<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xsi:schemaLocation="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2020v4.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2021-11-15T12:07:23-06:00</ReturnTs>
    <TaxPeriodEndDt>2020-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmName>
        <BusinessNameLine1Txt>BKD LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>211 N BROADWAY SUITE 600</AddressLine1Txt>
        <CityNm>ST LOUIS</CityNm>
        <StateAbbreviationCd>MO</StateAbbreviationCd>
        <ZIPCd>631022733</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2020-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>430817642</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>AFFINIA HEALTHCARE</BusinessNameLine1Txt>
      </BusinessName>
      <InCareOfNm>% AFFINIA HEALTHCARE</InCareOfNm>
      <BusinessNameControlTxt>AFFI</BusinessNameControlTxt>
      <PhoneNum>3148148571</PhoneNum>
      <USAddress>
        <AddressLine1Txt>PO BOX 551</AddressLine1Txt>
        <CityNm>ST LOUIS</CityNm>
        <StateAbbreviationCd>MO</StateAbbreviationCd>
        <ZIPCd>631880551</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>JANET VOSS</PersonNm>
      <PersonTitleTxt>CFO</PersonTitleTxt>
      <PhoneNum>3148981700</PhoneNum>
      <SignatureDt>2021-11-15</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <SigningOfficerGrp>
      <PersonFullName>
        <PersonFirstNm>Janet</PersonFirstNm>
        <PersonLastNm>Voss</PersonLastNm>
      </PersonFullName>
      <SSN>999009999</SSN>
    </SigningOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>Donna J Larson</PreparerPersonNm>
      <PTIN>P00043751</PTIN>
      <PhoneNum>3142315544</PhoneNum>
      <PreparationDt>2021-11-15</PreparationDt>
    </PreparerPersonGrp>
    <AdditionalFilerInformation>
      <TrustedCustomerGrp>
        <TrustedCustomerCd>2</TrustedCustomerCd>
      </TrustedCustomerGrp>
    </AdditionalFilerInformation>
    <TaxYr>2020</TaxYr>
    <BuildTS>2022-09-23 18:48:47Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="6">
    <IRS990 documentId="IRS990" referenceDocumentId="IRS990ScheduleO">
      <PrincipalOfficerNm>DR ALAN O FREEMAN</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>PO BOX 551</AddressLine1Txt>
        <CityNm>SAINT LOUIS</CityNm>
        <StateAbbreviationCd>MO</StateAbbreviationCd>
        <ZIPCd>631880551</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>40367020</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>WWW.AFFINIAHEALTHCARE.ORG</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1906</FormationYr>
      <LegalDomicileStateCd>MO</LegalDomicileStateCd>
      <ActivityOrMissionDesc>TO PROVIDE HIGH QUALITY HEALTH CARE AND EXCEPTIONAL SERVICE, WHILE PROMOTING HEALTHY LIFESTYLES.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>19</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>19</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>468</TotalEmployeeCnt>
      <TotalVolunteersCnt>100</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>11963616</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>17215807</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>29456972</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>23146416</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>125058</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>4797</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>0</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>0</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>41545646</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>40367020</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>27956344</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>27271085</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>11110305</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>10106935</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>39066649</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>37378020</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>2478997</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>2989000</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>26762562</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>34572214</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>21026847</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>26567120</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>5735715</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>8005094</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <MissionDesc>TO PROVIDE HIGH QUALITY HEALTH CARE AND EXCEPTIONAL SERVICE, WHILE PROMOTING HEALTHY LIFESTYLES.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>23691679</ExpenseAmt>
      <RevenueAmt>17567641</RevenueAmt>
      <Desc>PRIMARY MEDICAL CARE PROVIDES COMPREHENSIVE AND ROUTINE PREVENTATIVE SERVICES, INCLUDING MEDICAL, DENTAL, BEHAVIORAL HEALTH, PODIATRY, OPTOMETRY, SUBSTANCE ABUSE, AUDIOLOGY AND ENABLING SERVICES. APPROXIMATE PERSONS BENEFITED: 29,839</Desc>
      <ProgSrvcAccomActy2Grp>
        <ExpenseAmt>4540216</ExpenseAmt>
        <RevenueAmt>3608878</RevenueAmt>
        <Desc>HEALTH CARE FOR THE HOMELESS PROVIDES COMPREHENSIVE AND ROUTINE PREVENTATIVE SERVICES, INCLUDING MEDICAL, DENTAL, BEHAVIORAL HEALTH, PODIATRY, OPTOMETRY, SUBSTANCE ABUSE AND ENABLING SERVICES. APPROXIMATE PERSONS BENEFITED: 3,368</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <ExpenseAmt>1116939</ExpenseAmt>
        <RevenueAmt>780129</RevenueAmt>
        <Desc>PUBLIC HOUSING HEALTH PROVIDES COMPREHENSIVE AND ROUTINE PREVENTATIVE SERVICES, INCLUDING MEDICAL, DENTAL, BEHAVIORAL HEALTH AND ENABLING SERVICES. APPROXIMATE PERSONS BENEFITED: 3,132</Desc>
      </ProgSrvcAccomActy3Grp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>1188193</ExpenseAmt>
        <RevenueAmt>1189768</RevenueAmt>
        <Desc>WIC (WOMEN, INFANTS, AND CHILDREN) PROGRAM</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <Desc>PROVIDES NUTRITIONAL ASSISTANCE</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <TotalOtherProgSrvcExpenseAmt>1188193</TotalOtherProgSrvcExpenseAmt>
      <TotalOtherProgSrvcRevenueAmt>1189768</TotalOtherProgSrvcRevenueAmt>
      <TotalProgramServiceExpensesAmt>30537027</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="IRS990ScheduleB">true</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="IRS990ScheduleD">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="IRS990ScheduleD">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="IRS990ScheduleD">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="IRS990ScheduleD">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="IRS990ScheduleD">true</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="IRS990ScheduleD">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="IRS990ScheduleD">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="IRS990ScheduleD">true</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="IRS990ScheduleD">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="IRS990ScheduleD">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">false</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">true</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="IRS990ScheduleJ">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd>false</DisregardedEntityInd>
      <RelatedEntityInd>false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>22</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>true</BackupWthldComplianceInd>
      <EmployeeCnt>468</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>19</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>19</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>true</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>true</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>true</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>true</InvestmentInJointVentureInd>
      <WrittenPolicyOrProcedureInd>true</WrittenPolicyOrProcedureInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>AFFINIA HEALTHCARE</PersonNm>
        <PhoneNum>3148148513</PhoneNum>
        <USAddress>
          <AddressLine1Txt>PO BOX 551</AddressLine1Txt>
          <CityNm>SAINT LOUIS</CityNm>
          <StateAbbreviationCd>MO</StateAbbreviationCd>
          <ZIPCd>63188</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>ALAN FREEMAN</PersonNm>
        <TitleTxt>PRESIDENT/CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>313802</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>23223</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MELISSA TEPE MD</PersonNm>
        <TitleTxt>VICE PRESIDENT / CHIEF MEDICAL</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>322821</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>10184</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICAELA ONIEL-CALLAHAN</PersonNm>
        <TitleTxt>OB-GYN PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>246180</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>13811</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JUEE PHALAK</PersonNm>
        <TitleTxt>CHILD PSYCHIATRIST</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>240885</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>10555</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>THOMAS KUCIEJCZYK-KERNAN</PersonNm>
        <TitleTxt>FAMILY PRACTICE PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>229086</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>13539</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARY KEEGAN</PersonNm>
        <TitleTxt>OB-GYN PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>231836</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>5395</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TIMOTHY MCCANN</PersonNm>
        <TitleTxt>INTERNIST PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>221358</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>5452</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KENDRA HOLMES</PersonNm>
        <TitleTxt>SR. VICE PRESIDENT/CHIEF OPERA</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>221250</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>5450</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JANET VOSS</PersonNm>
        <TitleTxt>VICE PRESIDENT/CHIEF FINANCIAL</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>204189</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>12701</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LAUREL TINSLEY</PersonNm>
        <TitleTxt>CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JEAN FRAZEE</PersonNm>
        <TitleTxt>VICE CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT JACOBSEN</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GILBERT PEOPLES</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID WALTERS</PersonNm>
        <TitleTxt>IMMEDIATE PAST CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOAN D'AMBROSE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>HARRY DENGLER</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RIISA EASLEY</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ARACELI ESCALANTE-GUDINO</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>FORBES MCMULLIN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KIMBALL MCMULLIN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ELIZABETH COLEMAN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TONDALERIA CURRY</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PAULA DAVIS</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KEVIN HACHEGECHOG</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DEBRA LEONARD</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GWENDOLYN HALL</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GEORGIA HARRIS</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM VAN LUVEN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2231407</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>100310</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>40</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>MB HOLDINGS</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1736 WESTPARK CENTER DRIVE</AddressLine1Txt>
            <CityNm>FENTON</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63026</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>JANITORIAL</ServicesDesc>
        <CompensationAmt>515120</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>ALL ACCESS INTERPRETERS LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>8460 WATSON ROAD SUITE 220</AddressLine1Txt>
            <CityNm>SAINT LOUIS</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63119</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>TRANSLATION</ServicesDesc>
        <CompensationAmt>275272</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>MARSH MCLENNAN AGENCY LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 505311</AddressLine1Txt>
            <CityNm>SAINT LOUIS</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63150</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>INSURANCE BROKER</ServicesDesc>
        <CompensationAmt>184195</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>KENNETH NUERENBERGER</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1425 S 18TH STREET</AddressLine1Txt>
            <CityNm>SAINT LOUIS</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63104</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LESSOR BLDG RENT</ServicesDesc>
        <CompensationAmt>159033</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>BKD LLP</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>211 NORTH BROADWAY SUITE 2400</AddressLine1Txt>
            <CityNm>ST LOUIS</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63102</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ACCTG &amp; TAXATION</ServicesDesc>
        <CompensationAmt>146301</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>14200675</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>3015132</AllOtherContributionsAmt>
      <TotalContributionsAmt>17215807</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>MEDICARE/CAID REIMBURSEMENTS</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>14519768</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>14519768</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PROGRAM SERVICE FEES</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>8626648</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>8626648</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>23146416</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>3797</TotalRevenueColumnAmt>
        <ExclusionAmt>3797</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>
      <GrossAmountSalesAssetsGrp>
        <OtherAmt>1000</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <GainOrLossGrp>
        <OtherAmt>1000</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>1000</TotalRevenueColumnAmt>
        <ExclusionAmt>1000</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>
      <OtherRevenueTotalAmt>0</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>40367020</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>23146416</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>4797</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1108370</TotalAmt>
        <ProgramServicesAmt>327755</ProgramServicesAmt>
        <ManagementAndGeneralAmt>780615</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>21539008</TotalAmt>
        <ProgramServicesAmt>19304886</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2234122</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>494268</TotalAmt>
        <ProgramServicesAmt>422143</ProgramServicesAmt>
        <ManagementAndGeneralAmt>72125</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2878780</TotalAmt>
        <ProgramServicesAmt>2523854</ProgramServicesAmt>
        <ManagementAndGeneralAmt>354926</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1250659</TotalAmt>
        <ProgramServicesAmt>1068533</ProgramServicesAmt>
        <ManagementAndGeneralAmt>182126</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>55580</TotalAmt>
        <ManagementAndGeneralAmt>55580</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>202641</TotalAmt>
        <ManagementAndGeneralAmt>202641</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>2115140</TotalAmt>
        <ProgramServicesAmt>1960032</ProgramServicesAmt>
        <ManagementAndGeneralAmt>155108</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>0</TotalAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>3958698</TotalAmt>
        <ProgramServicesAmt>2672732</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1285966</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>630033</TotalAmt>
        <ManagementAndGeneralAmt>630033</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>1263439</TotalAmt>
        <ProgramServicesAmt>1202345</ProgramServicesAmt>
        <ManagementAndGeneralAmt>61094</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>10316</TotalAmt>
        <ProgramServicesAmt>5059</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5257</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>88697</TotalAmt>
        <ProgramServicesAmt>50008</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38689</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>271113</TotalAmt>
        <ManagementAndGeneralAmt>271113</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>852023</TotalAmt>
        <ProgramServicesAmt>724220</ProgramServicesAmt>
        <ManagementAndGeneralAmt>127803</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>169051</TotalAmt>
        <ProgramServicesAmt>17873</ProgramServicesAmt>
        <ManagementAndGeneralAmt>151178</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>ORGANIZATION DUES</Desc>
        <TotalAmt>129188</TotalAmt>
        <ProgramServicesAmt>32410</ProgramServicesAmt>
        <ManagementAndGeneralAmt>96778</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS AND MAINTENANCE</Desc>
        <TotalAmt>116866</TotalAmt>
        <ProgramServicesAmt>81344</ProgramServicesAmt>
        <ManagementAndGeneralAmt>35522</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MISCELLANEOUS</Desc>
        <TotalAmt>244150</TotalAmt>
        <ProgramServicesAmt>143833</ProgramServicesAmt>
        <ManagementAndGeneralAmt>100317</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>37378020</TotalAmt>
        <ProgramServicesAmt>30537027</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6840993</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>2085740</BOYAmt>
        <EOYAmt>9843959</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>710222</BOYAmt>
        <EOYAmt>1660165</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>3088835</BOYAmt>
        <EOYAmt>3314612</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>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>120390</BOYAmt>
        <EOYAmt>174927</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>25438137</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>13718218</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>12300243</BOYAmt>
        <EOYAmt>11719919</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>8457132</BOYAmt>
        <EOYAmt>7858632</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>26762562</BOYAmt>
        <EOYAmt>34572214</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>9928609</BOYAmt>
        <EOYAmt>9182673</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <GrantsPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </DeferredRevenueGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>5399030</BOYAmt>
        <EOYAmt>11220736</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>5699208</BOYAmt>
        <EOYAmt>6163711</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>21026847</BOYAmt>
        <EOYAmt>26567120</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>5735715</BOYAmt>
        <EOYAmt>7973002</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>32092</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>5735715</BOYAmt>
        <EOYAmt>8005094</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>26762562</BOYAmt>
        <EOYAmt>34572214</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>2989000</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>-719621</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>11798740</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>12046682</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11216652</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>11963615</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>17215807</CurrentTaxYearAmt>
        <TotalAmt>64241496</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TaxRevLeviedOrgnztnlBnft170Grp>
        <TotalAmt>0</TotalAmt>
      </TaxRevLeviedOrgnztnlBnft170Grp>
      <GovtFurnSrvcFcltsVl170Grp>
        <TotalAmt>0</TotalAmt>
      </GovtFurnSrvcFcltsVl170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>11798740</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>12046682</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11216652</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>11963615</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>17215807</CurrentTaxYearAmt>
        <TotalAmt>64241496</TotalAmt>
      </TotalCalendarYear170Grp>
      <SubstantialContributorsTotAmt>0</SubstantialContributorsTotAmt>
      <PublicSupportTotal170Amt>64241496</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>147</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>47</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>18642</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>22941</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3797</CurrentTaxYearAmt>
        <TotalAmt>45574</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <UnrelatedBusinessNetIncm170Grp>
        <TotalAmt>0</TotalAmt>
      </UnrelatedBusinessNetIncm170Grp>
      <OtherIncome170Grp>
        <TotalAmt>0</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>64287070</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>136892722</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.99929</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.99926</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
      <ArtPublicExhibitionAmountsGrp />
      <HeldWorksArtGrp />
      <CYEndwmtFundGrp>
        <ContributionsAmt>32092</ContributionsAmt>
        <EndYearBalanceAmt>32092</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>246403</BeginningYearBalanceAmt>
        <ContributionsAmt>235536</ContributionsAmt>
        <OtherExpendituresAmt>194471</OtherExpendituresAmt>
        <EndYearBalanceAmt>287468</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>168949</BeginningYearBalanceAmt>
        <ContributionsAmt>183427</ContributionsAmt>
        <OtherExpendituresAmt>105973</OtherExpendituresAmt>
        <EndYearBalanceAmt>246403</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <TermEndowmentBalanceEOYPct>1.00000</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>false</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>false</EndowmentsHeldRelatedOrgInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>368949</OtherCostOrOtherBasisAmt>
        <BookValueAmt>368949</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>15389752</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>6021977</DepreciationAmt>
        <BookValueAmt>9367775</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>1477038</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>427894</DepreciationAmt>
        <BookValueAmt>1049144</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>5851190</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>5278824</DepreciationAmt>
        <BookValueAmt>572366</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>2351208</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1989523</DepreciationAmt>
        <BookValueAmt>361685</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>11719919</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>INVESTMENT IN EQUITY INVESTEES</Desc>
        <BookValueAmt>779632</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>EST AMOUNTS DUE FROM MEDICAID</Desc>
        <BookValueAmt>7079000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>7858632</TotalBookValueOtherAssetsAmt>
      <FederalIncomeTaxLiabilityAmt>0</FederalIncomeTaxLiabilityAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED PENSION COSTS</Desc>
        <Amt>6163711</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>6163711</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>43432394</TotalRevEtcAuditedFinclStmtAmt>
      <DonatedServicesAndUseFcltsAmt>3098466</DonatedServicesAndUseFcltsAmt>
      <RevenueNotReportedAmt>3098466</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>40333928</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>33092</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>33092</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>40367020</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>40475486</TotExpnsEtcAuditedFinclStmtAmt>
      <DonatedServicesUseFcltsAmt>3098466</DonatedServicesUseFcltsAmt>
      <ExpensesNotReportedAmt>3098466</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>37377020</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>1000</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>1000</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>37378020</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART V, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>USE OF ENDOWMENT FUNDS: ENDOWMENT FUNDS ARE USED TO SUPPORT THE ORGANIZATION'S VARIOUS HEALTH CARE PROGRAMS SUCH AS THE DIABETES PROGRAM, BREAST CANCER PROGRAM, AND BEHAVIORAL HEALTH PROGRAM.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART X, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>ASC 740 DISCLOSURE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER AMOUNTS INCLUDED ON FORM 990 BUT NOT ON LINE 1: GAIN ON SALE OF FIXED ASSETS 1,000 RESTRICTED CONTRIBUTIONS RECEIVED 32,092 -------- 33,092</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER AMOUNTS INCLUDED ON FORM 990 BUT NOT ON LINE 1: GAIN ON SALE OF FIXED ASSETS 1,000</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ">
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <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>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICAELA ONIEL-CALLAHAN</PersonNm>
        <TitleTxt>OB-GYN PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>234079</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>11720</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>381</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4962</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>8849</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>259991</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JUEE PHALAK</PersonNm>
        <TitleTxt>CHILD PSYCHIATRIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>229728</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>10709</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>448</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4530</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>6025</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>251440</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>THOMAS KUCIEJCZYK-KERNAN</PersonNm>
        <TitleTxt>FAMILY PRACTICE PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>221920</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>4077</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>3089</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4675</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>8864</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>242625</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARY KEEGAN</PersonNm>
        <TitleTxt>OB-GYN PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>225911</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>5544</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>381</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4385</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>1010</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>237231</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TIMOTHY MCCANN</PersonNm>
        <TitleTxt>INTERNIST PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>214841</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>3573</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>2944</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4427</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>1025</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>226810</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ALAN FREEMAN</PersonNm>
        <TitleTxt>PRESIDENT/CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>308175</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>5627</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5500</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>17723</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>337025</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MELISSA TEPE MD</PersonNm>
        <TitleTxt>VICE PRESIDENT / CHIEF MEDICAL</TitleTxt>
        <BaseCompensationFilingOrgAmt>314576</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>7689</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>556</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>3909</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>6275</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>333005</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KENDRA HOLMES</PersonNm>
        <TitleTxt>SR. VICE PRESIDENT/CHIEF OPERA</TitleTxt>
        <BaseCompensationFilingOrgAmt>215798</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>5000</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>452</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4425</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>1025</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>226700</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JANET VOSS</PersonNm>
        <TitleTxt>VICE PRESIDENT/CHIEF FINANCIAL</TitleTxt>
        <BaseCompensationFilingOrgAmt>197394</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>5000</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>1795</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>3886</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>8815</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>216890</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>PROCESS USED FOR REVIEWING FORM 990: THE CONTROLLER, CFO AND BOARD TREASURER REVIEW THE FORM 990 IN DETAIL PRIOR TO FILING. COPIES ARE THEN DISTRIBUTED ELECTRONICALLY TO ALL BOARD MEMBERS PRIOR TO FILING THE FORM.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>PROCESS OF MONITORING AND ENFORCING COMPLIANCE WITH CONFLICT OF INTEREST: ALL BOARD MEMBERS AND MANAGEMENT STAFF ARE REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT NOTING FULL COMPLIANCE OR ANY EXCEPTIONS. ANY EXCEPTIONS ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND THE CORPORATE COMPLIANCE BOARD COMMITTEE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>PROCESS FOR DETERMINING CEO COMPENSATION: CEO COMPENSATION WAS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS BASED ON PERFORMANCE INDICATORS AND SURVEYS PROVIDED BY AN INDEPENDENT CONSULTING FIRM AND THE MISSOURI PRIMARY CARE ASSOCIATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>PROCESS FOR DETERMINING KEY EMPLOYEE COMPENSATION: A BI-ANNUAL SALARY SURVEY PROVIDED BY THE MISSOURI PRIMARY CARE ASSOCIATION IS USED IN CONJUNCTION WITH A SURVEY FROM AAIM TO DETERMINE RANGES FOR ALL KEY POSITIONS AND DETERMINE WHETHER SALARIES ARE COMPETITIVE. A COMPENSATION ANALYSIS IS CURRENTLY BEING PERFORMED BY THE CONSULTING FIRM CBIZ.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>PUBLIC AVAILABILITY OF CERTAIN DOCUMENTS: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE AS REQUIRED BY FEDERAL REGULATION THAT APPLIES TO COMMUNITY HEALTH CENTERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER CHANGE IN NET ASSETS OR FUND BALANCES: CHANGE IN DEFINED BENEFIT PLAN (719,621).</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
