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        <ExclusionAmt>52608</ExclusionAmt>
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      <GrantsToDomesticOrgsGrp>
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      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
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        <ProgramServicesAmt>3000</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
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      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
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        <ManagementAndGeneralAmt>165814</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
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        <ProgramServicesAmt>6874513</ProgramServicesAmt>
        <ManagementAndGeneralAmt>920706</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>55673</ProgramServicesAmt>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>905233</ProgramServicesAmt>
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      <PayrollTaxesGrp>
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        <ProgramServicesAmt>572416</ProgramServicesAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>62116</TotalAmt>
        <ManagementAndGeneralAmt>62116</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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        <ManagementAndGeneralAmt>43098</ManagementAndGeneralAmt>
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      <FeesForServicesLobbyingGrp>
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      <FeesForServicesProfFundraising>
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      <FeesForSrvcInvstMgmntFeesGrp>
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      <FeesForServicesOtherGrp>
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      <AdvertisingGrp>
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        <ManagementAndGeneralAmt>80045</ManagementAndGeneralAmt>
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      <OfficeExpensesGrp>
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        <ManagementAndGeneralAmt>156780</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>70831</ManagementAndGeneralAmt>
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      <RoyaltiesGrp>
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        <ProgramServicesAmt>324595</ProgramServicesAmt>
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      <TravelGrp>
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      <PymtTravelEntrtnmntPubOfclGrp>
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        <ProgramServicesAmt>235786</ProgramServicesAmt>
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      <PaymentsToAffiliatesGrp>
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        <ProgramServicesAmt>1178726</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>NURSING SUPPLIES AND DRUG COST</Desc>
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        <ProgramServicesAmt>954473</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>468354</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
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      <AllOtherExpensesGrp>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>12749774</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2165602</ManagementAndGeneralAmt>
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        <EOYAmt>1231019</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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      <EscrowAccountLiabilityGrp>
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      <LoansFromOfficersDirectorsGrp>
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        <EOYAmt>7929011</EOYAmt>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
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    <IRS990ScheduleB documentId="IRS990ScheduleB">
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        <ContributorUSAddress>
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    <IRS990ScheduleD documentId="IRS990ScheduleD">
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      <LandGrp>
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      <BuildingsGrp>
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      </BuildingsGrp>
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        <DepreciationAmt>3050886</DepreciationAmt>
        <BookValueAmt>631914</BookValueAmt>
      </EquipmentGrp>
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      <OtherLiabilitiesOrgGrp>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <SubstantialCompletionYr>2001</SubstantialCompletionYr>
        <CurrentRefundingInd>true</CurrentRefundingInd>
        <AdvanceRefundingInd>false</AdvanceRefundingInd>
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        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
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        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00000</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
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        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
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        <ProcsNonqualifiedBondRemdtdInd>false</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
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        <RebateNotDueYetInd>true</RebateNotDueYetInd>
        <ExceptionToRebateInd>true</ExceptionToRebateInd>
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        <VariableRateIssueInd>true</VariableRateIssueInd>
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        <WrittenProcToMonitorReqsInd>false</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
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        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
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    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>Members elect the directors and committee members at annual Board Meeting.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>Directors elect the officers and management committee members after annual Board Meeting.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>Directors report to the Members at the Annual Members meeting. Reports are reviewed, discussed and approved if agreed upon</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ANNUAL FORM 990 is handed to directors/members and reviewed at quarterly meeting following completion of return.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>Management Committee meets monthly and reports to Directors quarterly.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The annual compensation review includes documentation of peer level compensation information and analysis of peer review performance. Executive Director's compensation is reviewed by management committee, after related officers are excused. Employee compensation based on merit and cost of living increases.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THIS INFORMATION IS AVAILABLE IN THE BUSINESS OFFICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>James Stefo Sr. is the father of James Stefo Jr.</ExplanationTxt>
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