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        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
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      <IndivRcvdGreaterThan100KCnt>21</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>eClinicalWorks LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2 Technology Dr</AddressLine1Txt>
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            <StateAbbreviationCd>MA</StateAbbreviationCd>
            <ZIPCd>01581</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>software</ServicesDesc>
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      <CntrctRcvdGreaterThan100KCnt>1</CntrctRcvdGreaterThan100KCnt>
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      <ProgramServiceRevenueGrp>
        <Desc>Patient fees</Desc>
        <BusinessCd>621990</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>6771127</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>6771127</TotalProgramServiceRevenueAmt>
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      </InvestmentIncomeGrp>
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      </GrossRentsGrp>
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      </RentalIncomeOrLossGrp>
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        <ExclusionAmt>0</ExclusionAmt>
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        <ProgramServicesAmt>290884</ProgramServicesAmt>
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        <ProgramServicesAmt>6308928</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1563895</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>225183</ProgramServicesAmt>
        <ManagementAndGeneralAmt>64690</ManagementAndGeneralAmt>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>723244</ProgramServicesAmt>
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      <PayrollTaxesGrp>
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        <ProgramServicesAmt>468669</ProgramServicesAmt>
        <ManagementAndGeneralAmt>129912</ManagementAndGeneralAmt>
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      <FeesForServicesLegalGrp>
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        <ManagementAndGeneralAmt>9144</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>47755</TotalAmt>
        <ManagementAndGeneralAmt>47755</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
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        <ProgramServicesAmt>195569</ProgramServicesAmt>
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        <ProgramServicesAmt>596653</ProgramServicesAmt>
        <ManagementAndGeneralAmt>92317</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
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        <ProgramServicesAmt>133427</ProgramServicesAmt>
        <ManagementAndGeneralAmt>98762</ManagementAndGeneralAmt>
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      <InterestGrp>
        <TotalAmt>62036</TotalAmt>
        <ProgramServicesAmt>32116</ProgramServicesAmt>
        <ManagementAndGeneralAmt>29920</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
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        <ProgramServicesAmt>500121</ProgramServicesAmt>
        <ManagementAndGeneralAmt>144700</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>97385</TotalAmt>
        <ProgramServicesAmt>70393</ProgramServicesAmt>
        <ManagementAndGeneralAmt>26992</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Supplies</Desc>
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        <ProgramServicesAmt>1542180</ProgramServicesAmt>
        <ManagementAndGeneralAmt>101613</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Repairs and maintenance</Desc>
        <TotalAmt>529672</TotalAmt>
        <ProgramServicesAmt>436720</ProgramServicesAmt>
        <ManagementAndGeneralAmt>92952</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Electronic claims processing</Desc>
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        <ProgramServicesAmt>377962</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3151</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Dues and licenses</Desc>
        <TotalAmt>252578</TotalAmt>
        <ProgramServicesAmt>202396</ProgramServicesAmt>
        <ManagementAndGeneralAmt>50182</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>66019</TotalAmt>
        <ProgramServicesAmt>43579</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22440</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>15264359</TotalAmt>
        <ProgramServicesAmt>12148024</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3116335</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <CashNonInterestBearingGrp>
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        <EOYAmt>7032414</EOYAmt>
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        <EOYAmt>292988</EOYAmt>
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        <EOYAmt>95275</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>1152917</EOYAmt>
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      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>367485</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>315189</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>17640492</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>6981372</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>9832197</BOYAmt>
        <EOYAmt>10659120</EOYAmt>
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      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>1934163</BOYAmt>
        <EOYAmt>1847659</EOYAmt>
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      <OtherAssetsTotalGrp>
        <BOYAmt>55250</BOYAmt>
        <EOYAmt>194397</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>21957444</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>998883</BOYAmt>
        <EOYAmt>1280980</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>1233800</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
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        <EOYAmt>2514780</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
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        <BOYAmt>14717373</BOYAmt>
        <EOYAmt>19278816</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>327437</BOYAmt>
        <EOYAmt>163848</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>15044810</BOYAmt>
        <EOYAmt>19442664</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>17519648</BOYAmt>
        <EOYAmt>21957444</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>4268414</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>129440</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="990A">
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      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>6400895</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>7003516</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>7987253</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8537521</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12615351</CurrentTaxYearAmt>
        <TotalAmt>42544536</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>6400895</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>7003516</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>7987253</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8537521</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12615351</CurrentTaxYearAmt>
        <TotalAmt>42544536</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>42544536</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>69100</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>60134</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>69384</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>133337</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>146295</CurrentTaxYearAmt>
        <TotalAmt>478250</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <TotalSupportAmt>43022786</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>31571541</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.98890</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.98230</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="990D">
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        <OtherCostOrOtherBasisAmt>1502385</OtherCostOrOtherBasisAmt>
        <BookValueAmt>1502385</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>10970059</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4124261</DepreciationAmt>
        <BookValueAmt>6845798</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>990872</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>702809</DepreciationAmt>
        <BookValueAmt>288063</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
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        <DepreciationAmt>2140637</DepreciationAmt>
        <BookValueAmt>884287</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
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        <DepreciationAmt>13665</DepreciationAmt>
        <BookValueAmt>1138587</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>10659120</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>Corp bonds mutual fund CD</Desc>
        <BookValueAmt>1847659</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>1847659</TotalBookValueSecuritiesAmt>
      <OtherAssetsOrgGrp>
        <Desc>Deposits</Desc>
        <BookValueAmt>25271</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Receivable - other</Desc>
        <BookValueAmt>158467</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Accrued interest income</Desc>
        <BookValueAmt>10659</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>194397</TotalBookValueOtherAssetsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>19662213</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>129440</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>129440</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>19532773</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>19532773</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>15264359</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>15264359</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>15264359</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="990J">
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      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <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>
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        <PersonNm>Patrick Brown</PersonNm>
        <TitleTxt>Chief Medical Officer</TitleTxt>
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        <NontaxableBenefitsFilingOrgAmt>21479</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>246957</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jeffrey Wasserman</PersonNm>
        <TitleTxt>Provider</TitleTxt>
        <BaseCompensationFilingOrgAmt>219698</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>20544</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>240242</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Bogdan Maliszewski</PersonNm>
        <TitleTxt>Provider</TitleTxt>
        <BaseCompensationFilingOrgAmt>178054</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>18415</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>196469</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lane M Lunn</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>139762</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>34999</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>174761</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Sadi Ramirez Mercado</PersonNm>
        <TitleTxt>Provider</TitleTxt>
        <BaseCompensationFilingOrgAmt>175408</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>17464</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>192872</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jose Garces Rivera</PersonNm>
        <TitleTxt>Provider</TitleTxt>
        <BaseCompensationFilingOrgAmt>153804</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>16993</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>170797</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lysmar Carrion Dinguis</PersonNm>
        <TitleTxt>Provider</TitleTxt>
        <BaseCompensationFilingOrgAmt>152473</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>10716</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>163189</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="990O">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Committee meeting documentation Part VI line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>Each committee reviews and submits its recommendation on whatever the subject matter is to the Board for discussion/approval as necessary.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>Senior accountant reviews Form 990 for accuracy and comparison to the detailed trial balance. The CFO then reviews and submits the Form 990 to the board of directors for its review and approval prior to the annual filing.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Each board member and all officers are required to read and sign a Conflict of Interest form.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>CEO executive director top management comp Part VI line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>The CEOs compensation is reviewed each year by a compensation committee composed of selected board members using various compensation surveys for comparison purposes.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other officer or key employee compensation Part VI line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>For other officers or key employees, the CEO uses a variety of surveys for comparability.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>No documents are made available to the public.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>