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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18136</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DR MARCELLE MOSTERT</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>17.50</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>290072</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>8733</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID PFALZER</PersonNm>
        <TitleTxt>NURSE PRACTITIONER</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>179487</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>23604</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CYNTHIA VOELKER</PersonNm>
        <TitleTxt>ASSOCIATE CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>163359</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18792</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JULIE GUTKOWSKI</PersonNm>
        <TitleTxt>MANAGING DIR. OF CLINICAL</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>113085</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>16587</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DONALD DAUMAN</PersonNm>
        <TitleTxt>ASSISTANT CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>129122</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>21439</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK HENDRICKSON</PersonNm>
        <TitleTxt>VP OF HR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>102417</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>10097</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1365129</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>127690</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>8</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>WARSAW REDEVELOPMENT LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2071 CRITTENDEN RD</AddressLine1Txt>
            <CityNm>ALDEN</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14004</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SITE RENT</ServicesDesc>
        <CompensationAmt>288960</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>AIMEE DIPASQUA</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5072 WOODWAY COURT</AddressLine1Txt>
            <CityNm>HAMBURG</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14075</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL CONSULTANT</ServicesDesc>
        <CompensationAmt>204634</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>JEFFREY KASHIN MD</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>925 DELAWARE AVE</AddressLine1Txt>
            <CityNm>BUFFALO</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14209</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL CONSULTANT</ServicesDesc>
        <CompensationAmt>175348</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>COCO ENTERPRISES</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>8158 HILLSIDE ST</AddressLine1Txt>
            <CityNm>ANGOLA</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14006</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>JANITORIAL SERVICES</ServicesDesc>
        <CompensationAmt>127425</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>4</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>5389770</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>833261</AllOtherContributionsAmt>
      <TotalContributionsAmt>6223031</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>14571133</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>14571133</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>14571133</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>1596</TotalRevenueColumnAmt>
        <ExclusionAmt>1596</ExclusionAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <Desc>ADMINISTRATIVE SERVICE FEE</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>573281</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>573281</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>573281</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>21369041</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>15144414</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>1596</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>755723</TotalAmt>
        <ProgramServicesAmt>311374</ProgramServicesAmt>
        <ManagementAndGeneralAmt>444349</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>11221009</TotalAmt>
        <ProgramServicesAmt>9908335</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1312674</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>421774</TotalAmt>
        <ProgramServicesAmt>383742</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38032</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1171680</TotalAmt>
        <ProgramServicesAmt>1005510</ProgramServicesAmt>
        <ManagementAndGeneralAmt>166170</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1097619</TotalAmt>
        <ProgramServicesAmt>953065</ProgramServicesAmt>
        <ManagementAndGeneralAmt>144554</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>42561</TotalAmt>
        <ManagementAndGeneralAmt>42561</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>55700</TotalAmt>
        <ManagementAndGeneralAmt>55700</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1653435</TotalAmt>
        <ProgramServicesAmt>1548227</ProgramServicesAmt>
        <ManagementAndGeneralAmt>105208</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>256703</TotalAmt>
        <ProgramServicesAmt>203246</ProgramServicesAmt>
        <ManagementAndGeneralAmt>53457</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>148369</TotalAmt>
        <ProgramServicesAmt>148369</ProgramServicesAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>1728341</TotalAmt>
        <ProgramServicesAmt>1578139</ProgramServicesAmt>
        <ManagementAndGeneralAmt>150202</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>340089</TotalAmt>
        <ProgramServicesAmt>291775</ProgramServicesAmt>
        <ManagementAndGeneralAmt>48314</ManagementAndGeneralAmt>
      </TravelGrp>
      <InterestGrp>
        <TotalAmt>100071</TotalAmt>
        <ProgramServicesAmt>100071</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>192318</TotalAmt>
        <ProgramServicesAmt>184302</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8016</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>65352</TotalAmt>
        <ProgramServicesAmt>49533</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15819</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>EQUIPMENT</Desc>
        <TotalAmt>353744</TotalAmt>
        <ProgramServicesAmt>343794</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9950</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>CLIENT NEEDS</Desc>
        <TotalAmt>225601</TotalAmt>
        <ProgramServicesAmt>225601</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>STAFF DEVELOPMENT</Desc>
        <TotalAmt>177597</TotalAmt>
        <ProgramServicesAmt>177597</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MATERIALS &amp; SUPPLIES</Desc>
        <TotalAmt>132265</TotalAmt>
        <ProgramServicesAmt>132265</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>362663</TotalAmt>
        <ProgramServicesAmt>196146</ProgramServicesAmt>
        <ManagementAndGeneralAmt>166517</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>20502614</TotalAmt>
        <ProgramServicesAmt>17741091</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2761523</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>5300</BOYAmt>
        <EOYAmt>5320</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>1313453</BOYAmt>
        <EOYAmt>835029</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>2693653</BOYAmt>
        <EOYAmt>2505319</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>92712</BOYAmt>
        <EOYAmt>83187</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>3092419</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>2222427</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>960371</BOYAmt>
        <EOYAmt>869992</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>445662</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>5065489</BOYAmt>
        <EOYAmt>4744509</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1423822</BOYAmt>
        <EOYAmt>1438135</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>2092803</BOYAmt>
        <EOYAmt>730111</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>562872</BOYAmt>
        <EOYAmt>278182</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>4079497</BOYAmt>
        <EOYAmt>2446428</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>985992</BOYAmt>
        <EOYAmt>2298081</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>985992</BOYAmt>
        <EOYAmt>2298081</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>5065489</BOYAmt>
        <EOYAmt>4744509</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>866427</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>445662</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>1</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>3985555</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4517712</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4566084</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5946973</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>6223031</CurrentTaxYearAmt>
        <TotalAmt>25239355</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>3985555</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4517712</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4566084</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5946973</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>6223031</CurrentTaxYearAmt>
        <TotalAmt>25239355</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>25239355</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>4704</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>686</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>666</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>631</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1596</CurrentTaxYearAmt>
        <TotalAmt>8283</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>3388</CurrentTaxYearMinus4YearsAmt>
        <TotalAmt>3388</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>25251026</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>63707238</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.99950</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.99950</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001" />
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>460706</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>405441</DepreciationAmt>
        <BookValueAmt>55265</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1002138</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>817543</DepreciationAmt>
        <BookValueAmt>184595</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>1629575</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>999443</DepreciationAmt>
        <BookValueAmt>630132</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>869992</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>BENEFICIAL INTEREST IN THE FOUNDATION</Desc>
        <BookValueAmt>445662</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>445662</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>REFUNDABLE ADVANCES</Desc>
        <Amt>278182</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>278182</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>21419845</TotalRevEtcAuditedFinclStmtAmt>
      <OtherRevenueAmt>50804</OtherRevenueAmt>
      <RevenueNotReportedAmt>50804</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>21369041</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>21369041</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>20502614</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>20502614</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>20502614</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION IS EXEMPT FROM TAXATION UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE.THE TAX RETURNS FOR THE TAX YEARS 2013 THROUGH 2017 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR US. FEDERAL TAX PURPOSES AND ALSO BY NEW YORK STATE FOR STATE TAX PURPOSES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN BENEFICIAL INTEREST IN SPECTRUM FOUNDATION 50,804.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BRUCE NISBET</PersonNm>
        <TitleTxt>PRES./CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>222804</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>8153</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>10271</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>31</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>241259</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DAVID WAWRZYNEK</PersonNm>
        <TitleTxt>CIO</TitleTxt>
        <BaseCompensationFilingOrgAmt>156630</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <TotalCompensationFilingOrgAmt>174766</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DAVID PFALZER</PersonNm>
        <TitleTxt>NURSE PRACTITIONER</TitleTxt>
        <BaseCompensationFilingOrgAmt>179487</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CYNTHIA VOELKER</PersonNm>
        <TitleTxt>ASSOCIATE CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>163359</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>182151</TotalCompensationFilingOrgAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DONALD DAUMAN</PersonNm>
        <TitleTxt>ASSISTANT CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>129122</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5811</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>15628</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>150561</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>PATRICIA NISBET</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>RELATIVE OF BRUCE NISBET, KEY EMPLOYEE</RelationshipDescriptionTxt>
        <TransactionAmt>12000</TransactionAmt>
        <TransactionDesc>MEDICAL CONSULTANT SERVICES</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <BusinessName>
            <BusinessNameLine1Txt>PARKVIEW HEALTH SERVICES</BusinessNameLine1Txt>
          </BusinessName>
        </NameOfInterested>
        <RelationshipDescriptionTxt>OWNED BY ROBERT O'LEARY, MEMBER OF BOARD OF DIRECTORS</RelationshipDescriptionTxt>
        <TransactionAmt>4700</TransactionAmt>
        <TransactionDesc>MEDICAL SUPPLIES</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>SPECTRUM ONLY HAS A BOARD OF DIRECTORS AND FINANCE COMMITTEE. ALL DECISIONS MUST BE APPROVED THROUGH THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS PRESENTED IN DRAFT FORM TO ORGANIZATIONS CFO FOR REVIEW. THE RETURN IS THEN PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>IN ACCORDANCE WITH SPECTRUM'S CONFLICT OF INTEREST POLICY, EACH "OFFICER" INCLUDES ANY NON-DIRECTOR SERVING ON ANY COMMITTEE OF THE BOARD OF DIRECTORS AND DIRECTORS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, B. HAS READ AND UNDERSTANDS THE POLICY, C. HAS AGREED TO COMPLY WITH THE POLICY, AND D. UNDERSTANDS THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES, E. IS NOT AWARE THAT HE OR SHE HAS ANY FINANCIAL INTEREST OR, IF HE OR SHE IS AWARE OF ANY FINANCIAL INTEREST, A DESCRIPTION OF ALL MATERIAL FACT CONCERNING IT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD SUBCOMMITTEE HAS THE RESPONSIBILITY TO DETERMINE THE COMPENSATION OF KEY EMPLOYEES. THE PURPOSE OF THE COMMITTEE IS TO APPROVE ANNUAL PERFORMANCE STANDARDS AND TO DETERMINE APPROPRIATE PERFORMANCE MEASURES AND ESTABLISH CRITERIA FOR ANY INCENTIVE BASED COMPENSATION. IT ALSO ANNUALLY REVIEWS AND APPROVES ANY CHANGES TO THE TOTAL COMPENSATION OF KEY EMPLOYEES. THE COMMITTEE DETERMINES IF THE COMPENSATION IS REASONABLE. TO ACCOMPLISH THIS, THE COMMITTEE WILL OBTAIN COMPARABLE COMPENSATION DATA FOR EXECUTIVES OF OTHER NON PROFIT ORGANIZATIONS OF SIMILAR SIZE IN THE WESTERN NEW YORK AREA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON ITS OWN WEBSITE. COPIES CAN BE PROVIDED UPON REQUEST BY PHONE, IN WRITING, OR VIA E-MAIL. A COPY OF THE 990 CAN BE FOUND THROUGH THE WEBSITE WWW.GUIDESTAR.ORG.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>NET ASSETS OF SPECTRUM FOUNDATION 445,662.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990; PART XI; LINE 2C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>SPECTRUM HUMAN SERVICES FOUNDATION INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>227 THORN AVENUE-PO BOX 631</AddressLine1Txt>
          <CityNm>ORCHARD PARK</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14127</ZIPCd>
        </USAddress>
        <EIN>222832638</EIN>
        <PrimaryActivitiesTxt>SUPPORT THE MISSION OF SPECTRUM HUMAN SERVICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 12C, III-FI</PublicCharityStatusTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>1</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
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      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>SPECTRUM HUMAN SERVICE FOUNDATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>K</TransactionTypeTxt>
        <InvolvedAmt>299978</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>COST</MethodOfAmountDeterminationTxt>
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    </IRS990ScheduleR>
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</Return>