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        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>30875</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>827</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Tom Workman</PersonNm>
        <TitleTxt>Assistant Secretary</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>4.50</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <TotalReportableCompFromOrgAmt>1175683</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>897245</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>215478</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>19</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
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          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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        </ContractorAddress>
        <ServicesDesc>Construction</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Ridge View Construction Inc</BusinessNameLine1Txt>
          </BusinessName>
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        <ContractorAddress>
          <USAddress>
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            <ZIPCd>80106</ZIPCd>
          </USAddress>
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        <ServicesDesc>Construction</ServicesDesc>
        <CompensationAmt>1165715</CompensationAmt>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Healthcare Services Group</BusinessNameLine1Txt>
          </BusinessName>
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        <ContractorAddress>
          <USAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>The Carpet Shoppe Inc</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1827 E Seminole</AddressLine1Txt>
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            <StateAbbreviationCd>MO</StateAbbreviationCd>
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          </USAddress>
        </ContractorAddress>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Lantz-Boggio Architects PC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5650 DTC Parkway 200</AddressLine1Txt>
            <CityNm>Englewood</CityNm>
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            <ZIPCd>80111</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Architectual Design</ServicesDesc>
        <CompensationAmt>624778</CompensationAmt>
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      <TotalContributionsAmt>4034057</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
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        <BusinessCd>722320</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>40583035</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
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        <BusinessCd>900099</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>2299161</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
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        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>735594</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>735594</RelatedOrExemptFuncIncomeAmt>
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        <ExclusionAmt>146174</ExclusionAmt>
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        <PersonalAmt>1200</PersonalAmt>
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        <PersonalAmt>0</PersonalAmt>
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      <RentalIncomeOrLossGrp>
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        <PersonalAmt>1200</PersonalAmt>
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        <OtherAmt>497272</OtherAmt>
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      <NetGainOrLossInvestmentsGrp>
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        <ExclusionAmt>579916</ExclusionAmt>
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        <UnrelatedBusinessRevenueAmt>1200</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>743402</ExclusionAmt>
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        <ProgramServicesAmt>29861</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
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        <ManagementAndGeneralAmt>578092</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>2186048</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>220568</ProgramServicesAmt>
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        <ProgramServicesAmt>1320421</ProgramServicesAmt>
        <ManagementAndGeneralAmt>91015</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>1313579</ProgramServicesAmt>
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        <ManagementAndGeneralAmt>536150</ManagementAndGeneralAmt>
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      <FeesForServicesLegalGrp>
        <TotalAmt>88502</TotalAmt>
        <ProgramServicesAmt>20079</ProgramServicesAmt>
        <ManagementAndGeneralAmt>68423</ManagementAndGeneralAmt>
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      <FeesForServicesAccountingGrp>
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        <ProgramServicesAmt>8600</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33200</ManagementAndGeneralAmt>
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      <FeesForSrvcInvstMgmntFeesGrp>
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        <ManagementAndGeneralAmt>26479</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>4463672</ProgramServicesAmt>
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        <ProgramServicesAmt>986808</ProgramServicesAmt>
        <ManagementAndGeneralAmt>29941</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>3613419</ProgramServicesAmt>
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        <ProgramServicesAmt>285374</ProgramServicesAmt>
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        <ProgramServicesAmt>3655692</ProgramServicesAmt>
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        <ProgramServicesAmt>112828</ProgramServicesAmt>
        <ManagementAndGeneralAmt>526941</ManagementAndGeneralAmt>
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      <ConferencesMeetingsGrp>
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        <ProgramServicesAmt>69579</ProgramServicesAmt>
        <ManagementAndGeneralAmt>88802</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>3969497</ProgramServicesAmt>
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        <ProgramServicesAmt>5035226</ProgramServicesAmt>
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        <ProgramServicesAmt>1530161</ProgramServicesAmt>
        <ManagementAndGeneralAmt>37017</ManagementAndGeneralAmt>
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        <Desc>Bad Debts</Desc>
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        <ProgramServicesAmt>150260</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17191</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>141817</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ManagementAndGeneralAmt>26303</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>Taxes</Desc>
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        <ManagementAndGeneralAmt>8621</ManagementAndGeneralAmt>
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        <EOYAmt>13046</EOYAmt>
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        <EOYAmt>3000000</EOYAmt>
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        <EOYAmt>468888</EOYAmt>
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        <EOYAmt>382745</EOYAmt>
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        <EOYAmt>6169104</EOYAmt>
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      <IntangibleAssetsGrp>
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        <EOYAmt>4494000</EOYAmt>
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        <EOYAmt>2762249</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>103543302</EOYAmt>
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        <EOYAmt>24102745</EOYAmt>
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        <EOYAmt>58603912</EOYAmt>
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        <EOYAmt>98695352</EOYAmt>
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        <EOYAmt>4847950</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
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        <CurrentTaxYearMinus2YearsAmt>752639</CurrentTaxYearMinus2YearsAmt>
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        <CurrentTaxYearMinus1YearAmt>223763</CurrentTaxYearMinus1YearAmt>
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        <CurrentTaxYearAmt>34931</CurrentTaxYearAmt>
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        <CurrentTaxYearMinus1YearAmt>104762</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>168281</CurrentTaxYearAmt>
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        <CurrentTaxYearMinus3YearsAmt>37176055</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>37534387</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>43377162</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>48018545</CurrentTaxYearAmt>
        <TotalAmt>201031305</TotalAmt>
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      <PublicSupportCY509Pct>0.95260</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.94730</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00660</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00830</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III, Line 12, Explanation of Other Income:</FormAndLineReferenceDesc>
        <ExplanationTxt>Miscellaneous income - 2017 Amount: $ 146,194. 2018 Amount: $ 113,318. 2019 Amount: $ 93,469. 2020 Amount: $ 104,762. 2021 Amount: $ 168,281.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization is a public charity under section 509(a)(2) and completes Schedule A (Form 990), Part III. The organization has analyzed Schedule A (Form 990), Part II and established that it meets the 33 1/3% public support requirements under sections 509(a)(1) and 170(b)(1)(A)(vi), thus it qualifies to use the first listed special rule for Schedule B (Form 990) reporting.</ExplanationTxt>
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        <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>
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        <FilingOrganizationsTotalAmt>0</FilingOrganizationsTotalAmt>
        <AffiliatedGroupTotalAmt>0</AffiliatedGroupTotalAmt>
      </TotalGrassrootsLobbyingGrp>
      <TotalDirectLobbyingGrp>
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        <AffiliatedGroupTotalAmt>0</AffiliatedGroupTotalAmt>
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        <FilingOrganizationsTotalAmt>0</FilingOrganizationsTotalAmt>
        <AffiliatedGroupTotalAmt>0</AffiliatedGroupTotalAmt>
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      <TotalExemptPurposeExpendGrp>
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        <AffiliatedGroupTotalAmt>1000000</AffiliatedGroupTotalAmt>
      </LobbyingNontaxableAmountGrp>
      <GrassrootsNontaxableGrp>
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        <AffiliatedGroupTotalAmt>250000</AffiliatedGroupTotalAmt>
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      </TotLbbyngGrassrootMnsNonTxGrp>
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      </TotLbbyExpendMnsLbbyngNonTxGrp>
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        <CurrentYearAmt>1000000</CurrentYearAmt>
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        <CurrentYearMinus1Amt>250000</CurrentYearMinus1Amt>
        <CurrentYearAmt>250000</CurrentYearAmt>
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      <AvgGrassrootsLobbyingExpendGrp>
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        <CurrentYearMinus1Amt>1311</CurrentYearMinus1Amt>
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        <FormAndLineReferenceDesc>Part II-A:</FormAndLineReferenceDesc>
        <ExplanationTxt>Per the IRS instructions, the organization is required to complete Schedule C because they have a 501(h) election in place. During the year, the organization did not have any lobbying activity to report.</ExplanationTxt>
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        <DepreciationAmt>7657076</DepreciationAmt>
        <BookValueAmt>3228751</BookValueAmt>
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      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>1463994</OtherCostOrOtherBasisAmt>
        <BookValueAmt>1463994</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>81669844</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>Limited Partnerships</Desc>
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        <MethodValuationCd>C</MethodValuationCd>
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      <OtherSecuritiesGrp>
        <Desc>Hedge Funds</Desc>
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        <MethodValuationCd>C</MethodValuationCd>
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      <OtherSecuritiesGrp>
        <Desc>Captive Insurance</Desc>
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      <ContinuationTotalOfficeCnt>0</ContinuationTotalOfficeCnt>
      <ContinuationTotalEmployeeCnt>0</ContinuationTotalEmployeeCnt>
      <TotalOfficeCnt>0</TotalOfficeCnt>
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        <USAddress>
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          <StateAbbreviationCd>CO</StateAbbreviationCd>
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      <SupplementalInformationDetail>
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        <ExplanationTxt>The board of directors of Bethesda Foundation has responsibility for ongoing oversight of the charitable operations of Bethesda Ministries. Four directors of Bethesda Foundation sit on the board of directors of Bethesda Ministries, so they are involved in the financial oversight and use of all Bethesda Ministries funds to see that they are used for the intended purpose.</ExplanationTxt>
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      <ClubDuesOrFeesInd>X</ClubDuesOrFeesInd>
      <WrittenPolicyRefTAndEExpnssInd>1</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>1</SubstantiationRequiredInd>
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
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      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
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      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>1</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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        <PersonNm>Nathan Merrill</PersonNm>
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        <PersonNm>Joshua Thomas</PersonNm>
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        <PersonNm>Andrew McCormick</PersonNm>
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        <PersonNm>William Schwingen</PersonNm>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 1a</FormAndLineReferenceDesc>
        <ExplanationTxt>Travel for companions was provided to William Schwingen, Regional Director of Operations and Joshua Thomas, VP of Strategy &amp; Development. This benefit was included in taxable compensation. In order to assist in promoting a healthy lifestyle for its employees, the organization reimburses employees up to $40 per month to cover 50% of the cost of a gym membership. These expenses are submitted to management for approval. These reimbursements are taxable to the employee and included in their compensation. Rick Summers, Joshua Thomas and Kris Gillen participated in the program during the year.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization and related entities pay discretionary bonuses to their officers, directors, and key employees from time to time. The frequency and amount of the bonuses are determined by the Administrative Committee, CEO, or other management, and based on factors such as overall job performance, substantial extra projects, etc. The organizations do not have any employment contracts which obligate the payment of bonuses in the future.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
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          <BusinessNameLine1Txt>Colorado Health Facilities Authority</BusinessNameLine1Txt>
        </IssuerName>
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        <PurposeDesc>Improvement and Refunding Issues 5/2/2016, 2/7/2014, 9/26/2011</PurposeDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part I and Part II</FormAndLineReferenceDesc>
        <ExplanationTxt>The Bethesda Foundation Schedule K reflects the proportionate amount of the 2018 bond issue used by or for the benefit of Bethesda Foundation. The remaining portion of the 2018 bond issue is reported on Schedule K for BSLC II, a related entity, to reflect the amount used by or for the benefit of BSLC II.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Daniel Vagle and Dale Turner have a family relationship. Dana Rasic, Nathan Merrill, Dale Turner, Austin Harbach and Tom Workman serve as officers of a related corporate entity which creates a business relationship.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Certain officer functions for Bethesda Foundation are performed by management of Bethesda Associates under a cost-sharing practice.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Form 990 is prepared by an independent CPA firm and is reviewed in detail by the CFO and Accounting Manager. The final version of the Form 990 is distributed via email to the organization's Board of Directors for review and comments over a two day period prior to filing. Management answers all questions and incorporates the changes, if necessary, into the Form 990 prior to filing. After two days, the review period is closed.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Conflict of interest forms are completed annually by officers, directors, and key employees and are presented to the board for approval. When a potential conflict arises during the year, the officer, director, or key employee is responsible for updating the conflict of interest form and the revised form is provided to the board for approval. If there are any conflicts of interest approved by the board, the individual with the conflict is precluded from participating in any discussions or decisions related to the organization.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization utilizes the services of Payscale,Inc. to perform regular independent compensation studies for all officers and key employees and the results are provided to the Administrative committee of the board for review and approval. The approval process is documented in the minutes.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's governing documents, conflict of interest policy, and audited financial statements are available upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII</FormAndLineReferenceDesc>
        <ExplanationTxt>Many of the officers and directors provide services to affiliated organizations. The hours shown are specific to this organization but the compensation is total compensation for services provided to all of the affiliated organizations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VII, Section A</FormAndLineReferenceDesc>
        <ExplanationTxt>Independent Board Members Board members Daniel Vagle, Dale Turner, Don Morgan and Larry Smith were reasonably compensated solely for services provided in their capacity as members of the governing body. Therefore they are independent members of the board.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Other fees: Program service expenses 4,463,672. Management and general expenses 163,220. Fundraising expenses 0. Total expenses 4,626,892. Intercompany fees: Program service expenses 0. Management and general expenses 990,559. Fundraising expenses 0. Total expenses 990,559.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Change in investment in captive insurance held by related organization 3,523.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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