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        <OtherCompensationAmt>5654</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Kelly Reed</PersonNm>
        <TitleTxt>President/CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>124657</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>410</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>218328</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>6064</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>1</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>0</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Timothy Wiegand</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>601 Elmwood Ave</AddressLine1Txt>
            <CityNm>Rochester</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14642</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Medical</ServicesDesc>
        <CompensationAmt>175189</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>1</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>3190</FederatedCampaignsAmt>
      <GovernmentGrantsAmt>339704</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>6990</AllOtherContributionsAmt>
      <TotalContributionsAmt>349884</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Client Fees</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>4758388</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>4758388</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>4758388</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>7229</TotalRevenueColumnAmt>
        <ExclusionAmt>7229</ExclusionAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <Desc>Other Income</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>79715</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>79715</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>79715</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>5195216</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>4838103</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>7229</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>224392</TotalAmt>
        <ManagementAndGeneralAmt>224392</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>2873643</TotalAmt>
        <ProgramServicesAmt>2713704</ProgramServicesAmt>
        <ManagementAndGeneralAmt>159939</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>321848</TotalAmt>
        <ProgramServicesAmt>305262</ProgramServicesAmt>
        <ManagementAndGeneralAmt>16586</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>231486</TotalAmt>
        <ProgramServicesAmt>202789</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28697</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>24352</TotalAmt>
        <ManagementAndGeneralAmt>24352</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>235000</TotalAmt>
        <ProgramServicesAmt>141215</ProgramServicesAmt>
        <ManagementAndGeneralAmt>93785</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>134377</TotalAmt>
        <ProgramServicesAmt>110360</ProgramServicesAmt>
        <ManagementAndGeneralAmt>24017</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>180846</TotalAmt>
        <ProgramServicesAmt>180846</ProgramServicesAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>574617</TotalAmt>
        <ProgramServicesAmt>517331</ProgramServicesAmt>
        <ManagementAndGeneralAmt>57286</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <InterestGrp>
        <TotalAmt>1483</TotalAmt>
        <ProgramServicesAmt>989</ProgramServicesAmt>
        <ManagementAndGeneralAmt>494</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>26642</TotalAmt>
        <ProgramServicesAmt>17870</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8772</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>54971</TotalAmt>
        <ProgramServicesAmt>32908</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22063</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Consulting Fees</Desc>
        <TotalAmt>185170</TotalAmt>
        <ProgramServicesAmt>179157</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6013</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Bad Debt</Desc>
        <TotalAmt>74000</TotalAmt>
        <ManagementAndGeneralAmt>74000</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Licenses and Fees</Desc>
        <TotalAmt>46729</TotalAmt>
        <ProgramServicesAmt>43125</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3604</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>51388</TotalAmt>
        <ProgramServicesAmt>18806</ProgramServicesAmt>
        <ManagementAndGeneralAmt>32582</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>5240944</TotalAmt>
        <ProgramServicesAmt>4464362</ProgramServicesAmt>
        <ManagementAndGeneralAmt>776582</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>10099</BOYAmt>
        <EOYAmt>25200</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>7843787</BOYAmt>
        <EOYAmt>8459756</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <EOYAmt>74595</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>420639</BOYAmt>
        <EOYAmt>456106</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>37490</BOYAmt>
        <EOYAmt>24396</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>599804</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>444253</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>38463</BOYAmt>
        <EOYAmt>155551</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>296616</BOYAmt>
        <EOYAmt>336769</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>19649</BOYAmt>
        <EOYAmt>50924</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>8666743</BOYAmt>
        <EOYAmt>9583297</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>267959</BOYAmt>
        <EOYAmt>321015</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>199453</BOYAmt>
        <EOYAmt>39743</EOYAmt>
      </DeferredRevenueGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>9701</BOYAmt>
        <EOYAmt>2408</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>7255802</BOYAmt>
        <EOYAmt>8280902</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>7732915</BOYAmt>
        <EOYAmt>8644068</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>933828</BOYAmt>
        <EOYAmt>939229</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>933828</BOYAmt>
        <EOYAmt>939229</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>8666743</BOYAmt>
        <EOYAmt>9583297</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-45728</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>51129</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>572185</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>373506</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>893380</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>625242</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>349884</CurrentTaxYearAmt>
        <TotalAmt>2814197</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>3493648</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4467965</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4426559</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4607089</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4758388</CurrentTaxYearAmt>
        <TotalAmt>21753649</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>4065833</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4841471</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5319939</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5232331</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5108272</CurrentTaxYearAmt>
        <TotalAmt>24567846</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>24567846</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>3589</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3703</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6609</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7229</CurrentTaxYearAmt>
        <TotalAmt>21132</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>3589</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3703</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6609</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7229</CurrentTaxYearAmt>
        <TotalAmt>21132</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>31805</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>28152</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>55945</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>108280</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>79715</CurrentTaxYearAmt>
        <TotalAmt>303897</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>4101227</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4869625</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5379587</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5347220</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5195216</CurrentTaxYearAmt>
        <TotalAmt>24892875</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.98690</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.98810</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00080</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00080</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III, Line 12, Explanation of Other Income:</FormAndLineReferenceDesc>
        <ExplanationTxt>Other Income Derived from the Organizations Exempt Purpose</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001" />
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>148363</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>61856</DepreciationAmt>
        <BookValueAmt>86507</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>451441</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>382397</DepreciationAmt>
        <BookValueAmt>69044</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>155551</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Capital Lease Payable</Desc>
        <Amt>4230</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Funds Held for Others</Desc>
        <Amt>8276672</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>8280902</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>5246345</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>51129</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>51129</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>5195216</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>5195216</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>5240944</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>5240944</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>5240944</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization updated the exempt purposes in the by-laws.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The full board has access to the Form 990 for review prior to filing. The Board President and Treasurer review the form prior to the final filing.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Board members involved with any entity with which the organization conducts business must declare the involvement at the time of discussion. Management maintains a list of potential conflicts and ensures declaration. Board members with a declared conflict are encouraged, but not required, to recuse themselves from any vote.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>Board completed performance appraisal and met in two Executive Sessions to discuss compensation of the CEO. Length of tenure, experience, performance and community standard (wages) for comparable positions were discussed prior to establishing salary. The CEO does the performance review and determines the compensation level of the Chief Financial Officer.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Copies of the Organization's governing documents, conflict of interest policy, and financial statements are at the reception desk for those interested. Individuals may review the documents on premise or pay a copying charge and take one.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>