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      <Form990PartVIISectionAGrp>
        <PersonNm>DARIN SZILAGYI</PersonNm>
        <TitleTxt>VP</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>243616</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>13536</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>THOMAS WILKEN</PersonNm>
        <TitleTxt>SR VP</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>316846</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18536</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ANDREW VON ESCHENBACH</PersonNm>
        <TitleTxt>VP REVENUE CYCLE</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>248940</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>13172</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ALI BIRJANDI</PersonNm>
        <TitleTxt>VP</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>48181</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>653</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARY JACKSON</PersonNm>
        <TitleTxt>VP</TitleTxt>
        <AverageHoursPerWeekRt>20.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>240736</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>9996</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LINDA MOORE</PersonNm>
        <TitleTxt>VP/ATTORNEY</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>297948</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>7074</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARY E DODD</PersonNm>
        <TitleTxt>PROJECT DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>141841</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11094</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHRISTINA RAMSEY</PersonNm>
        <TitleTxt>SYSTEM CONTROLLER</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>140202</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>10533</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT JEHLING</PersonNm>
        <TitleTxt>ASSOCIATE VP</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>196420</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>9911</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SHELLY RUTHERFORD</PersonNm>
        <TitleTxt>FINANCE DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>132199</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>7797</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RICHARD GERTH</PersonNm>
        <TitleTxt>APP COORDINATOR PHARM</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>135842</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>13895</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GIFFORD ECKHOUT MD</PersonNm>
        <TitleTxt>EXECUTIVE VP/DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <FormerOfcrDirectorTrusteeInd>X</FormerOfcrDirectorTrusteeInd>
        <ReportableCompFromOrgAmt>434833</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>15185</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LEE PORTWOOD</PersonNm>
        <TitleTxt>FORMER VP</TitleTxt>
        <AverageHoursPerWeekRt>0.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.0</AverageHoursPerWeekRltdOrgRt>
        <FormerOfcrDirectorTrusteeInd>X</FormerOfcrDirectorTrusteeInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>267178</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>13882</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>6582031</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>3453218</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>327914</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>27</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>true</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>HURON CONSULTING SERVICES LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4795 PAYSHERE CIRCLE</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60674</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSULTING SERVICES</ServicesDesc>
        <CompensationAmt>2455288</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>RELAYHEALTH INC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 98347</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60693</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>BILLING SERVICES</ServicesDesc>
        <CompensationAmt>940806</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>LSQ FUNDING GROUP LC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2600 LUCIEN WAY SUITE 100</AddressLine1Txt>
            <CityNm>MAITLAND</CityNm>
            <StateAbbreviationCd>FL</StateAbbreviationCd>
            <ZIPCd>32751</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>BILLING SERVICES</ServicesDesc>
        <CompensationAmt>781483</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>BRIGGS AND CALDWELL LP</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>9801 WESTHEIMER RD</AddressLine1Txt>
            <CityNm>HOUSTON</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>77042</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ADVERTISING SERVICES</ServicesDesc>
        <CompensationAmt>753216</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>ADVANCED REIMBURSEMENT MANAGEMENT</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4524 SOUTHLAKE PARKWAY STE 15</AddressLine1Txt>
            <CityNm>HOOVER</CityNm>
            <StateAbbreviationCd>AL</StateAbbreviationCd>
            <ZIPCd>35244</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>COLLECTION SERVICES</ServicesDesc>
        <CompensationAmt>542983</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>40</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>24000</RelatedOrganizationsAmt>
      <TotalContributionsAmt>24000</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER OPERATING REVENUE</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>85463486</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>85463486</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>EHR INCENTIVE REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>93290</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>93290</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>85556776</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetRentalIncomeOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetGainOrLossInvestmentsGrp>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>LAUNDRY</Desc>
        <BusinessCd>812300</BusinessCd>
        <TotalRevenueColumnAmt>76965</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>76965</UnrelatedBusinessRevenueAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Rebate Income</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>172103</TotalRevenueColumnAmt>
        <ExclusionAmt>172103</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Miscellaneous Income</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>4640</TotalRevenueColumnAmt>
        <ExclusionAmt>4640</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>253708</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>85834484</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>85556776</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>76965</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>176743</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>226328</TotalAmt>
        <ProgramServicesAmt>226328</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>4328421</TotalAmt>
        <ProgramServicesAmt>3895579</ProgramServicesAmt>
        <ManagementAndGeneralAmt>432842</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>34653826</TotalAmt>
        <ProgramServicesAmt>31188443</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3465383</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>448130</TotalAmt>
        <ProgramServicesAmt>403317</ProgramServicesAmt>
        <ManagementAndGeneralAmt>44813</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2215698</TotalAmt>
        <ProgramServicesAmt>1994128</ProgramServicesAmt>
        <ManagementAndGeneralAmt>221570</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>4350210</TotalAmt>
        <ProgramServicesAmt>3915189</ProgramServicesAmt>
        <ManagementAndGeneralAmt>435021</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>984056</TotalAmt>
        <ProgramServicesAmt>885650</ProgramServicesAmt>
        <ManagementAndGeneralAmt>98406</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>155186</TotalAmt>
        <ProgramServicesAmt>139667</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15519</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>150</TotalAmt>
        <ProgramServicesAmt>135</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>14386854</TotalAmt>
        <ProgramServicesAmt>12948170</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1438684</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>1128436</TotalAmt>
        <ProgramServicesAmt>1015592</ProgramServicesAmt>
        <ManagementAndGeneralAmt>112844</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>2888238</TotalAmt>
        <ProgramServicesAmt>2599414</ProgramServicesAmt>
        <ManagementAndGeneralAmt>288824</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>7466686</TotalAmt>
        <ProgramServicesAmt>6720017</ProgramServicesAmt>
        <ManagementAndGeneralAmt>746669</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>358370</TotalAmt>
        <ProgramServicesAmt>322533</ProgramServicesAmt>
        <ManagementAndGeneralAmt>35837</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>65866</TotalAmt>
        <ProgramServicesAmt>59279</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6587</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>458084</TotalAmt>
        <ProgramServicesAmt>412276</ProgramServicesAmt>
        <ManagementAndGeneralAmt>45808</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>437021</TotalAmt>
        <ProgramServicesAmt>393319</ProgramServicesAmt>
        <ManagementAndGeneralAmt>43702</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>6319251</TotalAmt>
        <ProgramServicesAmt>5687326</ProgramServicesAmt>
        <ManagementAndGeneralAmt>631925</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>60614</TotalAmt>
        <ProgramServicesAmt>54553</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6061</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS AND MAINTENANCE</Desc>
        <TotalAmt>1231522</TotalAmt>
        <ProgramServicesAmt>1108370</ProgramServicesAmt>
        <ManagementAndGeneralAmt>123152</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITMENT</Desc>
        <TotalAmt>2581159</TotalAmt>
        <ProgramServicesAmt>2323043</ProgramServicesAmt>
        <ManagementAndGeneralAmt>258116</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LAUNDRY AND LINEN</Desc>
        <TotalAmt>468499</TotalAmt>
        <ProgramServicesAmt>421649</ProgramServicesAmt>
        <ManagementAndGeneralAmt>46850</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DIETARY</Desc>
        <TotalAmt>77029</TotalAmt>
        <ProgramServicesAmt>69326</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7703</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>523715</TotalAmt>
        <ProgramServicesAmt>471343</ProgramServicesAmt>
        <ManagementAndGeneralAmt>52372</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>85813349</TotalAmt>
        <ProgramServicesAmt>77254646</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8558703</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>562</BOYAmt>
        <EOYAmt>412</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>2369556</BOYAmt>
        <EOYAmt>2537889</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>0</BOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
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        </SupportedOrganizationName>
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          <BusinessNameLine1Txt>TRINITY CLINIC</BusinessNameLine1Txt>
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        <LoanDisqualifiedPersonInd>false</LoanDisqualifiedPersonInd>
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        <ExplanationTxt>MANAGEMENT OF SUPPORTING ORGANIZATION: THE MANAGEMENT OF TRINITY MOTHER FRANCES HEALTH SYSTEM (TMFHS) IS VESTED IN THE SAME PERSONS THAT MANAGE THE MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER (HOSPITAL) AND TRINITY CLINIC (CLINIC). THE BYLAWS STATE THAT THE BOARD OF DIRECTORS OF TMFHS DESIGNATE SYSTEM EXECUTIVES TO MANAGE THE DAILY BUSINESS OF THE ORGANIZATION. THE SYSTEM EXECUTIVES CONSIST OF FOUR MEMBERS. ONE MEMBER IS APPOINTED BY THE CLINIC, ONE MEMBER IS APPOINTED BY THE HOSPITAL, AND THE OTHER TWO MEMBERS ARE OFFICERS OF THE SYSTEM. THE SYSTEM EXECUTIVES ARE SHARED AMONG THE HOSPITAL AND ITS AFFILIATES.</ExplanationTxt>
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          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
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      <HeldWorksArtGrp />
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        <InvestmentEarningsOrLossesAmt>124881</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>1000</GrantsOrScholarshipsAmt>
        <EndYearBalanceAmt>2885953</EndYearBalanceAmt>
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        <InvestmentEarningsOrLossesAmt>360569</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>13191</GrantsOrScholarshipsAmt>
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        <InvestmentEarningsOrLossesAmt>163752</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>157934</GrantsOrScholarshipsAmt>
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        <InvestmentEarningsOrLossesAmt>27664</InvestmentEarningsOrLossesAmt>
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      <RelatedOrgListSchRInd>true</RelatedOrgListSchRInd>
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      <BuildingsGrp />
      <LeaseholdImprovementsGrp />
      <EquipmentGrp />
      <OtherLandBuildingsGrp />
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        <BookValueAmt>9229509</BookValueAmt>
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      <FootnoteTextInd>X</FootnoteTextInd>
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      <RevenueNotReportedFinclStmtAmt>172103</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>85834484</TotalRevenuePerForm990Amt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART V, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>INTENDED USE OF ENDOWMENT FUNDS: THE ORGANIZATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR THE ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND ITEMS SUPPORTED BY THE ENDOWMENT WHILE SEEKING TO MAINTAIN ITS PURCHASING POWER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART X, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>LIABILITY FOR UNCERTAIN TAX POSITIONS: The System, the Hospital, RMSA, the Clinic, Jacksonville and Winnsboro have been recognized as exempt from income taxes under Section 501 of the Internal Revenue Code (IRC) and a similar provision of state law. However, these entities are subject to federal income tax on any unrelated business taxable income. APET will be applying for tax-exempt status. THFIC is not considered to be engaged in a United States trade or business and, therefore, is not subject to United States income taxes. If THFIC were to be considered engaged in a United States trade or business, it could be subject to federal income tax. THFIC is currently exempt from income taxes in the Cayman Islands. Accordingly, no provision for taxes has been made. With a few exceptions, the Health System is no longer subject to U.S. federal examinations by tax authorities for years before 2011.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: CHANGE IN FINANCIAL INTEREST OF AFFILIATE - FOUNDATION $5,611,000 EQUITY IN EARNINGS OF AFFILIATE - FOUNDATION (1,849,448) ------------ TOTAL 3,761,552</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: REBATE INCOME $172,103</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: REBATE INCOME $(172,103) EQUITY IN INCOME OF CONSOLIDATED SUBSIDIARY 17,077 ------------ TOTAL (155,026)</ExplanationTxt>
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    </IRS990ScheduleD>
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          <BusinessNameLine1Txt>Alzheimers Alliance of Smith County</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>211 Winchester Drive</AddressLine1Txt>
          <CityNm>Tyler</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
          <ZIPCd>75701</ZIPCd>
        </USAddress>
        <RecipientEIN>752486061</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>7000</CashGrantAmt>
        <PurposeOfGrantTxt>COMMUNITY HEALTHCARE</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>American Cancer Society</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>1301 S Broadway</AddressLine1Txt>
          <CityNm>Tyler</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
          <ZIPCd>75701</ZIPCd>
        </USAddress>
        <RecipientEIN>131788491</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>20000</CashGrantAmt>
        <PurposeOfGrantTxt>COMMUNITY HEALTHCARE</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>American Heart Association</BusinessNameLine1Txt>
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          <AddressLine1Txt>PO Box 4002903</AddressLine1Txt>
          <CityNm>Des Moines</CityNm>
          <StateAbbreviationCd>IA</StateAbbreviationCd>
          <ZIPCd>50340</ZIPCd>
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        <RecipientEIN>135613797</RecipientEIN>
        <IRCSectionDesc>501(c)(3)</IRCSectionDesc>
        <CashGrantAmt>30000</CashGrantAmt>
        <PurposeOfGrantTxt>COMMUNITY HEALTHCARE</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Cancer Foundation for Life</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>PO Box 130849</AddressLine1Txt>
          <CityNm>Tyler</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
          <ZIPCd>75713</ZIPCd>
        </USAddress>
        <RecipientEIN>752957440</RecipientEIN>
        <IRCSectionDesc>501(c)(3)</IRCSectionDesc>
        <CashGrantAmt>25000</CashGrantAmt>
        <PurposeOfGrantTxt>COMMUNITY HEALTHCARE</PurposeOfGrantTxt>
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      <RecipientTable>
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          <BusinessNameLine1Txt>St Gregory Cathedral School</BusinessNameLine1Txt>
        </RecipientBusinessName>
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          <AddressLine1Txt>500 S College Ave</AddressLine1Txt>
          <CityNm>Tyler</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
          <ZIPCd>75702</ZIPCd>
        </USAddress>
        <RecipientEIN>272769354</RecipientEIN>
        <IRCSectionDesc>501(c)(3)</IRCSectionDesc>
        <CashGrantAmt>20000</CashGrantAmt>
        <PurposeOfGrantTxt>COMMUNITY HEALTHCARE</PurposeOfGrantTxt>
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      <RecipientTable>
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          <BusinessNameLine1Txt>Texas Association of Business</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>1209 Nueces Street</AddressLine1Txt>
          <CityNm>Austin</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
          <ZIPCd>78701</ZIPCd>
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        <RecipientEIN>740944130</RecipientEIN>
        <IRCSectionDesc>501(c)(3)</IRCSectionDesc>
        <CashGrantAmt>5987</CashGrantAmt>
        <PurposeOfGrantTxt>COMMUNITY HEALTHCARE</PurposeOfGrantTxt>
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      <RecipientTable>
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          <BusinessNameLine1Txt>Tyler Chamber of Commerce</BusinessNameLine1Txt>
        </RecipientBusinessName>
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          <AddressLine1Txt>315 N Broadway</AddressLine1Txt>
          <CityNm>Tyler</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
          <ZIPCd>75702</ZIPCd>
        </USAddress>
        <RecipientEIN>750624670</RecipientEIN>
        <IRCSectionDesc>501(c)(3)</IRCSectionDesc>
        <CashGrantAmt>17012</CashGrantAmt>
        <PurposeOfGrantTxt>COMMUNITY HEALTHCARE</PurposeOfGrantTxt>
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      <RecipientTable>
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          <CityNm>Tyler</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
          <ZIPCd>75711</ZIPCd>
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      <RecipientTable>
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          <BusinessNameLine1Txt>University of Texas at Tyler</BusinessNameLine1Txt>
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          <CityNm>Tyler</CityNm>
          <StateAbbreviationCd>TX</StateAbbreviationCd>
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        <IRCSectionDesc>501(c)(3)</IRCSectionDesc>
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        <ExplanationTxt>PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: GRANT RECIPIENTS ARE REQUIRED TO ACKNOWLEDGE PRIOR TO THE ISSUANCE OF GRANT FUNDS THAT THE GRANT WILL BE USED IN ACCORDANCE WITH THE STATED PURPOSE OF THE GRANT APPLICATION AND ANY UNUSED FUNDS RELATED TO THE SPECIFIC PURPOSE OF THE GRANT WILL BE RETURNED TO THE ORGANIZATION. THE ORGANIZATION MONITORS AND REVIEWS THE FINANCIAL DATA OF RECIPIENTS TO ENSURE THAT THE GRANTED FUNDS ARE BEING USED PROPERLY.</ExplanationTxt>
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        <PersonNm>J LINDSEY BRADLEY JR</PersonNm>
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        <TotalCompensationRltdOrgsAmt>564538</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>4355</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>281060</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- --------------- --------------------- STEVEN KEUER MD $458,028 NONE PARTICIPANTS IN 457(F) REPORTED IN W-2 ---------------------- ----------------- STEVEN KEUER MD $3,174 GIFFORD ECKHOUT NONE</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>MEMBERS OR STOCKHOLDERS: THE SOLE MEMBER IS THE CONGREGATION OF THE SISTERS OF THE HOLY FAMILY OF NAZARETH, A RELIGIOUS ORDER OF THE ROMAN CATHOLIC CHURCH.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BODY: THE MEMBER HAS THE SOLE RIGHT AND AUTHORITY TO APPOINT ONE OF THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL BY THE MEMBER: THE MEMBER HAS THE RIGHT TO APPROVE OR DISAPPROVE CERTAIN ACTIONS THAT HAVE BEEN PREVIOUSLY APPROVED BY THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>PROCESS TO REVIEW THE FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND A COPY IS PROVIDED TO THE BOARD PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>PROCESS TO MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY: THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINES 15A &amp; 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>REVIEW OF COMPENSATION OF CEO, OFFICER, OR KEY EMPLOYEES: THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY. THE MOST RECENT REVIEW OF OFFICER COMPENSATION WAS CONDUCTED IN 2015 BY LAURA LOCKHART, TMFHS DIRECTOR OF TOTAL REWARDS, AND JARED SEIGER, TMFHS BENEFIT SPECIALIST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>AVAILABILITY OF DOCUMENTS: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART V, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>1099S REPORTED BY ORGANIZATION: THE ORGANIZATION'S 1099S ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHO REPORTS ALL 1099S FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII, SECTION A, LINE 1A &amp; SCHEDULE J, PART II</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION FROM RELATED ORGANIZATIONS: THE GOVERNING BOARD OF TRINITY MOTHER FRANCES HEALTH SYSTEM UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND NON-COMPETITION CLAUSES THAT CREATE A RISK OF FORFEITURE. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS, HEALTH, DENTAL AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER CHANGES IN NET ASSETS: CHANGE IN FINANCIAL INTEREST - FOUNDATION $5,611,000 NET ASSETS RELEASED FROM RESTRICTION (2,378,616) CHANGE IN FINANCIAL INTEREST - TEMP RESTRICTED 1,977,303 EQUITY IN EARNINGS OF AFFILIATE - FOUNDATION (1,849,448) EQUITY IN INCOME OF CONSOLIDATED SUBSIDIARY (17,077) CHANGE IN FINANCIAL INTEREST - PERM RESTRICTED 500 -------------- TOTAL $3,343,662</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>RELATIONSHIPS BETWEEN OFFICERS &amp; DIRECTORS: THE MEMBERS OF THE EXECUTIVE TEAM ALL HAVE BUSINESS RELATIONSHIPS WITH EACHOTHER THROUGH THEIR EMPLOYMENT WITH RELATED ORGANIZATIONS.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:COLLECTION FEES TOTAL FEES:4968886</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:CONSULTING TOTAL FEES:3386093</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:CONTRACT LABOR TOTAL FEES:455990</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:219258</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PURCHASED SERVICES TOTAL FEES:7464632</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:SPONSORSHIPS TOTAL FEES:160000</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:CORPORATE ALLOCATION TOTAL FEES:-2268005</ExplanationTxt>
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      <IdRelatedOrgTxblCorpTrGrp>
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      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>true</DivRelatedOrganizationInd>
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      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>true</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>true</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>56901962</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>TRINITY CLINIC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>14866966</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>MOTHER FRANCES HOSPITAL - JACKSONVILLE</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>3531969</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>MOTHER FRANCES HOSPITAL - WINNSBORO</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>2172861</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>TRINCARE INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>704053</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE R, PART II,COLUMN F</FormAndLineReferenceDesc>
        <ExplanationTxt>DIRECT CONTROLLING ENTITY: THE FOLLOWING RELATED ORGANIZATIONS REPORTABLE IN PART II ARE DIRECTLY CONTROLLED BY TRINITY MOTHER FRANCES HEALTH SYSTEM ("TMFHS"): MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER MOTHER FRANCES HOSPITAL - JACKSONVILLE TRINITY MOTHER FRANCES HEALTH SYSTEM FOUNDATION TRINITY CLINIC MOTHER FRANCES HOSPITAL - WINNSBORO REGIONAL MEDICAL SERVICES ASSOCIATION AND ALIGNED PROVIDERS OF EAST TEXAS ARE DIRECTLY CONTROLLED BY MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER ("MFH REG").</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleR>
  </ReturnData>
</Return>