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        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>131574</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>21454</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GERARD A HAMANN</PersonNm>
        <TitleTxt>CONTROLLER</TitleTxt>
        <AverageHoursPerWeekRt>20.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>127553</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>22031</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NANCY KOWAL</PersonNm>
        <TitleTxt>CHIEF COMPLIANCE OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>20.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>139565</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>21826</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>3310622</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>212000</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>286458</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>20</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ENVISION PHARMACEUTICAL SERVICES</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2181 E AURORA RD STE 201</AddressLine1Txt>
            <CityNm>MINNEAPOLIS</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>55401</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHARMACY BENEFITS MANAGEMENT</ServicesDesc>
        <CompensationAmt>33852766</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>UNIVERSAL HEALTH MANAGEMENT</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <CityNm>CLINTON TOWNSHIP</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48038</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ADMINISTRATIVE SERVICES COMPANY</ServicesDesc>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
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          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>3915 SECURITY PARK DRIVE SUITE B</AddressLine1Txt>
            <CityNm>RANCHO CORDOVA</CityNm>
            <StateAbbreviationCd>CA</StateAbbreviationCd>
            <ZIPCd>95742</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>DRG VALIDATION</ServicesDesc>
        <CompensationAmt>329220</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>EQUIAN</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>P O BOX 641</AddressLine1Txt>
            <CityNm>INDIANAPOLIS</CityNm>
            <StateAbbreviationCd>IN</StateAbbreviationCd>
            <ZIPCd>46250</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>FRAUD, WASTE &amp; ABUSE INVESTIGATIONS</ServicesDesc>
        <CompensationAmt>119822</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>HUMAN ARC CORP</BusinessNameLine1Txt>
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        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <CityNm>CINCINNATI</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45263</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>OUTREACH CONVERSION</ServicesDesc>
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      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <ProgramServiceRevenueGrp>
        <Desc>MEDICAID CAPITATION</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>284119555</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>284119555</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>284119555</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
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        <ExclusionAmt>186085</ExclusionAmt>
      </InvestmentIncomeGrp>
      <TotalRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>284119555</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>186085</ExclusionAmt>
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      <BenefitsToMembersGrp>
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        <ProgramServicesAmt>241059225</ProgramServicesAmt>
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      <InsuranceGrp>
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        <ManagementAndGeneralAmt>268812</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
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        <ManagementAndGeneralAmt>26382257</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>USE TAX</Desc>
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        <ManagementAndGeneralAmt>16673754</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>CLAIMS TAX EXPENSE</Desc>
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        <ManagementAndGeneralAmt>1698799</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>241059225</ProgramServicesAmt>
        <ManagementAndGeneralAmt>45023622</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <CashNonInterestBearingGrp>
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        <EOYAmt>37746299</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>5135088</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>9717961</EOYAmt>
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      <InvestmentsOtherSecuritiesGrp>
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        <EOYAmt>31786398</EOYAmt>
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        <EOYAmt>186286</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>84572032</EOYAmt>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>36635701</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrgDoesNotFollowSFAS117Ind>X</OrgDoesNotFollowSFAS117Ind>
      <CapStkTrPrinCurrentFundsGrp>
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        <EOYAmt>0</EOYAmt>
      </CapStkTrPrinCurrentFundsGrp>
      <PdInCapSrplsLandBldgEqpFundGrp>
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        <EOYAmt>0</EOYAmt>
      </PdInCapSrplsLandBldgEqpFundGrp>
      <RtnEarnEndowmentIncmOthFndsGrp>
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      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>47936331</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
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        <EOYAmt>84572032</EOYAmt>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-1777207</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>6698152</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
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      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleD documentId="RetDoc1040000001">
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      <OtherSecuritiesGrp>
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        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <OtherSecuritiesGrp>
        <Desc>INVESTMENT IN SUBSIDIARIES</Desc>
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        <MethodValuationCd>C</MethodValuationCd>
      </OtherSecuritiesGrp>
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      <RevenueSubtotalAmt>284305640</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
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      <ExpensesSubtotalAmt>286082847</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>286082847</TotalExpensesPerForm990Amt>
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    <IRS990ScheduleJ documentId="RetDoc1042400001">
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      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
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      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
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      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>1230446</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>12957</DeferredCompensationFlngOrgAmt>
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        <NontaxableBenefitsFilingOrgAmt>19519</NontaxableBenefitsFilingOrgAmt>
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        <TotalCompensationFilingOrgAmt>291618</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NOAH MONRO</PersonNm>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>7837</DeferredCompensationFlngOrgAmt>
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        <NontaxableBenefitsFilingOrgAmt>15366</NontaxableBenefitsFilingOrgAmt>
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        <TotalCompensationFilingOrgAmt>179942</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>13250</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>333062</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
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        <DeferredCompensationFlngOrgAmt>7376</DeferredCompensationFlngOrgAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KANU PATEL</PersonNm>
        <TitleTxt>ADMINISTRATION</TitleTxt>
        <BaseCompensationFilingOrgAmt>108074</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>23500</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>6579</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>14875</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>153028</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NANCY KOWAL</PersonNm>
        <TitleTxt>CHIEF COMPLIANCE OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>87065</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>52500</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>6978</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>14848</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>161391</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SEE SCHEDULE O FOR ADDITIONAL REPORTING.</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION FOR THE FOLLOWING INDIVIDUALS REPORTED ON PART VII, COLUMN D IS FROM UNIVERSAL HEALTH MANAGEMENT, LLC., AN ADMINISTRATIVE SERVICES COMPANY. SEE SCHEDULE O FOR ADDITIONAL REPORTING. RANDY NAROWITZ ROBYN J ARRINGTON,JR,MD HAROLD ARRINGTON, MD NOAH MONRO NICOLE ROUSH LINDA ALEXANDER GERALD HAMANN NANCY KOWAL SUSAN STIMPLE KANU PATEL SUSAN RYAN</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <BusinessName>
            <BusinessNameLine1Txt>UNIVERSAL HEALTH MANAGEMENT LLC</BusinessNameLine1Txt>
          </BusinessName>
        </NameOfInterested>
        <RelationshipDescriptionTxt>ROBYN J. ARRINGTON, JR., MD INDIRECTLY OWNS MORE THAN 35% OF UHM, LLC.</RelationshipDescriptionTxt>
        <TransactionAmt>26382257</TransactionAmt>
        <TransactionDesc>ADMINISTRATIVE SERVICES COMPANY</TransactionDesc>
        <SharingOfRevenuesInd>1</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP: RANDY NAROWITZ, NICOLE ROUSH, ROBYN ARRINGTON, HAROLD ARRINGTON, NANCY KOWAL, NOAH MONRO, LINDA ALEXANDER, KANU PATEL, SUSAN RYAN, GERARD HAMANN AND SUSAN STIMPLE. THE FOLLOWING INDIVIDUALS HAVE A FAMILY RELATIONSHIP: HAROLD ARRINGTON AND ROBYN ARRINGTON.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THC HAS CONTRACTED WITH AN ADMINISTRATIVE SERVICES COMPANY, UNIVERSAL HEALTH MANAGEMENT LLC, TO PERFORM THESE FUNCTIONS, SUCH AS HIRING THE NECESSARY EMPLOYEES. THE PERFORMANCE OF THESE SERVICES BY UHM IS SUBJECT TO OVERSIGHT BY THE BOARD OF TOTAL HEALTH CARE, INC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>THE TAX RETURN IS REVIEWED BY ITS CHIEF FINANCIAL OFFICER AND EXECUTIVE DIRECTOR BEFORE FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>TOTAL HEALTH CARE, INC. HAS A CONFLICT OF INTEREST POLICY THAT COVERS ALL EMPLOYEES, WHICH REQUIRES NOTIFICATION TO THE COO OR CEO OF ANY POTENTIAL CONFLICTS. FAILURE TO DO SO PUTS THE EMPLOYEE AT RISK OF TERMINATION. OFFICERS AND BOARD MEMBERS ARE REQUIRED TO ANNUALLY CERTIFY THE CONFLICT OF INTEREST STATEMENT, WHICH ALSO REQUIRES NOTIFICATION TO THE BOARD OF DIRECTORS IF ANY POTENTIAL CONFLICTS ARISE DURING THE YEAR. THE ANNUAL STATEMENTS ARE REVIEWED BY THE EXECUTIVE AND BOARD CHAIR IF THERE ARE CONCERNS ABOUT POTENTIAL CONFLICTS. IF ANY CONFLICT EXISTS, THE INDIVIDUAL WOULD ABSTAIN FROM ANY ACTION OR INVOLVEMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL COMPENSATION IS PAID BY AN ADMINISTRATIVE SERVICES COMPANY, UNIVERSAL HEALTH MANAGEMENT LLC. HOWEVER, BEGINNING IN 2017, COMPENSATION FOR THE CEO AND OTHER TOP MANAGEMENT OFFICIALS IS DISCUSSED AND APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR OTHER OFFICERS OR KEY EMPLOYEES IS REVIEWED AND APPROVED BY THE TOP MANAGEMENT OFFICIALS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>ORGANIZATIONAL DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>INCOME FROM SUBSIDIARY EQUITY INVESTMENT - TOTAL HEALTHCARE USA 6,698,152.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE HAVE BEEN NO CHANGES FROM PRIOR YEAR TO THE OVERSIGHT RESPONSIBILITIES OF THE AUDIT COMMITTEE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>990 PART IV, LINE 12:</FormAndLineReferenceDesc>
        <ExplanationTxt>TOTAL HEALTH CARE, INC. HAS ITS FINANCIAL STATEMENTS AUDITED UNDER THE STATUTORY BASIS OF ACCOUNTING, AS OPPOSED TO UNDER THE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) BASIS OF ACCOUNTING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII, COLUMN (D) &amp; SCHEDULE J, PART II, ROW (I):</FormAndLineReferenceDesc>
        <ExplanationTxt>TOTAL HEALTH CARE INC., HAS ENTERED INTO AN ADMINISTRATIVE SERVICES CONTRACT WITH AN ADMINISTRATIVE SERVICES COMPANY, UNIVERSAL HEALTH MANAGEMENT, LLC. ALL SALARIES AND BENEFITS ARE PAID BY THE ADMINISTRATIVE SERVICES COMPANY TO ITS EMPLOYEES WHO PROVIDE SERVICES TO TOTAL HEALTH CARE, INC. THE AMOUNTS SHOWN AS COMPENSATION FOR THE OFFICERS AND EMPLOYEES ON SCHEDULE J ARE THE TOTAL W-2 COMPENSATION FOR THE YEAR. ONLY A PORTION OF THIS COMPENSATION IS ATTRIBUTABLE TO THEIR SERVICES FOR TOTAL HEALTH CARE, INC. THE REMAINING SERVICES ARE ATTRIBUTABLE TO A RELATED ENTITY, TOTAL HEALTH CARE USA, INC.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>TOTAL HEALTH CARE USA INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>3011 W GRAND BLVD SUITE 1600</AddressLine1Txt>
          <CityNm>DETROIT</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>48202</ZIPCd>
        </USAddress>
        <EIN>383240485</EIN>
        <PrimaryActivitiesTxt>HMO</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MI</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>IRC CODE 501(c)(4)</ExemptCodeSectionTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>TOTAL HEALTH CARE INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
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      <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>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
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          <BusinessNameLine1Txt>TOTAL HEALTH CARE USA INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>Q</TransactionTypeTxt>
        <InvolvedAmt>9453592</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>ACTUAL COSTS</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>