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        <TitleTxt>DIRECTOR</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOANNE HAEFNER</PersonNm>
        <TitleTxt>CEO</TitleTxt>
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        <OfficerInd>X</OfficerInd>
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        <OtherCompensationAmt>9143</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>EDWARD GOLEBIEWSKI</PersonNm>
        <TitleTxt>CFO</TitleTxt>
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        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>14794</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MICHELE H FRECH</PersonNm>
        <TitleTxt>DO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18404</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ELLIS GOMEZ</PersonNm>
        <TitleTxt>MD</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>232931</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>17463</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JAMES BURRUANO</PersonNm>
        <TitleTxt>CMA</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>4450</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KYLA MARTE</PersonNm>
        <TitleTxt>MD</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>4159</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>CHRISTOPHER BIONDOLILLO</PersonNm>
        <TitleTxt>CMO</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>16939</OtherCompensationAmt>
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      <TotalReportableCompFromOrgAmt>1517477</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>85352</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>36</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>KALEIDA HEALTH</BusinessNameLine1Txt>
          </BusinessName>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>100 HIGH STREET</AddressLine1Txt>
            <CityNm>BUFFALO</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14203</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>RENT</ServicesDesc>
        <CompensationAmt>376629</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>KAREN KARP &amp; PARTNERS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 515</AddressLine1Txt>
            <CityNm>SOUTHOLD</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>11971</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HR SERVICES</ServicesDesc>
        <CompensationAmt>138771</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>NORTHWEST BUFFALO COMMUNITY CENTER</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>155 LAWN AVE</AddressLine1Txt>
            <CityNm>BUFFALO</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14207</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>RENT</ServicesDesc>
        <CompensationAmt>132405</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ACCESSIUM GROUP INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>305 SPINDRIFT DRIVE SUITE 2</AddressLine1Txt>
            <CityNm>WILLIAMSVILLE</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14221</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>IT SERVICES</ServicesDesc>
        <CompensationAmt>129624</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>4</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>309</FederatedCampaignsAmt>
      <GovernmentGrantsAmt>4217274</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>395924</AllOtherContributionsAmt>
      <TotalContributionsAmt>4613507</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>23243245</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>23243245</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>23243245</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>9254</TotalRevenueColumnAmt>
        <ExclusionAmt>9254</ExclusionAmt>
      </InvestmentIncomeGrp>
      <FundraisingGrossIncomeAmt>109251</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>38997</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>70254</TotalRevenueColumnAmt>
        <ExclusionAmt>70254</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>41424</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>41424</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>41424</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>27977684</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>23284669</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>79508</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>315036</TotalAmt>
        <ProgramServicesAmt>10777</ProgramServicesAmt>
        <ManagementAndGeneralAmt>294259</ManagementAndGeneralAmt>
        <FundraisingAmt>10000</FundraisingAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>15946522</TotalAmt>
        <ProgramServicesAmt>14167871</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1778651</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>174283</TotalAmt>
        <ProgramServicesAmt>151915</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22368</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1182388</TotalAmt>
        <ProgramServicesAmt>864624</ProgramServicesAmt>
        <ManagementAndGeneralAmt>317764</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1414913</TotalAmt>
        <ProgramServicesAmt>1122104</ProgramServicesAmt>
        <ManagementAndGeneralAmt>292044</ManagementAndGeneralAmt>
        <FundraisingAmt>765</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>18097</TotalAmt>
        <ManagementAndGeneralAmt>18097</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>42500</TotalAmt>
        <ManagementAndGeneralAmt>42500</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>635061</TotalAmt>
        <ProgramServicesAmt>270090</ProgramServicesAmt>
        <ManagementAndGeneralAmt>364971</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>35547</TotalAmt>
        <ProgramServicesAmt>31992</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3555</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>363929</TotalAmt>
        <ProgramServicesAmt>363929</ProgramServicesAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>637983</TotalAmt>
        <ProgramServicesAmt>574185</ProgramServicesAmt>
        <ManagementAndGeneralAmt>63798</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>53667</TotalAmt>
        <ProgramServicesAmt>11297</ProgramServicesAmt>
        <ManagementAndGeneralAmt>42370</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>54442</TotalAmt>
        <ProgramServicesAmt>36843</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17599</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>280987</TotalAmt>
        <ProgramServicesAmt>252888</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28099</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>921968</TotalAmt>
        <ProgramServicesAmt>829771</ProgramServicesAmt>
        <ManagementAndGeneralAmt>92197</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>59026</TotalAmt>
        <ProgramServicesAmt>53123</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5903</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>3395701</TotalAmt>
        <ProgramServicesAmt>3395701</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>1560358</TotalAmt>
        <ProgramServicesAmt>1198888</ProgramServicesAmt>
        <ManagementAndGeneralAmt>361470</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PROVISION FOR DOUBTFUL</Desc>
        <TotalAmt>342761</TotalAmt>
        <ManagementAndGeneralAmt>342761</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PATIENT SUPPORT</Desc>
        <TotalAmt>231643</TotalAmt>
        <ProgramServicesAmt>50887</ProgramServicesAmt>
        <ManagementAndGeneralAmt>180756</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1201688</TotalAmt>
        <ProgramServicesAmt>758641</ProgramServicesAmt>
        <ManagementAndGeneralAmt>443047</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>28868500</TotalAmt>
        <ProgramServicesAmt>24145526</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4712209</ManagementAndGeneralAmt>
        <FundraisingAmt>10765</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>648156</BOYAmt>
        <EOYAmt>345239</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>1915259</BOYAmt>
        <EOYAmt>307198</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>92536</BOYAmt>
        <EOYAmt>63100</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>3036958</BOYAmt>
        <EOYAmt>3298571</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>345957</BOYAmt>
        <EOYAmt>333640</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>134466</BOYAmt>
        <EOYAmt>148655</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>13964336</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>5487971</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>8832653</BOYAmt>
        <EOYAmt>8476365</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>11199</BOYAmt>
        <EOYAmt>11199</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>15017184</BOYAmt>
        <EOYAmt>12983967</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>2347042</BOYAmt>
        <EOYAmt>1972140</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>5624134</BOYAmt>
        <EOYAmt>5336625</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>7971176</BOYAmt>
        <EOYAmt>7308765</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>7046008</BOYAmt>
        <EOYAmt>5675202</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>7046008</BOYAmt>
        <EOYAmt>5675202</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>15017184</BOYAmt>
        <EOYAmt>12983967</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-890816</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>-479990</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>1</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>2753978</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3074797</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4262385</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4242059</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4684720</CurrentTaxYearAmt>
        <TotalAmt>19017939</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>2753978</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3074797</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4262385</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4242059</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4684720</CurrentTaxYearAmt>
        <TotalAmt>19017939</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>19017939</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>917</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>516</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>10709</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>26079</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>9254</CurrentTaxYearAmt>
        <TotalAmt>47475</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>14032</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2024</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>10128</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>29757</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>41424</CurrentTaxYearAmt>
        <TotalAmt>97365</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>19162779</TotalSupportAmt>
      <PublicSupportCY170Pct>0.99240</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.99380</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>218000</OtherCostOrOtherBasisAmt>
        <BookValueAmt>218000</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>6112697</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>156736</DepreciationAmt>
        <BookValueAmt>5955961</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>2632466</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1581600</DepreciationAmt>
        <BookValueAmt>1050866</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>4985185</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3749635</DepreciationAmt>
        <BookValueAmt>1235550</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>15988</OtherCostOrOtherBasisAmt>
        <BookValueAmt>15988</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>8476365</TotalBookValueLandBuildingsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>28016681</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueNotReportedAmt>0</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>28016681</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-38997</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-38997</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>27977684</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>28907497</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>28907497</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>-38997</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>-38997</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>28868500</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 4B - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>SPECIAL EVENT EXPENSE -38,997.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 4B - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>SPECIAL EVENTS EXPENSE -38,997.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="RetDoc1041300001">
      <FundraisingEventInformationGrp>
        <Event1Nm>GROWING HEALTH</Event1Nm>
        <GrossReceiptsEvent1Amt>109251</GrossReceiptsEvent1Amt>
        <GrossRevenueEvent1Amt>109251</GrossRevenueEvent1Amt>
        <RentFacilityCostsEvent1Amt>4258</RentFacilityCostsEvent1Amt>
        <FoodAndBeverageEvent1Amt>15134</FoodAndBeverageEvent1Amt>
        <EntertainmentEvent1Amt>720</EntertainmentEvent1Amt>
        <OtherDirectExpensesEvent1Amt>18885</OtherDirectExpensesEvent1Amt>
        <GrossReceiptsTotalAmt>109251</GrossReceiptsTotalAmt>
        <GrossRevenueTotalEventsAmt>109251</GrossRevenueTotalEventsAmt>
        <RentFcltyCostsTotalEventsAmt>4258</RentFcltyCostsTotalEventsAmt>
        <FoodAndBeverageTotalEventsAmt>15134</FoodAndBeverageTotalEventsAmt>
        <EntertainmentTotalEventsAmt>720</EntertainmentTotalEventsAmt>
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        <PersonNm>MICHELE H FRECH</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JAMES BURRUANO</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KYLA MARTE</PersonNm>
        <TitleTxt>MD</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHRISTOPHER BIONDOLILLO</PersonNm>
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    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE RETURN IS DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING. THE RETURN IS REVIEWED AND ANY QUESTIONS/CHANGES ARE BROUGHT TO THE ATTENTION OF MANAGEMENT. APPROPRIATE CHANGES, IF NECESSARY, ARE MADE PRIOR TO FILING THE RETURN.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>ON ENTRY TO THE BOARD OF DIRECTORS AND ANNUALLY THEREAFTER, EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS ANNUALLY REVIEWS THE BYLAWS INCLUDING THE CONFLICT OF INTEREST STATEMENT; AND THEN EACH MEMBER IS REQUIRED TO SIGN AND SUBMIT A CONFLICT OF INTEREST STATEMENT ANNUALLY; UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES; AND DISCLOSES ANY POTENTIAL CONFLICTS OF INTEREST IN WRITING. ON AN ANNUAL BASIS, ALL TRANSACTIONS DISCUSSED AND IDENTIFIED AS CONFLICTS OF INTEREST WILL BE EVALUATED BY THE DISINTERESTED PERSONS AS TO WHETHER THE TRANSACTION MEETS THE REQUIREMENTS OF A FAIR AND REASONABLE TRANSACTION IN ACCORDANCE WITH THE NYS ATTORNEY GENERAL GUIDANCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF DIRECTORS REVIEWS THE EXECUTIVE DIRECTOR'S PERFORMANCE ANNUALLY. SALARY INCREASES ARE BASED ON THE RESULTS OF THAT REVIEW, ORGANIZATIONAL PERFORMANCE, AND COMPARATIVE ANALYSIS OF EXECUTIVE DIRECTOR COMPENSATION. THE ORGANIZATION PARTICIPATES IN AN ANNUAL COMPENSATION SURVEY FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND OBTAINS COMPENSATION DATA FOR DIRECTORS, MANAGERS, AND PROVIDERS THAT IS CATEGORIZED BY NATIONAL, REGIONAL, STATE, AND REVENUE VOLUME. THIS INFORMATION IS USED IN DETERMINING SALARY AND COMPENSATION RANGES FOR DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CENTER MAINTAINS ELECTRONIC COPIES AND DISTRIBUTES THEM UPON REQUEST. ADDITIONALLY, THE FORM 990 IS A PUBLIC DOCUMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN ACCOUNTING PRINCIPLE -479,990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART XII, LINE 2C</FormAndLineReferenceDesc>
        <ExplanationTxt>NO CHANGES TO THIS PROCESS HAVE TAKEN PLACE DURING THE FISCAL YEAR ENDED DECEMBER 31, 2019.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>