>MEDICAL SERVICES - TO PROVIDE HIGH QUALITY, EFFECTIVE AND COMPREHENSIVE PRIMARY CARE SERVICES THAT ARE ACCESSIBLE TO ALL REGARDLESS OF THE ABILITY TO PAY AND OTHER SOCIAL AND ECONOMICAL FACTORS BY ACTING AS A MEDICAL PROVIDER OFFERING ROUTINE, PREVENTATIVE AND CHRONIC CARE MANAGEMENT THAT IS CONTINUOUS FOR INDIVIDUALS AND FAMILIES OF ALL AGES.</Desc>
      <ProgSrvcAccomActy2Grp>
        <ExpenseAmt>4463746</ExpenseAmt>
        <RevenueAmt>5056860</RevenueAmt>
        <Desc>BEHAVIORAL HEALTH - TO PROVIDE HIGH QUALITY, EFFECTIVE AND COMPREHENSIVE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES THAT ARE ACCESSIBLE TO ALL REGARDLESS OF THE ABILITY TO PAY AND OTHER SOCIAL AND ECONOMICAL FACTORS BY OFFERING A COMPREHENSIVE LIST OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES SPECIALIZING AND INTEGRATION BETWEEN PRIMARY CARE AND MENTAL HEALTH SERVICES.</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <ExpenseAmt>13830203</ExpenseAmt>
        <RevenueAmt>15667871</RevenueAmt>
        <Desc>PHARMACY - TO OPERATE IN-HOUSE PHARMACIES FOR THE CONVENIENCE OF OUR PATIENTS AND THE GREATER COMMUNITY.</Desc>
      </ProgSrvcAccomActy3Grp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>2308278</ExpenseAmt>
        <RevenueAmt>2614987</RevenueAmt>
        <Desc>DENTAL SERVICES - TO PROVIDE HIGH QUALITY, EFFECTIVE AND COMPREHENSIVE DENTAL CARE SERVICES THAT ARE ACCESSIBLE TO ALL REGARDLESS OF THE ABILITY TO PAY AND OTHER SOCIAL AND ECONOMICAL FACTORS BY OFFERING A FULL-RANGE OF DENTAL SERVICES FROM CLEANING, PREVENTATIVE AND RESTORATIVE SERVICES.</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <TotalOtherProgSrvcExpenseAmt>2308278</TotalOtherProgSrvcExpenseAmt>
      <TotalOtherProgSrvcRevenueAmt>2614987</TotalOtherProgSrvcRevenueAmt>
      <TotalProgramServiceExpensesAmt>42857236</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc7">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1">true</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc3">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc3">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc3">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc3">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="RetDoc3">false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc3">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc3">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc3">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc3">false</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc3">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc3">true</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc3">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc3">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc4">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd referenceDocumentId="RetDoc5">true</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd referenceDocumentId="RetDoc5">false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd>false</DisregardedEntityInd>
      <RelatedEntityInd>false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>56</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <EmployeeCnt>438</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <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>
      <OtherWebsiteInd>X</OtherWebsiteInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>SUE HOES</PersonNm>
        <PhoneNum>9893583909</PhoneNum>
        <USAddress>
          <AddressLine1Txt>1035 W WASHINGTON</AddressLine1Txt>
          <CityNm>ALPENA</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>49707</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>CAROLYNN BRUMMUND</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOE GARBER</PersonNm>
        <TitleTxt>TREASURER/SE</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CAROL LUND</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RICHARD SANGSTER</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SHELLEY CHAMBERLAIN</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TERI JOHNSON</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SCOTT KORB</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MIKE ERICKSON</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GAIL STIMSON</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ANGIE BRUNING</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NANCY SPENCER</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>268737</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>26000</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SUSAN HOES</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>136843</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>6673</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN MCMASTER</PersonNm>
        <TitleTxt>CMO</TitleTxt>
        <AverageHoursPerWeekRt>24.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>170675</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>5120</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ADRIENNE WESTPHAL</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>309542</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27328</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RAJ RAO</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>272041</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>26084</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NATHAN BARDEN</PersonNm>
        <TitleTxt>PA</TitleTxt>
        <AverageHoursPerWeekRt>38.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>260793</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>25814</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHELLE LAFAVE</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>252369</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>14995</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ELEANOR MANZINI</PersonNm>
        <TitleTxt>DDS</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>251834</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>14820</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1922834</TotalReportableCompFromOrgAmt>
      <TotalOtherCompensationAmt>146834</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>52</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ADVANCED PSYCHIATRIC SERVICES</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>32905 W 12 MILE RD</AddressLine1Txt>
            <CityNm>FARMINGTON HILLS</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48334</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PSYCHIATRIC</ServicesDesc>
        <CompensationAmt>486003</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MCLAREN NORTHERN MICHIGAN</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>416 CONNABLE AVE</AddressLine1Txt>
            <CityNm>PETOSKEY</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49770</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>RENT</ServicesDesc>
        <CompensationAmt>345696</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>D&amp;T SERVICES</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>6419 E STATE ST</AddressLine1Txt>
            <CityNm>PELLSTON</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49770</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACTED SERV</ServicesDesc>
        <CompensationAmt>154080</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>G &amp; K PLUMBING &amp; HEATING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>10924 GRAND LAKE RD</AddressLine1Txt>
            <CityNm>ALPENA</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49707</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>131161</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BRUCE DIETZ DEVELOPERS LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>100 N RIPLEY ST</AddressLine1Txt>
            <CityNm>ALPENA</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49707</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>123400</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>6</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>5484655</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>4031275</AllOtherContributionsAmt>
      <NoncashContributionsAmt>811039</NoncashContributionsAmt>
      <TotalContributionsAmt>9515930</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT FEES</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>27621309</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>27621309</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PHARMACY FEES</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>19873897</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>19873897</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER PATIENT FEES</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>1056622</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1056622</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>48551828</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>530381</TotalRevenueColumnAmt>
        <ExclusionAmt>530381</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>155584</RealAmt>
      </GrossRentsGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>155584</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>155584</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>155584</RelatedOrExemptFuncIncomeAmt>
      </NetRentalIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>MI COMM HEALTH NETWORK K-1</Desc>
        <TotalRevenueColumnAmt>-70561</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>-70561</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>-70561</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>58683162</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>48636851</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>530381</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>576255</TotalAmt>
        <ManagementAndGeneralAmt>576255</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>22609236</TotalAmt>
        <ProgramServicesAmt>18815336</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3793900</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>6854328</TotalAmt>
        <ProgramServicesAmt>4018759</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2835569</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1691193</TotalAmt>
        <ProgramServicesAmt>1356145</ProgramServicesAmt>
        <ManagementAndGeneralAmt>335048</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>3442103</TotalAmt>
        <ProgramServicesAmt>2788055</ProgramServicesAmt>
        <ManagementAndGeneralAmt>654048</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <AdvertisingGrp>
        <TotalAmt>291909</TotalAmt>
        <ProgramServicesAmt>105981</ProgramServicesAmt>
        <ManagementAndGeneralAmt>185928</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>350517</TotalAmt>
        <ProgramServicesAmt>264051</ProgramServicesAmt>
        <ManagementAndGeneralAmt>86466</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>435049</TotalAmt>
        <ProgramServicesAmt>315565</ProgramServicesAmt>
        <ManagementAndGeneralAmt>119484</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>357227</TotalAmt>
        <ProgramServicesAmt>101540</ProgramServicesAmt>
        <ManagementAndGeneralAmt>255687</ManagementAndGeneralAmt>
      </TravelGrp>
      <InterestGrp>
        <TotalAmt>430757</TotalAmt>
        <ProgramServicesAmt>277534</ProgramServicesAmt>
        <ManagementAndGeneralAmt>153223</ManagementAndGeneralAmt>
      </InterestGrp>
      <InsuranceGrp>
        <TotalAmt>114186</TotalAmt>
        <ProgramServicesAmt>60677</ProgramServicesAmt>
        <ManagementAndGeneralAmt>53509</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>12455910</TotalAmt>
        <ProgramServicesAmt>12455910</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <TotalAmt>1840811</TotalAmt>
        <ProgramServicesAmt>921169</ProgramServicesAmt>
        <ManagementAndGeneralAmt>919642</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIR AND MAINT</Desc>
        <TotalAmt>1066024</TotalAmt>
        <ProgramServicesAmt>343838</ProgramServicesAmt>
        <ManagementAndGeneralAmt>722186</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DONATED DRUGS ANDSUPPLIES</Desc>
        <TotalAmt>774920</TotalAmt>
        <ProgramServicesAmt>774920</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>835794</TotalAmt>
        <ProgramServicesAmt>257756</ProgramServicesAmt>
        <ManagementAndGeneralAmt>578038</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>54126219</TotalAmt>
        <ProgramServicesAmt>42857236</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11268983</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>863251</BOYAmt>
        <EOYAmt>1042373</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>10214274</BOYAmt>
        <EOYAmt>14114872</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>459873</BOYAmt>
        <EOYAmt>428065</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>4549416</BOYAmt>
        <EOYAmt>6401278</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>821168</BOYAmt>
        <EOYAmt>913839</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>355982</BOYAmt>
        <EOYAmt>389622</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>26095716</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>11110995</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>15755514</BOYAmt>
        <EOYAmt>14984721</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>124420</BOYAmt>
        <EOYAmt>161824</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>1641179</BOYAmt>
        <EOYAmt>1432776</EOYAmt>
      </IntangibleAssetsGrp>
      <TotalAssetsGrp>
        <BOYAmt>34785077</BOYAmt>
        <EOYAmt>39869370</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1685516</BOYAmt>
        <EOYAmt>2380672</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>212965</BOYAmt>
        <EOYAmt>137990</EOYAmt>
      </DeferredRevenueGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>7646622</BOYAmt>
        <EOYAmt>7701653</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>2503028</BOYAmt>
        <EOYAmt>2284605</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>12048131</BOYAmt>
        <EOYAmt>12504920</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>22736946</BOYAmt>
        <EOYAmt>27364450</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>22736946</BOYAmt>
        <EOYAmt>27364450</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>34785077</BOYAmt>
        <EOYAmt>39869370</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>4556943</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>70561</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc7">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1">
      <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="RetDoc3">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>840188</OtherCostOrOtherBasisAmt>
        <BookValueAmt>840188</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>19640510</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>7114095</DepreciationAmt>
        <BookValueAmt>12526415</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>742925</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>432022</DepreciationAmt>
        <BookValueAmt>310903</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>4872093</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3564878</DepreciationAmt>
        <BookValueAmt>1307215</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>14984721</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>ROU - OPERATING LEASE</Desc>
        <Amt>1409770</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>COMPENSATED ABSENCES</Desc>
        <Amt>826974</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>ROU - FINANCING LEASE</Desc>
        <Amt>47861</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>2284605</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>58753723</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>58753723</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-70561</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-70561</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>58683162</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>54126219</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>54126219</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>54126219</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 3, PART X</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CENTER IS INCORPORATED AS A NOT-FOR-PROFIT CORPORATION ORGANIZED UNDER THE LAWS OF THE STATE OF MICHIGAN. THE CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND THEREFORE HAS MADE NO PROVISION FOR FEDERAL INCOME TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CENTER AND HAS CONCLUDED THAT AS OF APRIL 30, 2025, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. ADDITIONALLY, THE CENTER HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A PRIVATE FOUNDATION WITHIN THE MEANING AS DESCRIBED IN SECTION 509(A) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEAR ENDED APRIL 30, 2025.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 4, PART XI, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>MI COMM HEALTH NETWORK K-1 -70,561</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc4">
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <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>NANCY SPENCER</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>268737</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>23528</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2472</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>294737</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOHN MCMASTER</PersonNm>
        <TitleTxt>CMO</TitleTxt>
        <BaseCompensationFilingOrgAmt>170675</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>5120</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>175795</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ADRIENNE WESTPHAL</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>309542</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>24856</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2472</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>336870</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RAJ RAO</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>272041</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>23612</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2472</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>298125</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NATHAN BARDEN</PersonNm>
        <TitleTxt>PA</TitleTxt>
        <BaseCompensationFilingOrgAmt>260793</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>23381</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2433</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>286607</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHELLE LAFAVE</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>252369</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>12023</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2972</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>267364</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ELEANOR MANZINI</PersonNm>
        <TitleTxt>DDS</TitleTxt>
        <BaseCompensationFilingOrgAmt>251834</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>12348</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2472</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>266654</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleM documentId="RetDoc5">
      <RealEstateCommercialGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>36119</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>FAIR MARKET VALUE</MethodOfDeterminingRevenuesTxt>
      </RealEstateCommercialGrp>
      <DrugsAndMedicalSuppliesGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>774920</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>FAIR MARKET VALUE</MethodOfDeterminingRevenuesTxt>
      </DrugsAndMedicalSuppliesGrp>
      <AnyPropertyThatMustBeHeldInd>false</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>false</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>false</ThirdPartiesUsedInd>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="RetDoc6">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 - ORGANIZATION'S MISSION</FormAndLineReferenceDesc>
        <ExplanationTxt>MISSION STATEMENT: TO PROVIDE PATIENT-CENTERED, QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. VISION STATEMENT: TO BE THE LEAD PROVIDER OF INNOVTIVE, QUALITY HEALTHCARE SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 1, PART I, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>CENTER HAS A VOLUNTEER BOARD OF DIRECTORS WHO ARE THE GOVERING BODY OF THE ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 2, PART III, LINE 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>DENTAL SERVICES - TO PROVIDE HIGH QUALITY, EFFECTIVE AND COMPREHENSIVE DENTAL CARE SERVICES THAT ARE ACCESSIBLE TO ALL REGARDLESS OF THE ABILITY TO PAY AND OTHER SOCIAL AND ECONOMICAL FACTORS BY OFFERING A FULL-RANGE OF DENTAL SERVICES FROM CLEANING, PREVENTATIVE AND RESTORATIVE SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE MAIN PAGES OF THE 990 ARE INCLUDED IN THE MONTHLY BOARD PACKET AND THERE IS A FORMAL MOTION TO "ACCEPT IT". THE ENTIRE REPORT IS AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>WE ASK THE BOARD OF DIRECTORS AT EACH BOARD MEETING IF ANYONE HAS A CONFLICT OF INTEREST TO DISCLOSE. WE REQUIRE STAFF TO COMPLETE TRAINING AND SUBMIT ACKNOWLEDGMENT OF THE UNDERSTANDING OF OUR CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>CEO COMPENSATION ANNUALLY REVIEWED AND DETERMINED BY BOARD</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION IS REVIEWED BY AN AHC GROUP COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A CONFLICT OF INTEREST WITH RESPECT TO COMPENSATION FOR OTHER OFFICERS OR KEY EMPLOYEES. AHC RELIES ON COMPARABILITY DATA THAT DEMONSTRATES THE FAIR MARKET VALUE OF THE COMPENSATION IN QUESTION. WHEN CRAFTING COMPENSATION PACKAGES, WE SECURE DATA THAT DOCUMENTS COMPENSATION LEVELS FOR SIMILARLY QUALIFIED INDIVIDUALS IN LIKE POSITIONS AT LIKE ORGANIZATIONS. THIS DATA MAY INCLUDE THE FOLLOWING: A) EXPERT COMPENSATION STUDIES OF NON-PROFIT AND FOR-PROFIT BY INTEREST GROUPS, AND INDEPENDENT FIRMS; B) WRITTEN JOB POSTINGS FOR POSITIONS AT SIMILAR ORGANIZATIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>UPON REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>MI COMM HEALTH NETWORK K-1 70,561</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>