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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>38 Waring Welfare Rd</AddressLine1Txt>
            <CityNm>Boerne</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>78006</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Physician Assistant</ServicesDesc>
        <CompensationAmt>100395</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>2</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>3624474</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>142490</AllOtherContributionsAmt>
      <TotalContributionsAmt>3766964</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient Fees</Desc>
        <BusinessCd>621111</BusinessCd>
        <TotalRevenueColumnAmt>1742648</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>1742648</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>5662</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <Desc>Other Revenue</Desc>
        <BusinessCd>621498</BusinessCd>
        <TotalRevenueColumnAmt>28563</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>28563</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>28563</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>5543837</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1776873</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>710765</TotalAmt>
        <ProgramServicesAmt>273327</ProgramServicesAmt>
        <ManagementAndGeneralAmt>437438</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <OtherSalariesAndWagesGrp>
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        <ProgramServicesAmt>1869357</ProgramServicesAmt>
        <ManagementAndGeneralAmt>577493</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>167237</TotalAmt>
        <ProgramServicesAmt>106658</ProgramServicesAmt>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>199408</ProgramServicesAmt>
        <ManagementAndGeneralAmt>109353</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <PayrollTaxesGrp>
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        <ManagementAndGeneralAmt>10771</ManagementAndGeneralAmt>
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      <FeesForServicesLegalGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>99</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>34145</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesAccountingGrp>
      <AdvertisingGrp>
        <TotalAmt>237</TotalAmt>
        <ProgramServicesAmt>107</ProgramServicesAmt>
        <ManagementAndGeneralAmt>130</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>106755</TotalAmt>
        <ProgramServicesAmt>37746</ProgramServicesAmt>
        <ManagementAndGeneralAmt>69009</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>142616</TotalAmt>
        <ProgramServicesAmt>581</ProgramServicesAmt>
        <ManagementAndGeneralAmt>142035</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <OccupancyGrp>
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        <ProgramServicesAmt>41941</ProgramServicesAmt>
        <ManagementAndGeneralAmt>52175</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <TravelGrp>
        <TotalAmt>30088</TotalAmt>
        <ProgramServicesAmt>20440</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9648</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>43744</TotalAmt>
        <ProgramServicesAmt>26076</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17668</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <InterestGrp>
        <TotalAmt>5977</TotalAmt>
        <ProgramServicesAmt>1235</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4742</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <DepreciationDepletionGrp>
        <TotalAmt>146012</TotalAmt>
        <ProgramServicesAmt>99898</ProgramServicesAmt>
        <ManagementAndGeneralAmt>46114</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <InsuranceGrp>
        <TotalAmt>30446</TotalAmt>
        <ProgramServicesAmt>29749</ProgramServicesAmt>
        <ManagementAndGeneralAmt>697</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Maintenance/Repairs</Desc>
        <TotalAmt>34701</TotalAmt>
        <ProgramServicesAmt>27385</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7316</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>Recruiting</Desc>
        <TotalAmt>11049</TotalAmt>
        <ProgramServicesAmt>10000</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1049</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>Patient Care Services</Desc>
        <TotalAmt>476993</TotalAmt>
        <ProgramServicesAmt>476993</ProgramServicesAmt>
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        <FundraisingAmt>0</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>Supplies</Desc>
        <TotalAmt>412029</TotalAmt>
        <ProgramServicesAmt>351118</ProgramServicesAmt>
        <ManagementAndGeneralAmt>60911</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>3783567</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1721435</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <CashNonInterestBearingGrp>
        <BOYAmt>1755555</BOYAmt>
        <EOYAmt>1512448</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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        <EOYAmt>478291</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>362055</EOYAmt>
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      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>195</BOYAmt>
        <EOYAmt>22188</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>89816</BOYAmt>
        <EOYAmt>42742</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>19780</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>4640391</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>2498681</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>2187246</BOYAmt>
        <EOYAmt>2141710</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>4565051</BOYAmt>
        <EOYAmt>4579214</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>300341</BOYAmt>
        <EOYAmt>275671</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>300341</BOYAmt>
        <EOYAmt>275671</EOYAmt>
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      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>4264710</BOYAmt>
        <EOYAmt>4303543</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>4264710</BOYAmt>
        <EOYAmt>4303543</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>4565051</BOYAmt>
        <EOYAmt>4579214</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>38835</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>-2</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>false</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
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      <OtherSupportSumAmt>0</OtherSupportSumAmt>
      <PublicSupportCY170Pct>0</PublicSupportCY170Pct>
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        <CurrentTaxYearMinus4YearsAmt>2991426</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3385994</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3488790</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3641532</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3766964</CurrentTaxYearAmt>
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      <GrossReceiptsAdmissionsGrp>
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        <CurrentTaxYearMinus3YearsAmt>1796640</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1976290</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1764665</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1742648</CurrentTaxYearAmt>
        <TotalAmt>9140942</TotalAmt>
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      <GrossReceiptsNonUnrltBusGrp>
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      <TaxRevLeviedOrgnztnlBnft509Grp>
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      </TaxRevLeviedOrgnztnlBnft509Grp>
      <Total509Grp>
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        <CurrentTaxYearMinus3YearsAmt>5182634</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5465080</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5406197</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5509612</CurrentTaxYearAmt>
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      <AmountsRcvdDsqlfyPersonGrp>
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        <CurrentTaxYearMinus3YearsAmt>2725</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3604</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4056</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5562</CurrentTaxYearAmt>
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        <CurrentTaxYearMinus2YearsAmt>3604</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4056</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5562</CurrentTaxYearAmt>
        <TotalAmt>18125</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
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        <CurrentTaxYearMinus3YearsAmt>107897</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>90121</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>71201</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>28563</CurrentTaxYearAmt>
        <TotalAmt>367158</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <TotalAmt>26800931</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.98560</PublicSupportCY509Pct>
      <InvestmentIncomeCYPct>0.00070</InvestmentIncomeCYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Pt III Ln 12</FormAndLineReferenceDesc>
        <ExplanationTxt>Other Income Part III, Line 12 Description: Other Income 2014: 69376. 2015: 107897. 2016: 90121. 2017: 71201. 2018: 28563.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
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      <LandGrp>
        <InvestmentCostOrOtherBasisAmt>0</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>21292</OtherCostOrOtherBasisAmt>
        <BookValueAmt>21292</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>3384816</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1580109</DepreciationAmt>
        <BookValueAmt>1804707</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1146845</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>835567</DepreciationAmt>
        <BookValueAmt>311278</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>87438</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>83005</DepreciationAmt>
        <BookValueAmt>4433</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>2141710</TotalBookValueLandBuildingsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>5543837</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>5543837</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>5543837</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>5505002</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>5505002</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>5505002</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="IRS990ScheduleO-01" softwareId="18007482">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Chief Financial Officer reviews the Form 990 in its entirety before signing. The Form 990 will be presented to the Board of Directors as well for their review.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Through training, emails, letters, and disciplinary measures when violations occur</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>Through the National Association of Community Health Centers benefits and yearly surveys in the area.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Through Board of Directors meetings which are open to the public.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization has Board Members are the governing body that provides oversight of management decisions</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>Through the National Association of Community Health Centers benefits and yearly surveys in the area.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt XI</FormAndLineReferenceDesc>
        <ExplanationTxt>Line 9 Rounding adjustments.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>