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      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>SLETTEN CONSTRUCTION OF WYOMING INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 2630</AddressLine1Txt>
            <CityNm>CODY</CityNm>
            <StateAbbreviationCd>WY</StateAbbreviationCd>
            <ZIPCd>82414</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>4307849</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>TIGHTLINE DESIGN LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>208 S FIFTH ST</AddressLine1Txt>
            <CityNm>MILES CITY</CityNm>
            <StateAbbreviationCd>MT</StateAbbreviationCd>
            <ZIPCd>59301</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>728701</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>JACKSON CONTRACTOR GROUP INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 967</AddressLine1Txt>
            <CityNm>MISSOULA</CityNm>
            <StateAbbreviationCd>MT</StateAbbreviationCd>
            <ZIPCd>59806</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>377498</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CIVIC FOUNDRY LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1919 JOANTHAN AVE</AddressLine1Txt>
            <CityNm>SAN JOSE</CityNm>
            <StateAbbreviationCd>CA</StateAbbreviationCd>
            <ZIPCd>95125</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>IT &amp; CONSULTING</ServicesDesc>
        <CompensationAmt>329971</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>PLAN ONE ARCHITECTS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4020 DEWAR DR</AddressLine1Txt>
            <CityNm>ROCK SPRINGS</CityNm>
            <StateAbbreviationCd>WY</StateAbbreviationCd>
            <ZIPCd>82901</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>164525</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>10</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>26324578</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>2297518</AllOtherContributionsAmt>
      <NoncashContributionsAmt>974400</NoncashContributionsAmt>
      <TotalContributionsAmt>28622096</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICES</Desc>
        <BusinessCd>624110</BusinessCd>
        <TotalRevenueColumnAmt>32099881</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>32099881</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CONTRACT INCOME</Desc>
        <BusinessCd>624110</BusinessCd>
        <TotalRevenueColumnAmt>2633916</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2633916</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>34733797</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>319896</TotalRevenueColumnAmt>
        <ExclusionAmt>319896</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>145182</RealAmt>
      </GrossRentsGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>145182</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>145182</TotalRevenueColumnAmt>
        <ExclusionAmt>145182</ExclusionAmt>
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      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>161585</SecuritiesAmt>
        <OtherAmt>10868</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <OtherAmt>936622</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>161585</SecuritiesAmt>
        <OtherAmt>-925754</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-764169</TotalRevenueColumnAmt>
        <ExclusionAmt>-764169</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>7757</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>2238</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>5519</TotalRevenueColumnAmt>
        <ExclusionAmt>5519</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>QUALITY/INCENTIVE REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>630009</TotalRevenueColumnAmt>
        <ExclusionAmt>630009</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>133699</TotalRevenueColumnAmt>
        <ExclusionAmt>133699</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>763708</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>63826029</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>34733797</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>470136</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>30239</TotalAmt>
        <ProgramServicesAmt>30239</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>89128</TotalAmt>
        <ProgramServicesAmt>89128</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>406738</TotalAmt>
        <ProgramServicesAmt>194533</ProgramServicesAmt>
        <ManagementAndGeneralAmt>210994</ManagementAndGeneralAmt>
        <FundraisingAmt>1211</FundraisingAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>30013513</TotalAmt>
        <ProgramServicesAmt>24960908</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4911300</ManagementAndGeneralAmt>
        <FundraisingAmt>141305</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>578354</TotalAmt>
        <ProgramServicesAmt>456767</ProgramServicesAmt>
        <ManagementAndGeneralAmt>117590</ManagementAndGeneralAmt>
        <FundraisingAmt>3997</FundraisingAmt>
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      <OtherEmployeeBenefitsGrp>
        <TotalAmt>3744868</TotalAmt>
        <ProgramServicesAmt>3107178</ProgramServicesAmt>
        <ManagementAndGeneralAmt>605620</ManagementAndGeneralAmt>
        <FundraisingAmt>32070</FundraisingAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>2616368</TotalAmt>
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        <ManagementAndGeneralAmt>445192</ManagementAndGeneralAmt>
        <FundraisingAmt>13253</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
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        <ManagementAndGeneralAmt>163989</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>182792</TotalAmt>
        <ManagementAndGeneralAmt>182792</ManagementAndGeneralAmt>
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        <FundraisingAmt>117</FundraisingAmt>
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        <FundraisingAmt>2674</FundraisingAmt>
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      <InformationTechnologyGrp>
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      <OccupancyGrp>
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      <TravelGrp>
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        <ProgramServicesAmt>416374</ProgramServicesAmt>
        <ManagementAndGeneralAmt>146701</ManagementAndGeneralAmt>
        <FundraisingAmt>4653</FundraisingAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
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      <InterestGrp>
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        <ProgramServicesAmt>408202</ProgramServicesAmt>
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        <FundraisingAmt>323</FundraisingAmt>
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      <DepreciationDepletionGrp>
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        <ProgramServicesAmt>1268544</ProgramServicesAmt>
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      <InsuranceGrp>
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        <ProgramServicesAmt>244398</ProgramServicesAmt>
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        <FundraisingAmt>1784</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES &amp; DRUGS</Desc>
        <TotalAmt>7904887</TotalAmt>
        <ProgramServicesAmt>7904887</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>REPAIR &amp; MAINTENANCE</Desc>
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        <ProgramServicesAmt>219218</ProgramServicesAmt>
        <ManagementAndGeneralAmt>39304</ManagementAndGeneralAmt>
        <FundraisingAmt>1506</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>DUES &amp; LICENSES</Desc>
        <TotalAmt>259824</TotalAmt>
        <ProgramServicesAmt>215224</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36933</ManagementAndGeneralAmt>
        <FundraisingAmt>7667</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>OUTREACH</Desc>
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        <ProgramServicesAmt>184263</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3367</ManagementAndGeneralAmt>
        <FundraisingAmt>1347</FundraisingAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>179791</TotalAmt>
        <ProgramServicesAmt>91408</ProgramServicesAmt>
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        <FundraisingAmt>714</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>58317642</TotalAmt>
        <ProgramServicesAmt>48859203</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9152329</ManagementAndGeneralAmt>
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      <CashNonInterestBearingGrp>
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        <EOYAmt>2756514</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
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      <PledgesAndGrantsReceivableGrp>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
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      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
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      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
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        <CurrentTaxYearMinus2YearsAmt>13092299</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>15197384</CurrentTaxYearMinus1YearAmt>
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      <GrossInvestmentIncome170Grp>
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        <CurrentTaxYearMinus2YearsAmt>131507</CurrentTaxYearMinus2YearsAmt>
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        <CurrentTaxYearMinus3YearsAmt>373499</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>393602</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>474925</CurrentTaxYearMinus1YearAmt>
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      <Form990ScheduleAPartVIGrp>
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          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
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      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc3">
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        <BookValueAmt>1916358</BookValueAmt>
      </LandGrp>
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        <BookValueAmt>19638606</BookValueAmt>
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      <LeaseholdImprovementsGrp>
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        <DepreciationAmt>756231</DepreciationAmt>
        <BookValueAmt>1312615</BookValueAmt>
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      <EquipmentGrp>
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        <DepreciationAmt>1817992</DepreciationAmt>
        <BookValueAmt>1364327</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>1796986</OtherCostOrOtherBasisAmt>
        <BookValueAmt>1796986</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>26028892</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>SUBLEASE RIGHT-OF-USE ASSET</Desc>
        <BookValueAmt>6019078</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>MEDICAID RATE INCREASE RECEIVABLE</Desc>
        <BookValueAmt>2829431</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>OPERATING RIGHT-OF-USE ASSETS</Desc>
        <BookValueAmt>2319625</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INTERCOMPANY RECEIVABLES</Desc>
        <BookValueAmt>56533</BookValueAmt>
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      <OtherAssetsOrgGrp>
        <Desc>OTHER ASSETS</Desc>
        <BookValueAmt>250</BookValueAmt>
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