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      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2381025</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>348905</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>49</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>NEXTGEN - RCM</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 809390</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>606809390</ZIPCd>
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        </ContractorAddress>
        <ServicesDesc>REVENUE CYCLE/BILLING</ServicesDesc>
        <CompensationAmt>751651</CompensationAmt>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>WMU SCHOOL OF MEDICINE</BusinessNameLine1Txt>
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        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>300 PORTAGE STREET</AddressLine1Txt>
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            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49007</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYSICIANS/RESIDENCY PROGRAM</ServicesDesc>
        <CompensationAmt>557590</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>COMPHEALTH ASSOCIATES INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>7259 S BINGHAM JCT BLVD</AddressLine1Txt>
            <CityNm>MIDVALE</CityNm>
            <StateAbbreviationCd>UT</StateAbbreviationCd>
            <ZIPCd>84047</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYSICIANS</ServicesDesc>
        <CompensationAmt>531635</CompensationAmt>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CHRONIC CARE STAFFING LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1156 BOWMAN RD STE 200</AddressLine1Txt>
            <CityNm>MOUNT PLEASANT</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>29464</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CARE MANAGEMENT</ServicesDesc>
        <CompensationAmt>386067</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>WICKERT DENTAL LABORATORY</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>84 SOUTH WOODROW AVE</AddressLine1Txt>
            <CityNm>BATTLE CREEK</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49015</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>DENTAL LAB</ServicesDesc>
        <CompensationAmt>295988</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>9</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>5311684</GovernmentGrantsAmt>
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      <TotalContributionsAmt>8672602</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>29253808</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>29253808</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PHARMACY REVENUE</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>21537863</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>21537863</RelatedOrExemptFuncIncomeAmt>
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      <TotalProgramServiceRevenueAmt>50791671</TotalProgramServiceRevenueAmt>
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        <ExclusionAmt>1040941</ExclusionAmt>
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      <GrossAmountSalesAssetsGrp>
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      <NetGainOrLossInvestmentsGrp>
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        <ExclusionAmt>-126862</ExclusionAmt>
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        <BusinessCd>900099</BusinessCd>
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        <ExclusionAmt>176604</ExclusionAmt>
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      <FeesForServicesLegalGrp>
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      <FeesForServicesAccountingGrp>
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        <ProgramServicesAmt>331120</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1618014</ManagementAndGeneralAmt>
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      <OccupancyGrp>
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        <ProgramServicesAmt>468355</ProgramServicesAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>233611</ProgramServicesAmt>
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      <OtherExpensesGrp>
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      <OtherExpensesGrp>
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      <OtherExpensesGrp>
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      <TotalFunctionalExpensesGrp>
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      <InvestmentIncomePYPct>0.00890</InvestmentIncomePYPct>
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      <TotalRevEtcAuditedFinclStmtAmt>61683507</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>1128551</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>1128551</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>60554956</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>60554956</TotalRevenuePerForm990Amt>
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      <ExpensesSubtotalAmt>57509027</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART V, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ENDOWMENT WAS ESTABLISHED BY THE ORGANIZATION AND IS CURRENTLY UNRESTRICTED.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
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      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
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      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
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        <TotalCompensationFilingOrgAmt>444396</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <TotalCompensationFilingOrgAmt>318432</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NICOLE SALERNO-FETTERHOFF</PersonNm>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>282519</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>252458</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>PHUONG TRAN</PersonNm>
        <TitleTxt>DENTIST</TitleTxt>
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        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <TotalCompensationFilingOrgAmt>243879</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ELIZABETH METTLER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
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        <TitleTxt>VICE PRESIDENT/CIO</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MELISSA KEIL</PersonNm>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <TotalCompensationFilingOrgAmt>223873</TotalCompensationFilingOrgAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION OF THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD CHAIR COMPARES THE COMPENSATION TO SALARY RANGES SET BY NATIONAL INDUSTRY ASSOCIATIONS FOR VALIDATION.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS REVIEWED BY SENIOR LEADERSHIP, WHICH INCLUDES THE CHIEF FINANCIAL OFFICER. THE 990 IS MADE AVAILABLE UPON REQUEST TO THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>ENFORCEMENT OF CONFLICTS POLICY: THE BOARD ANNUALLY COMPLETES AND SIGNS A CONFLICT OF INTEREST SHEET WHICH IS REVIEWED BY EXECUTIVE MANAGEMENT AND FILED IN ADMINISTRATION. WHEN EXCEPTIONS ARE IDENTIFIED THEY ARE DISCUSSED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION PROCESS FOR TOP OFFICIAL: THE COMPENSATION OF THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD CHAIR COMPARES THE COMPENSATION TO SALARY RANGES SET BY NATIONAL AND STATE INDUSTRY ASSOCIATIONS FOR VALIDATION. THE BOARD CHAIR NOTIFIES THE CEO AND CFO OF THE BOARD APPROVED AMOUNT. COMPENSATION PROCESS FOR OFFICERS: THE PRESIDENT/CEO DETERMINES COMPENSATION FOR EXECUTIVE MANAGEMENT USING THE NATIONAL AND STATE INDUSTRY ASSOCIATIONS AS A GUIDELINE. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2025.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS DISCLOSURE EXPLANATION: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>