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        <RelatedOrExemptFuncIncomeAmt>1411</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1142</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1142</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>11853932</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>9737</TotalRevenueColumnAmt>
        <ExclusionAmt>9737</ExclusionAmt>
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      <IncmFromInvestBondProceedsGrp>
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      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
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        <PersonalAmt>0</PersonalAmt>
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      <NetRentalIncomeOrLossGrp>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
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      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>11871657</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>11853932</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>9737</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
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      <CompCurrentOfcrDirectorsGrp>
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        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
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        <ProgramServicesAmt>5077373</ProgramServicesAmt>
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      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>62136</ProgramServicesAmt>
        <ManagementAndGeneralAmt>10946</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
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      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
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        <ManagementAndGeneralAmt>62400</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>33972</TotalAmt>
        <ManagementAndGeneralAmt>33972</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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        <ManagementAndGeneralAmt>28212</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>755069</TotalAmt>
        <ProgramServicesAmt>715411</ProgramServicesAmt>
        <ManagementAndGeneralAmt>39658</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>80123</TotalAmt>
        <ManagementAndGeneralAmt>80123</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
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        <ProgramServicesAmt>195885</ProgramServicesAmt>
        <ManagementAndGeneralAmt>845961</ManagementAndGeneralAmt>
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      <InformationTechnologyGrp>
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        <ManagementAndGeneralAmt>132925</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
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      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>305422</TotalAmt>
        <ProgramServicesAmt>212248</ProgramServicesAmt>
        <ManagementAndGeneralAmt>93174</ManagementAndGeneralAmt>
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      <TravelGrp>
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      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
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      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
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      <PaymentsToAffiliatesGrp>
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      <DepreciationDepletionGrp>
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        <Desc>MEDICAL SUPPLIES &amp; DRUGS</Desc>
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        <ProgramServicesAmt>704133</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>PROVIDER TAX</Desc>
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        <ProgramServicesAmt>201208</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>LICENSES, DUES, SUBSCRIPTIONS</Desc>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>8815496</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2353889</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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        <EOYAmt>0</EOYAmt>
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      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
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      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
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      <GovtFurnSrvcFcltsVl509Grp>
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        <CurrentTaxYearMinus3YearsAmt>9392080</CurrentTaxYearMinus3YearsAmt>
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      <OtherIncome509Grp>
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      <TotalSupportCalendarYearGrp>
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    </IRS990ScheduleA>
    <IRS990ScheduleC documentId="IRS990ScheduleC">
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      <TotalDirectLobbyingGrp />
      <TotalLobbyingExpendGrp />
      <OtherExemptPurposeExpendGrp />
      <TotalExemptPurposeExpendGrp />
      <LobbyingNontaxableAmountGrp />
      <GrassrootsNontaxableGrp />
      <TotLbbyngGrassrootMnsNonTxGrp />
      <TotLbbyExpendMnsLbbyngNonTxGrp />
      <VolunteersInd>false</VolunteersInd>
      <PaidStaffOrManagementInd>false</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>false</MediaAdvertisementsInd>
      <MailingsMembersInd>false</MailingsMembersInd>
      <PublicationsOrBroadcastInd>false</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>false</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>false</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>false</RalliesDemonstrationsInd>
      <OtherActivitiesInd>true</OtherActivitiesInd>
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      <TotalLobbyingExpendituresAmt>1791</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE C, PART II-B, LINE 1(I)</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER LOBBYING ACTIVITIES: THE ORGANIZATION IS A MEMBER OF THE MISSOURI HEALTH CARE ASSOCIATION AND AMERICAN HEALTH CARE ASSOCIATION. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING PURPOSES.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
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      <ExplanationProvidedInd>X</ExplanationProvidedInd>
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      <CYMinus4YrEndwmtFundGrp />
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      </BuildingsGrp>
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      <RevenueSubtotalAmt>11871657</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>11871657</TotalRevenuePerForm990Amt>
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      <ExpensesSubtotalAmt>11169385</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>11169385</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART IV, LINE 2B</FormAndLineReferenceDesc>
        <ExplanationTxt>ESCROW ARRANGEMENTS: THE PROJECT IS THE TRUSTEE OF FUNDS RECEIVED ON BEHALF OF VARIOUS RESIDENTS. THE PROJECT HAS A FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THE BANK ACCOUNT AND THE DISTRIBUTION OF THE FUNDS TO RESIDENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART X, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>UNCERTAIN TAX POSITIONS: 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>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE BOARD OF DIRECTORS REVIEWS THE FORM 990 AFTER FILING THE FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>CONFLICTS OF INTEREST POLICY: EACH DIRECTOR WILL BE REQUIRED ANNUALLY TO COMPLETE A DISCLOSURE OF CONFLICT-OF-INTEREST FORM FOR THE PURPOSE OF DISCLOSING CONFLICT PRIOR TO BOARD DISCUSSIONS OR ACTIONS. IN THE EVENT ANY OFFICER OR DIRECTOR SHALL HAVE ANY DIRECT OR INDIRECT INTEREST IN, OR RELATIONSHIP WITH, ANY INDIVIDUAL OR ORGANIZATION WHICH PROPOSES TO ENTER INTO ANY TRANSACTION WITH THE CORPORATION, INCLUDING BUT NOT LIMITED TO: (A) THE SALE, PURCHASE, LEASE OR RENTAL OF ANY PROPERTY OR ASSETS; (B) EMPLOYMENT, OR RENDITION OF SERVICES, PERSONAL OR OTHERWISE; (C) THE AWARD OF ANY DONATION GRANT, CONTRACT OR SUBCONTRACT; OR (D) THE INVESTMENT OR DEPOSIT OF ANY FUNDS OF THE CORPORATION; THEN SUCH PERSON SHALL GIVE NOTICE OF SUCH INTEREST OR RELATIONSHIP AND SHALL THEREAFTER REFRAIN FROM DISCUSSING OR VOTING ON THE PARTICULAR TRANSACTION IN WHICH THEY HAVE AN INTEREST, OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE BOARD, OR ITS COMMITTEES TO AFFECT A DECISION TO PARTICIPATE OR NOT PARTICIPATE IN SUCH TRANSACTION. NOTWITHSTANDING THE FOREGOING, SUCH PERSON MAY OFFER INPUT OR PRESENT OPTIONS REGARDING THE TRANSACTION PRIOR TO ANY MOTION BEING MADE TO PUT THE TRANSACTION TO A VOTE BY THE BOARD OR ITS COMMITTEES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A &amp; 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>EXECUTIVE AND OTHER OFFICERS COMPENSATION DETERMINATION: SALARY FOR THE EXECUTIVE DIRECTOR IS REVIEWED AND ASSIGNED BY THE INDEPENDENT BOARD OF DIRECTORS USING WAGE COMPARISONS FOR INDIVIDUALS IN THE SAME POSITION IN SIMILAR ORGANIZATIONS OF THE SAME SIZE. THE EXECUTIVE DIRECTOR RECEIVES AN ANNUAL EVALUATION OF WORK PERFORMANCE AND SALARY DECISIONS ARE BASED UPON THIS. THE EXECUTIVE DIRECTOR REVIEWS AND ASSIGNS OTHER OFFICERS' SALARIES, WITH INDEPENDENT BOARD APPROVAL USING WAGE COMPARISONS FOR INDIVIDUALS IN THE SAME POSITIONS IN SIMILAR ORGANIZATIONS OF THE SAME SIZE. EMPLOYEES RECEIVE AN ANNUAL EVALUATION AND MAY EARN UP TO A 3% INCREASE BASED UPON THE EVALUATION. IN 2022, ROYSTAN PAIS, EXECUTIVE DIRECTOR, PERFORMED A COST-OF-LIVING REVIEW. TORI MOORE, ASSISTANT ADMINISTRATOR, AND SHAUNA RIOS, HR DIRECTOR, REVIEW ALL OTHER COMPENSATION AGREEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>DOCUMENT DISCLOSURE: THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE DOCUMENTS WILL BE PROVIDED UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
