﻿<?xml version="1.0" encoding="utf-8"?>
<Return returnVersion="2020v4.0" xmlns="http://www.irs.gov/efile">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2022-06-16T00:03:53Z</ReturnTs>
    <TaxPeriodEndDt>2020-12-31</TaxPeriodEndDt>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2020-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>382168007</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>MIDMICHIGAN HEALTH SERVICES</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>MIDM</BusinessNameControlTxt>
      <PhoneNum>9892024604</PhoneNum>
      <USAddress>
        <AddressLine1Txt>9249 W LAKE CITY RD</AddressLine1Txt>
        <CityNm>HOUGHTON LAKE</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>486299602</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>William Collin</PersonNm>
      <PersonTitleTxt>Chief Financial Officer</PersonTitleTxt>
      <PhoneNum>9892024604</PhoneNum>
      <SignatureDt>2022-06-15</SignatureDt>
    </BusinessOfficerGrp>
    <TaxYr>2020</TaxYr>
    <BuildTS>2022-09-23 18:48:47Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="6">
    <IRS990 documentId="SIMPLE990" documentName="IRS990" referenceDocumentName="IRS990ScheduleO ReasonableCauseExplanation BinaryAttachment">
      <PrincipalOfficerNm>William Collin</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>9249 W Lake City Road</AddressLine1Txt>
        <CityNm>Houghton Lake</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>48629</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>19923131</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>www.miidmichigan.org/microsites/chs</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1975</FormationYr>
      <LegalDomicileStateCd>MI</LegalDomicileStateCd>
      <ActivityOrMissionDesc>Community Health Center providing primary health care services to Roscommon, Gladwin counties and surrounding areas of Michigan. Through four clinics and three school-based health centers. MidMichigan Health Services provided services to 15,316 patients through 48.070 medical encounters.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>12</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>12</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>164</TotalEmployeeCnt>
      <TotalVolunteersCnt>0</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>3876773</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>7386037</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>11410956</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>11312828</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>544962</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>679352</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>242348</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>544914</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>16075039</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>19923131</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>9970466</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>11312864</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>5804455</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>7172988</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>15774921</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>18485852</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>300118</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>1437279</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>11998731</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>14288719</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>3477584</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>4330290</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>8521147</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>9958429</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>To provide high quality, community-oriented, patient-centered health services for all.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>18485852</ExpenseAmt>
      <RevenueAmt>19923131</RevenueAmt>
      <Desc>Community Health Center provides primary health care to Roscommon, Gladwin and surrounding counties of Michigan. Located at four clinic sites and three school-based health centers. MidMichigan Health Services provided services to 15,316 patients through 48,070 medical encounters. MidMichigan Health Services offers Imaging services in Houghton Lake. In addition, through an affiliation with MidMichigan Health, on-site laboratory services are offered at the Houghton Lake site. Physical Therapy and Specialty Services are also provided in Houghton Lake by our affiliation agreement. The three school-based health centers offer health care services to students o school campuses, allowing the students to receive services while minimizing the time spent out of the classroom. In keeping with it's mission, the clinic provides high quality healthcare services to all patients, regardless of the individual's inability to pay. Through its 340b drug program, the clinic was able to provide significant discounts on prescriptions filled with our contracted pharmacies.</Desc>
      <ProgSrvcAccomActy2Grp />
      <ProgSrvcAccomActy3Grp />
      <TotalProgramServiceExpensesAmt>18485852</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="ScheduleA" referenceDocumentName="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentName="IRS990ScheduleB">false</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd referenceDocumentName="IRS990ScheduleC">false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd referenceDocumentName="IRS990ScheduleC">false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd referenceDocumentName="IRS990ScheduleC">false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="ScheduleD" referenceDocumentName="IRS990ScheduleD">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd referenceDocumentName="IRS990ScheduleE">false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd referenceDocumentName="IRS990ScheduleF">false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd referenceDocumentName="IRS990ScheduleF">false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd referenceDocumentName="IRS990ScheduleF">false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd referenceDocumentName="IRS990ScheduleG">false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd referenceDocumentName="IRS990ScheduleG">false</FundraisingActivitiesInd>
      <GamingActivitiesInd referenceDocumentName="IRS990ScheduleG">false</GamingActivitiesInd>
      <OperateHospitalInd referenceDocumentName="IRS990ScheduleH">false</OperateHospitalInd>
      <GrantsToOrganizationsInd referenceDocumentName="IRS990ScheduleI">false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd referenceDocumentName="IRS990ScheduleI">false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="ScheduleJ" referenceDocumentName="IRS990ScheduleJ">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd referenceDocumentName="IRS990ScheduleK">false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd referenceDocumentName="IRS990ScheduleL">false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd referenceDocumentName="IRS990ScheduleL">false</PYExcessBenefitTransInd>
      <LoanOutstandingInd referenceDocumentName="IRS990ScheduleL">false</LoanOutstandingInd>
      <GrantToRelatedPersonInd referenceDocumentName="IRS990ScheduleL">false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd referenceDocumentName="IRS990ScheduleL">false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd referenceDocumentName="IRS990ScheduleL">false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd referenceDocumentName="IRS990ScheduleL">false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd referenceDocumentName="IRS990ScheduleM">false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd referenceDocumentName="IRS990ScheduleM">false</DeductibleArtContributionInd>
      <TerminateOperationsInd referenceDocumentName="IRS990ScheduleN">false</TerminateOperationsInd>
      <PartialLiquidationInd referenceDocumentName="IRS990ScheduleN">false</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentName="IRS990ScheduleR">false</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentName="IRS990ScheduleR">false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentName="IRS990ScheduleR">false</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentName="IRS990ScheduleR">false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentName="IRS990ScheduleR">false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>10</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>true</BackupWthldComplianceInd>
      <EmployeeCnt>164</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <Form990TFiledInd>false</Form990TFiledInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>true</PayPremiumsPrsnlBnftCntrctInd>
      <Form8899Filedind>false</Form8899Filedind>
      <Form1098CFiledInd>false</Form1098CFiledInd>
      <DAFExcessBusinessHoldingsInd>false</DAFExcessBusinessHoldingsInd>
      <TaxableDistributionsInd>false</TaxableDistributionsInd>
      <DistributionToDonorInd>false</DistributionToDonorInd>
      <InitiationFeesAndCapContriAmt>0</InitiationFeesAndCapContriAmt>
      <GrossReceiptsForPublicUseAmt>0</GrossReceiptsForPublicUseAmt>
      <MembersAndShrGrossIncomeAmt>0</MembersAndShrGrossIncomeAmt>
      <OtherSourcesGrossIncomeAmt>0</OtherSourcesGrossIncomeAmt>
      <OrgFiledInLieuOfForm1041Ind>false</OrgFiledInLieuOfForm1041Ind>
      <TaxExemptInterestAmt>0</TaxExemptInterestAmt>
      <LicensedMoreThanOneStateInd>false</LicensedMoreThanOneStateInd>
      <StateRequiredReservesAmt>0</StateRequiredReservesAmt>
      <ReservesMaintainedAmt>0</ReservesMaintainedAmt>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>12</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>12</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>false</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>MI</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>Alisa Davidson</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>9894225122</PhoneNum>
        <USAddress>
          <AddressLine1Txt>9249 W Lake City Road</AddressLine1Txt>
          <AddressLine2Txt>9249 W Lake City Road</AddressLine2Txt>
          <CityNm>Houghton Lake</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>48629</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>Scott Govitz</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Dawn LaCasse</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Fred Roemer</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Greg Rogers</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jeff Fossitt</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jim Bischoff</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Shannon Phelps</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Ray Stover</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Joe Passalacqua</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Tom Moreau</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lorelei King</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>James Raschke</PersonNm>
        <TitleTxt>Chief Executive Officer</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>176891</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>3972</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jeffrey Strickler</PersonNm>
        <TitleTxt>Chief Medical Officer</TitleTxt>
        <AverageHoursPerWeekRt>8.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>80139</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>William Collin</PersonNm>
        <TitleTxt>Chief Financial Officer</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>143626</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>5016</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jennifer Shamel</PersonNm>
        <TitleTxt>Chief Operations Officer</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>77223</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>6243</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Candie Barnum</PersonNm>
        <TitleTxt>Director of Clinical Operations</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>84191</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>6781</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Allison Hubbard</PersonNm>
        <TitleTxt>Human Resources Director</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>90065</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>3804</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Kevin Denlinger</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>225995</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>13506</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Stacey Gedeon</PersonNm>
        <TitleTxt>Psychologist</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>216287</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>1400</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Roberto Viguilla</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>226301</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lyndsy McMorrow</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <ReportableCompFromOrgAmt>220422</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Robert McMorrow</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>270000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jeffrey Strickler</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>32.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>257045</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>28705</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2068185</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>69427</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>18</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MidMichigan-Clare</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>703 McEwan Steet</AddressLine1Txt>
            <CityNm>Clare</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48617</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Imaging Services</ServicesDesc>
        <CompensationAmt>316544</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Three Rivers Corporation</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>3069 E Vantage Point Drive</AddressLine1Txt>
            <CityNm>Midland</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48641</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Building Construction</ServicesDesc>
        <CompensationAmt>228070</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Hi-Tech Cleaning</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>6578 Roger Drive</AddressLine1Txt>
            <AddressLine2Txt>Suite A</AddressLine2Txt>
            <CityNm>Jenison</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49428</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Cleaning Service</ServicesDesc>
        <CompensationAmt>141008</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Michigan Primary Care Association</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>7215 W Shire Drive</AddressLine1Txt>
            <CityNm>Lansing</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48917</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Computer Server Hosting</ServicesDesc>
        <CompensationAmt>96827</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Net Express Inc</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 280</AddressLine1Txt>
            <CityNm>Farmington</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48332</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Telephone/Internet Service</ServicesDesc>
        <CompensationAmt>111085</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>0</FederatedCampaignsAmt>
      <MembershipDuesAmt>0</MembershipDuesAmt>
      <FundraisingAmt>0</FundraisingAmt>
      <RelatedOrganizationsAmt>0</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>7386037</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>0</AllOtherContributionsAmt>
      <NoncashContributionsAmt>0</NoncashContributionsAmt>
      <TotalContributionsAmt>7386037</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>11312828</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>11312828</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp />
      <TotalOthProgramServiceRevGrp />
      <TotalProgramServiceRevenueAmt>11312828</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp />
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>24627</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>24627</RelatedOrExemptFuncIncomeAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp />
      <GrossRentsGrp>
        <RealAmt>198778</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp />
      <RentalIncomeOrLossGrp>
        <RealAmt>198778</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>198788</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>198788</RelatedOrExemptFuncIncomeAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>654725</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp />
      <GainOrLossGrp>
        <SecuritiesAmt>654725</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>654725</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>654725</RelatedOrExemptFuncIncomeAmt>
      </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>
      <OtherRevenueMiscGrp>
        <Desc>Misc</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>346126</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>346126</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>346126</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>19923131</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12537094</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2068185</TotalAmt>
        <ProgramServicesAmt>1481206</ProgramServicesAmt>
        <ManagementAndGeneralAmt>586979</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>6293467</TotalAmt>
        <ProgramServicesAmt>4052359</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2241108</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>271152</TotalAmt>
        <ProgramServicesAmt>179444</ProgramServicesAmt>
        <ManagementAndGeneralAmt>91708</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2099243</TotalAmt>
        <ProgramServicesAmt>1235601</ProgramServicesAmt>
        <ManagementAndGeneralAmt>863642</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>580817</TotalAmt>
        <ProgramServicesAmt>365874</ProgramServicesAmt>
        <ManagementAndGeneralAmt>214943</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>443813</TotalAmt>
        <ProgramServicesAmt>3960</ProgramServicesAmt>
        <ManagementAndGeneralAmt>439853</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>36900</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36900</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesAccountingGrp>
      <AdvertisingGrp>
        <TotalAmt>101531</TotalAmt>
        <ProgramServicesAmt>7679</ProgramServicesAmt>
        <ManagementAndGeneralAmt>93852</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>3050202</TotalAmt>
        <ProgramServicesAmt>2776987</ProgramServicesAmt>
        <ManagementAndGeneralAmt>273215</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>359827</TotalAmt>
        <ProgramServicesAmt>159662</ProgramServicesAmt>
        <ManagementAndGeneralAmt>200165</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>363531</TotalAmt>
        <ProgramServicesAmt>209646</ProgramServicesAmt>
        <ManagementAndGeneralAmt>153885</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>39174</TotalAmt>
        <ProgramServicesAmt>13966</ProgramServicesAmt>
        <ManagementAndGeneralAmt>25208</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>64778</TotalAmt>
        <ProgramServicesAmt>37534</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27244</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>642690</TotalAmt>
        <ProgramServicesAmt>581110</ProgramServicesAmt>
        <ManagementAndGeneralAmt>61580</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>29894</TotalAmt>
        <ProgramServicesAmt>29894</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Equipment &amp; Repair Expense</Desc>
        <TotalAmt>416836</TotalAmt>
        <ProgramServicesAmt>384133</ProgramServicesAmt>
        <ManagementAndGeneralAmt>32703</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Purchased &amp; Contract Services</Desc>
        <TotalAmt>1184343</TotalAmt>
        <ProgramServicesAmt>1166993</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17350</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>439469</TotalAmt>
        <ProgramServicesAmt>281380</ProgramServicesAmt>
        <ManagementAndGeneralAmt>158089</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>18485852</TotalAmt>
        <ProgramServicesAmt>12967428</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5518424</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>557794</BOYAmt>
        <EOYAmt>2099914</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2056594</BOYAmt>
        <EOYAmt>2684575</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>486498</BOYAmt>
        <EOYAmt>822724</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1293985</BOYAmt>
        <EOYAmt>921175</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>542303</BOYAmt>
        <EOYAmt>537991</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>229484</BOYAmt>
        <EOYAmt>276715</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>6929237</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>8075259</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>6797555</BOYAmt>
        <EOYAmt>6929237</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>34518</BOYAmt>
        <EOYAmt>16388</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <TotalAssetsGrp>
        <BOYAmt>11998731</BOYAmt>
        <EOYAmt>14288719</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1211537</BOYAmt>
        <EOYAmt>1591779</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>350671</BOYAmt>
        <EOYAmt>317147</EOYAmt>
      </DeferredRevenueGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1915376</BOYAmt>
        <EOYAmt>2421364</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>3477584</BOYAmt>
        <EOYAmt>4330290</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>8521147</BOYAmt>
        <EOYAmt>9958429</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <CapStkTrPrinCurrentFundsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </CapStkTrPrinCurrentFundsGrp>
      <PdInCapSrplsLandBldgEqpFundGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PdInCapSrplsLandBldgEqpFundGrp>
      <RtnEarnEndowmentIncmOthFndsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RtnEarnEndowmentIncmOthFndsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>8521147</BOYAmt>
        <EOYAmt>9958429</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>11998731</BOYAmt>
        <EOYAmt>14288719</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>1437279</ReconcilationRevenueExpnssAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <AcctCompileOrReviewBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </AcctCompileOrReviewBasisGrp>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="ScheduleA" documentName="IRS990ScheduleA">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <SupportedOrganizationsCnt>0</SupportedOrganizationsCnt>
      <SupportedOrganizationsTotalCnt>0</SupportedOrganizationsTotalCnt>
      <SupportSumAmt>0</SupportSumAmt>
      <OtherSupportSumAmt>0</OtherSupportSumAmt>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>4100929</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3326802</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3412423</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3876773</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7386037</CurrentTaxYearAmt>
        <TotalAmt>22102964</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TaxRevLeviedOrgnztnlBnft170Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </TaxRevLeviedOrgnztnlBnft170Grp>
      <GovtFurnSrvcFcltsVl170Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </GovtFurnSrvcFcltsVl170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>4100929</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3326802</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3412423</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3876773</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7386037</CurrentTaxYearAmt>
        <TotalAmt>22102964</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>22102964</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>209066</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>483306</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>33032</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>544962</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>654725</CurrentTaxYearAmt>
        <TotalAmt>1925091</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <UnrelatedBusinessNetIncm170Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </UnrelatedBusinessNetIncm170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>4309995</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3810108</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3445455</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4421735</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>8040762</CurrentTaxYearAmt>
        <TotalAmt>24028055</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>48056110</TotalSupportAmt>
      <PublicSupportCY170Pct>0.45990</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.45990</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="ScheduleD" documentName="IRS990ScheduleD">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>188192</OtherCostOrOtherBasisAmt>
        <BookValueAmt>188192</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>11778972</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>5820482</DepreciationAmt>
        <BookValueAmt>5958490</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp />
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>2775527</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2060073</DepreciationAmt>
        <BookValueAmt>715454</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>261805</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>194704</DepreciationAmt>
        <BookValueAmt>67101</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>6929237</TotalBookValueLandBuildingsAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="ScheduleJ" documentName="IRS990ScheduleJ">
      <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>James Raschke</PersonNm>
        <TitleTxt>Chief Executive Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>176891</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>3972</BonusFilingOrganizationAmount>
        <TotalCompensationFilingOrgAmt>180863</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>William Collin</PersonNm>
        <TitleTxt>Chief Financial Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>143626</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>5016</CompensationBasedOnRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>143626</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>5016</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Allison Hubbard</PersonNm>
        <TitleTxt>Human Resources Director</TitleTxt>
        <BaseCompensationFilingOrgAmt>90065</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>3804</BonusFilingOrganizationAmount>
        <TotalCompensationFilingOrgAmt>93869</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jennifer Shamel</PersonNm>
        <TitleTxt>Chief Operations Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>77223</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>6243</BonusFilingOrganizationAmount>
        <TotalCompensationFilingOrgAmt>83466</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jeffrey Strickler</PersonNm>
        <TitleTxt>Chief Medical Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>80139</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <TotalCompensationFilingOrgAmt>80139</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="ScheduleO" documentName="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents, conflict of interest policy, and financial statements are made available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>VI, 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>Subsequent to completion, a copy of the 990 is reviewed by the Executive Director and the Executive Committee of the Board of Directors prior to submission to the IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>VI, 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>At the time of initial election, and annually thereafter, each board member shall be asked to complete and file a Disclosure of Certain Interests form. Before discussion of each issue at a Committee or Board Meeting, board members should voluntarily state any conflict of interest they may have. When a conflict of interest is established, members with a conflict may not participate in the discussion or vote on the matter before the body.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>VI, 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Directors provide regular annual performance evaluations of the Executive Director in which compensation is determined and approved for the following year. The Executive Director provides annual performance evaluations for other officers and top management officials, while reporting and justifying compensation changes to the Board Executive Committee.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>VI, 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents, conflict of interest policy, and financial statements are made available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <ReasonableCauseExplanation documentId="ReasonableCauseExplanation" documentName="ReasonableCauseExplanation">
      <ExplanationTxt>The return was filed on time per our extension. The form was not returned to us until June 14, 2022, so we were not aware that it was required to be electronically filed.</ExplanationTxt>
    </ReasonableCauseExplanation>
  </ReturnData>
</Return>