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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
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        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
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      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
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      <PublicOrganization170Ind>X</PublicOrganization170Ind>
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        <CurrentTaxYearMinus2YearsAmt>5683758</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6795167</CurrentTaxYearMinus1YearAmt>
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        <CurrentTaxYearMinus3YearsAmt>7304064</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8887700</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>9703448</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>9398533</CurrentTaxYearAmt>
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        <CurrentTaxYearMinus3YearsAmt>160658</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>214583</CurrentTaxYearMinus2YearsAmt>
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      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART II, LINE 10</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER INCOME 1,158,066</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>SUPPLEMENTAL INFORMATION</FormAndLineReferenceDesc>
        <ExplanationTxt>2019 OTHER INCOME 447,959 2020 OTHER INCOME 160.658 2021 OTHER INCOME 214,583 2023 OTHER INCOME 334,866</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc2">
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        <BookValueAmt>1138426</BookValueAmt>
      </LandGrp>
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        <DepreciationAmt>1639629</DepreciationAmt>
        <BookValueAmt>2531117</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
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        <DepreciationAmt>2033557</DepreciationAmt>
        <BookValueAmt>448120</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>4117663</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>RIGHT-OF-USE ASSETS</Desc>
        <BookValueAmt>1357067</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>1357067</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>LEASE LIABILITY</Desc>
        <Amt>1424670</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED ANNUAL LEAVE</Desc>
        <Amt>574283</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>SALARIES PAYABLE</Desc>
        <Amt>492074</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>OTHER ACCRUED LIABILITIES</Desc>
        <Amt>3726</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>PAYROLL TAX OVERPAYMENT</Desc>
        <Amt>-24944</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>2469809</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>16610762</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>16610762</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>16610762</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>16813183</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>16813183</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>16813183</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 3, PART X</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION IS EXEMPT FROM CORPORATE FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND FROM STATE INCOME TAXES. THEREFORE, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE CORPORATE INCOME TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS THE ORGANIZATION HAS ANALYZED ITS TAX POSITIONS TAKEN FOR FILINGS WITH THE INTERNAL REVENUE. IT BELIEVES THAT ITS TAX FILING POSITIONS WILL BE SUSTAINED UPON EXAMINATION AND DOES NOT ANTICIPATE ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL ADVERSE EFFECT ON ITS FINANCIAL CONDITION, RESULTS OF OPERATIONS, OR CASH FLOWS. THE ORGANIZATION'S FEDERAL AND STATE INCOME TAX RETURNS FOR 2019, 2018 AND 2017 ARE SUBJECT TO EXAMINATION BY FEDERAL, STATE AND LOCAL TAXING AUTHORITIES, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc3">
      <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>DR ELISEO RIVERA</PersonNm>
        <TitleTxt>PHYSICIAN/CMO</TitleTxt>
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        <TotalCompensationFilingOrgAmt>559701</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR SWETHA JANGANGARI</PersonNm>
        <TitleTxt>MEDICAL DIRECTOR</TitleTxt>
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        <TotalCompensationFilingOrgAmt>281307</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR KHADIJAH ABDURRAZA</PersonNm>
        <TitleTxt>PHYSICIAN/PEDIATRICS</TitleTxt>
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        <TotalCompensationFilingOrgAmt>264045</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL OKOYE</PersonNm>
        <TitleTxt>DO/MEDICAL DOCTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>243122</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>243122</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>IRINA REMSBERG</PersonNm>
        <TitleTxt>MEDICAL DOCTOR</TitleTxt>
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        <TotalCompensationFilingOrgAmt>229879</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHANDAN MAZUMDER</PersonNm>
        <TitleTxt>MEDICAL DOCTOR</TitleTxt>
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        <TotalCompensationFilingOrgAmt>212875</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL AUSTIN</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>200407</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>200407</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR ELLIOT AYOUB</PersonNm>
        <TitleTxt>DENTAL DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>193414</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>193414</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHABACANA MAXWELL</PersonNm>
        <TitleTxt>MEDICAL DOCTOR</TitleTxt>
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        <TotalCompensationFilingOrgAmt>160693</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MAEETTA NELSON</PersonNm>
        <TitleTxt>CFO</TitleTxt>
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        <TotalCompensationFilingOrgAmt>151571</TotalCompensationFilingOrgAmt>
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    <IRS990ScheduleO documentId="RetDoc4">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 SUPPORT AND BACK UP IS PROVIDED TO THE CEO AND BOARD FOR REVIEW. AFTER IT IS REVIEWED BY THE BOARD, 990 IS SUBMITTED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE BY ENFORCING THE IMPORTANCE OF FOLLOWING AND COMPLYING WITH THE ORGANIZATION'S POLICY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SALARY RANGE FOR EACH CLASSIFICATION IS DETERMINED BY A MARKET ANALYSIS OF PAY SCALES FOR SIMILAR JOBS IN LIKE ORGANIZATIONS IS THE SAME OR SIMILAR GEOGRAPHIC AREAS. A BROADER GEOGRAPHIC AREA MAY BE ANALYZED FOR A PARTICULAR CLASSIFICATION IF THERE IS A SHORTAGE OF QUALIFIED PEOPLE AVAILABLE LOCALLY FOR SOME POSITIONS. THE MARKET ANALYSIS WILL BE PERFORMED ANNUALLY. THE SALARY RANGE INCLUDES FIVE DIVISIONAL LEVELS OR BANDS WITHIN EACH CLASSIFICATION AND ARE DETERMINED BASED ON CRITERIA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SALARY RANGE FOR EACH CLASSIFICATION IS DETERMINED BY A MARKET ANALYSIS OF PAY SCALES FOR SIMILAR JOBS IN LIKE ORGANIZATIONS IN THE SAME OR SIMILAR GEOGRAPHIC AREAS. A BROADER GEOGRAPHIC AREA MAY BE ANALYZED FOR A PARTICULAR CLASSIFICATION IF THERE IS A SHORTAGE OF QUALIFIED PEOPLE AVAILABLE LOCALLY FOR SOME POSITIONS. THE MARKET ANALYSIS WILL BE PERFORMED ANNUALLY. THE SALARY RANGE INCLUDES FIVE DIVISIONAL LEVELS OR BANDS WITHIN EACH CLASSIFICATION AND ARE DETERMINED BASED ON CRITERIA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>