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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ELIZABETH S KOEHNEN</PersonNm>
        <TitleTxt>CAO</TitleTxt>
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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>145084</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
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      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>0</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>1</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>0</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MAYO CLINIC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <CityNm>ROCHESTER</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
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        </ContractorAddress>
        <ServicesDesc>CONSULTING</ServicesDesc>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>HOGAN LOVELLS US LLP</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>555 THIRTEENTH STREET</AddressLine1Txt>
            <CityNm>WASHINGTON</CityNm>
            <StateAbbreviationCd>DC</StateAbbreviationCd>
            <ZIPCd>200041109</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LEGAL</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>SCITENT</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 6449</AddressLine1Txt>
            <CityNm>CHARLOTTESVILLE</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>22906</ZIPCd>
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        </ContractorAddress>
        <ServicesDesc>BILLING PLATFORM</ServicesDesc>
        <CompensationAmt>102770</CompensationAmt>
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      <CntrctRcvdGreaterThan100KCnt>3</CntrctRcvdGreaterThan100KCnt>
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      <ProgramServiceRevenueGrp>
        <Desc>EXAMINATION FEES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>2191385</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2191385</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>APPLICATION FEES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>450000</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>450000</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>AFFILIATE INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>148950</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>148950</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>2790335</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>81201</TotalRevenueColumnAmt>
        <ExclusionAmt>81201</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>4287357</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>3914928</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>372429</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>372429</TotalRevenueColumnAmt>
        <ExclusionAmt>372429</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>4910630</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2790335</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>453630</ExclusionAmt>
      </TotalRevenueGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>451540</TotalAmt>
        <ProgramServicesAmt>307257</ProgramServicesAmt>
        <ManagementAndGeneralAmt>144283</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>80516</TotalAmt>
        <ProgramServicesAmt>34839</ProgramServicesAmt>
        <ManagementAndGeneralAmt>45677</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>290809</TotalAmt>
        <ProgramServicesAmt>65796</ProgramServicesAmt>
        <ManagementAndGeneralAmt>225013</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>179869</TotalAmt>
        <ManagementAndGeneralAmt>179869</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>32670</TotalAmt>
        <ManagementAndGeneralAmt>32670</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>25583</TotalAmt>
        <ManagementAndGeneralAmt>25583</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>119640</TotalAmt>
        <ProgramServicesAmt>23639</ProgramServicesAmt>
        <ManagementAndGeneralAmt>96001</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>30597</TotalAmt>
        <ProgramServicesAmt>5528</ProgramServicesAmt>
        <ManagementAndGeneralAmt>25069</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>273054</TotalAmt>
        <ProgramServicesAmt>11288</ProgramServicesAmt>
        <ManagementAndGeneralAmt>261766</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>15784</TotalAmt>
        <ProgramServicesAmt>1871</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13913</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>293990</TotalAmt>
        <ProgramServicesAmt>127038</ProgramServicesAmt>
        <ManagementAndGeneralAmt>166952</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>15949</TotalAmt>
        <ProgramServicesAmt>9015</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6934</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>26215</TotalAmt>
        <ManagementAndGeneralAmt>26215</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>88915</TotalAmt>
        <ManagementAndGeneralAmt>88915</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT EXPENSE</Desc>
        <TotalAmt>590742</TotalAmt>
        <ProgramServicesAmt>590742</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EXAM ADMINISTRATION</Desc>
        <TotalAmt>203547</TotalAmt>
        <ProgramServicesAmt>203547</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MISCELLANEOUS</Desc>
        <TotalAmt>119975</TotalAmt>
        <ProgramServicesAmt>105310</ProgramServicesAmt>
        <ManagementAndGeneralAmt>14665</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES AND SUBSCRIPTIONS</Desc>
        <TotalAmt>77212</TotalAmt>
        <ProgramServicesAmt>52785</ProgramServicesAmt>
        <ManagementAndGeneralAmt>24427</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>18130</TotalAmt>
        <ProgramServicesAmt>17450</ProgramServicesAmt>
        <ManagementAndGeneralAmt>680</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>2934737</TotalAmt>
        <ProgramServicesAmt>1556105</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1378632</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1137224</BOYAmt>
        <EOYAmt>1223940</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>609611</BOYAmt>
        <EOYAmt>3607</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>529359</BOYAmt>
        <EOYAmt>1159761</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>215499</BOYAmt>
        <EOYAmt>256033</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>478534</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>38313</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>339864</BOYAmt>
        <EOYAmt>440221</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>4045223</BOYAmt>
        <EOYAmt>6063411</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <TotalAssetsGrp>
        <BOYAmt>6876780</BOYAmt>
        <EOYAmt>9146973</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>157594</BOYAmt>
        <EOYAmt>270879</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>89925</BOYAmt>
        <EOYAmt>36840</EOYAmt>
      </DeferredRevenueGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>247519</BOYAmt>
        <EOYAmt>307719</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>6629261</BOYAmt>
        <EOYAmt>8839254</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>6629261</BOYAmt>
        <EOYAmt>8839254</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>6876780</BOYAmt>
        <EOYAmt>9146973</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>1975893</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>234100</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleC documentId="RetDoc1039700001">
      <SubstantiallyAllDuesNondedInd>1</SubstantiallyAllDuesNondedInd>
      <OnlyInHouseLobbyingInd>1</OnlyInHouseLobbyingInd>
      <AgreeCarryoverPriorYearInd>0</AgreeCarryoverPriorYearInd>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>294978</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>14694</DepreciationAmt>
        <BookValueAmt>280284</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>178336</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>23619</DepreciationAmt>
        <BookValueAmt>154717</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>5220</OtherCostOrOtherBasisAmt>
        <BookValueAmt>5220</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>440221</TotalBookValueLandBuildingsAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>5119147</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>234100</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>-25583</OtherRevenueAmt>
      <RevenueNotReportedAmt>208517</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>4910630</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>4910630</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>2909154</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>2909154</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>25583</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>25583</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>2934737</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>U.S. GAAP REQUIRES MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY A TAXING AUTHORITY. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS, HOWEVER, THERE ARE CURRENTLY NO AUDITS IN PROGRESS FOR ANY TAX PERIOD. THE ORGANIZATION WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN INCOME TAX EXPENSE IF INCURRED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>INVESTMENT FEES -25,583.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 4B - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>INVESTMENT FEES 25,583.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 990 IS REVIEWED AND APPROVED BY THE BOARD BEFORE FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD MEMBERS AND OFFICERS OF THE ORGANIZATION COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY WHICH IS THEN REVIEWED BY THE CAO.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE DIRECTOR RECEIVES NO DIRECT COMPENSATION FROM THE BOARD.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION POSTS ITS BYLAWS AND RULES AND REGULATIONS ON THEIR WEBSITE AND PROVIDES THE CONFLICT OF INTEREST POLICY UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>NEITHER THE OVERSIGHT PROCESS NOR THE SELECTION PROCESS HAS CHANGED FROM THE PRIOR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 1</FormAndLineReferenceDesc>
        <ExplanationTxt>THIS RETURN IS BEING AMENDED TO APPROPRIATELY REFELCT THE UPDATED FINANCIAL NUMBERS AS ADJUSTED UPON COMPLETION OF THE AUDIT. THE 990 WAS ORIGINALLY FILED PRIOR TO COMPLETION OF THE AUDIT IN ORDER TO TIMELY FILE THE 990 AND AVOID PENALTIES, AS THE AUDIT WAS NOT COMPLETED AT THAT TIME. THIS AMENDED RETURN NOW REFLECTS THE AUDITED 2020 FINANCIALS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
