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        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SAMUEL CARBAJAL</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SCOTT EMISON CLAIR</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KARIN DERRY</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DENISE ESSMAN</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SANDY HANSEN</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SERGIO HERNANDEZ</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JANET HICKS</PersonNm>
        <TitleTxt>VICE CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>4.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TED JOHNSON</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROGER LACOY</PersonNm>
        <TitleTxt>BOARD CHAIR</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM SCHOENENBERGER</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BILLIE WADE</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2094477</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>224664</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>30</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>QUEST DIAGNOSTICS</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 775460</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>606775460</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LAB TESTING SERVICES</ServicesDesc>
        <CompensationAmt>289230</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>TELELANGUAGE INC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>610 SW BROADWAY STE 200</AddressLine1Txt>
            <CityNm>PORTLAND</CityNm>
            <StateAbbreviationCd>OR</StateAbbreviationCd>
            <ZIPCd>97205</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>INTERPRETATION SVCS</ServicesDesc>
        <CompensationAmt>240080</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>CENTRAL IOWA SHELTER AND SERVICES</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1420 MULBERRY ST</AddressLine1Txt>
            <CityNm>DES MOINES</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
            <ZIPCd>50309</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MED/DENTAL/BH SVCS</ServicesDesc>
        <CompensationAmt>193756</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>RICHARD M BURKE JR</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2212 OXFORD ROAD</AddressLine1Txt>
            <CityNm>RALEIGH</CityNm>
            <StateAbbreviationCd>NC</StateAbbreviationCd>
            <ZIPCd>27608</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>DENTISTRY SERVICES</ServicesDesc>
        <CompensationAmt>137341</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>BKD LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 1190</AddressLine1Txt>
            <CityNm>SPRINGFIELD</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>658011190</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>AUDIT/TAX/CONSULTING</ServicesDesc>
        <CompensationAmt>134188</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>141712</FederatedCampaignsAmt>
      <GovernmentGrantsAmt>25604322</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>3968836</AllOtherContributionsAmt>
      <NoncashContributionsAmt>35282</NoncashContributionsAmt>
      <TotalContributionsAmt>29714870</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient Service Revenue</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>27743819</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>27743819</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>187687</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>187687</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>27931506</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>13449</TotalRevenueColumnAmt>
        <ExclusionAmt>13449</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetRentalIncomeOrLossGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <OtherAmt>10874</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <OtherAmt>-10874</OtherAmt>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-10874</TotalRevenueColumnAmt>
        <ExclusionAmt>-10874</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <GrossSalesOfInventoryAmt>0</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>Gain on investment in equity investee</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>252910</TotalRevenueColumnAmt>
        <ExclusionAmt>252910</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>252910</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>57901861</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>27931506</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>255485</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>4800000</TotalAmt>
        <ProgramServicesAmt>4800000</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>1419343</TotalAmt>
        <ProgramServicesAmt>1419343</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1337257</TotalAmt>
        <ProgramServicesAmt>1007901</ProgramServicesAmt>
        <ManagementAndGeneralAmt>329356</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>20493390</TotalAmt>
        <ProgramServicesAmt>14277501</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6215889</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>669819</TotalAmt>
        <ProgramServicesAmt>462207</ProgramServicesAmt>
        <ManagementAndGeneralAmt>207612</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>3041077</TotalAmt>
        <ProgramServicesAmt>2027832</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1013245</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1583397</TotalAmt>
        <ProgramServicesAmt>1129170</ProgramServicesAmt>
        <ManagementAndGeneralAmt>454227</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>67312</TotalAmt>
        <ManagementAndGeneralAmt>67312</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>287447</TotalAmt>
        <ManagementAndGeneralAmt>287447</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>2868</TotalAmt>
        <FundraisingAmt>2868</FundraisingAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>5245029</TotalAmt>
        <ProgramServicesAmt>4528370</ProgramServicesAmt>
        <ManagementAndGeneralAmt>716659</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>186696</TotalAmt>
        <ProgramServicesAmt>17037</ProgramServicesAmt>
        <ManagementAndGeneralAmt>169659</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>736730</TotalAmt>
        <ProgramServicesAmt>461938</ProgramServicesAmt>
        <ManagementAndGeneralAmt>274792</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>1368089</TotalAmt>
        <ProgramServicesAmt>977967</ProgramServicesAmt>
        <ManagementAndGeneralAmt>390122</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>1769009</TotalAmt>
        <ProgramServicesAmt>1286860</ProgramServicesAmt>
        <ManagementAndGeneralAmt>482149</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>65813</TotalAmt>
        <ProgramServicesAmt>31573</ProgramServicesAmt>
        <ManagementAndGeneralAmt>34240</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>111114</TotalAmt>
        <ProgramServicesAmt>54241</ProgramServicesAmt>
        <ManagementAndGeneralAmt>56873</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>14425</TotalAmt>
        <ProgramServicesAmt>411</ProgramServicesAmt>
        <ManagementAndGeneralAmt>14014</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>1037725</TotalAmt>
        <ProgramServicesAmt>879870</ProgramServicesAmt>
        <ManagementAndGeneralAmt>157855</ManagementAndGeneralAmt>
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      <InsuranceGrp>
        <TotalAmt>253942</TotalAmt>
        <ProgramServicesAmt>105963</ProgramServicesAmt>
        <ManagementAndGeneralAmt>147979</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
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        <TotalAmt>5285782</TotalAmt>
        <ProgramServicesAmt>5285782</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LICENSES, DUES, SUBSCRIPTIONS</Desc>
        <TotalAmt>244262</TotalAmt>
        <ProgramServicesAmt>122256</ProgramServicesAmt>
        <ManagementAndGeneralAmt>122006</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITING &amp; RETENTION</Desc>
        <TotalAmt>118933</TotalAmt>
        <ProgramServicesAmt>99851</ProgramServicesAmt>
        <ManagementAndGeneralAmt>19082</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS AND MAINTENANCE</Desc>
        <TotalAmt>105516</TotalAmt>
        <ProgramServicesAmt>72155</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33361</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>50244975</TotalAmt>
        <ProgramServicesAmt>39048228</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11193879</ManagementAndGeneralAmt>
        <FundraisingAmt>2868</FundraisingAmt>
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      <CashNonInterestBearingGrp>
        <BOYAmt>6477156</BOYAmt>
        <EOYAmt>1847573</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>1954235</BOYAmt>
        <EOYAmt>9980123</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>1877389</BOYAmt>
        <EOYAmt>2015486</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>2549805</BOYAmt>
        <EOYAmt>2322896</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>31982</BOYAmt>
        <EOYAmt>34257</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>280277</BOYAmt>
        <EOYAmt>346956</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>20636835</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>8765403</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>8738801</BOYAmt>
        <EOYAmt>11871432</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>226418</BOYAmt>
        <EOYAmt>479328</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>1346831</BOYAmt>
        <EOYAmt>93000</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>23482894</BOYAmt>
        <EOYAmt>28991051</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>3310304</BOYAmt>
        <EOYAmt>5103002</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
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        <TotalCompensationFilingOrgAmt>152062</TotalCompensationFilingOrgAmt>
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        <PersonNm>BERY ENGEBRETSEN</PersonNm>
        <TitleTxt>CVO</TitleTxt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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        <PersonNm>SUSAN KENNEDY</PersonNm>
        <TitleTxt>PHYSICIAN - FAMILY PRACTICE</TitleTxt>
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      <ClothingAndHouseholdGoodsGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <NoncashContributionsRptF990Amt>5643</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>FMV</MethodOfDeterminingRevenuesTxt>
      </ClothingAndHouseholdGoodsGrp>
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      <RealEstateOtherGrp />
      <CollectiblesGrp />
      <FoodInventoryGrp />
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        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>29639</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>WHOLESALE COST</MethodOfDeterminingRevenuesTxt>
      </DrugsAndMedicalSuppliesGrp>
      <TaxidermyGrp />
      <HistoricalArtifactsGrp />
      <ScientificSpecimensGrp />
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      <AnyPropertyThatMustBeHeldInd>false</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>true</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>false</ThirdPartiesUsedInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE M, PART I, LINE 20, COLUMN (B)</FormAndLineReferenceDesc>
        <ExplanationTxt>NUMBER OF CONTRIBUTIONS: THE NUMBER ENTERED IN COLUMN B REPRESENTS THE NUMBER OF DONORS WHO CONTRIBUTED THESE ITEMS DURING THE YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER PROGRAM SERVICES: PRIMARY HEALTH CARE, INC. PROVIDES HOMELESS SUPPORT SERVICES FOR THE HOMELESS POPULATION OF CENTRAL IOWA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FROM 990 IS REVIEWED AT THE FIRST FULL BOARD OF DIRECTORS MEETING THAT IS HELD AFTER THE RETURN IS COMPLETED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PARTVI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY: THE BOARD OF DIRECTORS SHALL ADOPT AND ENFORCE A POLICY ON CONFLICTS OF INTEREST AND SELF-DEALING THAT REQUIRES DISCLOSURE BY ALL DIRECTORS AND OFFICERS OF THE CORPORATION, AND OTHER PERSONS WHO ARE IN A POSITION TO INFLUENCE CORPORATE DECISIONS, OF ACTUAL AND POTENTIAL CONFLICTS OF INTEREST, AND THAT WILL ASSURE THAT NO PERSON HOLDING SUCH A POSITION IS PERMITTED TO VOTE ON ANY ISSUE, MOTION, OR RESOLUTION THAT DIRECTLY OR INDIRECTLY INURES TO HIS OR HER BENEFIT FINANCIALLY OR WITH RESPECT TO WHICH HE OR SHE MAY HAVE ANY OTHER CONFLICT OF INTEREST, EXCEPT THAT A VOTING DIRECTOR WHO HAS A CONFLICT OF INTEREST MAY BE COUNTED IN ORDER TO CONSTITUTE A QUORUM, AND MAY PARTICIPATE IN THE DISCUSSION OF THE ISSUE, MOTION OR RESOLUTION TO THE EXTENT PERMITTED BY THE CONFLICT OF INTEREST POLICY OR AS OTHERWISE DETERMINED BY THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION DETERMINATION: CEO SALARY IS RESEARCHED BY THE CHIEF HUMAN RESOURCES OFFICER, USING MARKET DATA. THIS INFORMATION IS GIVEN TO THE BOARD PERSONNEL COMMITTEE TO REVIEW AND RECOMMEND A SALARY TO THE FULL BOARD. THE BOARD MAY APPROVE, DISAPPROVE, OR MODIFY THE RECOMMENDATION. THIS DETAIL IS RECORDED IN THE BOARD MINUTES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>PUBLIC DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST IN THE ORGANIZATION'S ADMINISTRATIVE OFFICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PURCHASED SERVICES TOTAL FEES:906332</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:LEASED CLINIC STAFF TOTAL FEES:3221821</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PROFESSIONAL LAB FEES TOTAL FEES:309521</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:TEMP SERVICES TOTAL FEES:264451</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:INTERPRETING SERVICES TOTAL FEES:243252</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PHYSICIANS TOTAL FEES:181225</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:CONSULTS &amp; REFERRALS TOTAL FEES:23521</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:TRANSCRIPTION SERVICES TOTAL FEES:10</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:OTHER SERVICES TOTAL FEES:63412</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:OCCUPATIONAL HEALTH TOTAL FEES:31484</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
