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      </ProgramServiceRevenue>
      <TotalProgramServiceRevenue>30380115</TotalProgramServiceRevenue>
      <InvestmentIncome>
        <TotalRevenueColumn>1048657</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>979755</RelatedOrExemptFunctionIncome>
        <ExclusionAmount>68902</ExclusionAmount>
      </InvestmentIncome>
      <OtherRevenueMisc>
        <Description>Other Revenue</Description>
        <BusinessCode>621110</BusinessCode>
        <TotalRevenueColumn>189628</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>189628</RelatedOrExemptFunctionIncome>
      </OtherRevenueMisc>
      <TotalOtherRevenue>189628</TotalOtherRevenue>
      <TotalRevenue>
        <TotalRevenueColumn>40034124</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>31549498</RelatedOrExemptFunctionIncome>
        <UnrelatedBusinessRevenue>0</UnrelatedBusinessRevenue>
        <ExclusionAmount>68902</ExclusionAmount>
      </TotalRevenue>
      <CompCurrentOfficersDirectors>
        <Total>1472582</Total>
        <ProgramServices>1213502</ProgramServices>
        <ManagementAndGeneral>259080</ManagementAndGeneral>
      </CompCurrentOfficersDirectors>
      <OtherSalariesAndWages>
        <Total>17664421</Total>
        <ProgramServices>14556620</ProgramServices>
        <ManagementAndGeneral>3107801</ManagementAndGeneral>
      </OtherSalariesAndWages>
      <PensionPlanContributions>
        <Total>1026340</Total>
        <ProgramServices>829095</ProgramServices>
        <ManagementAndGeneral>197245</ManagementAndGeneral>
      </PensionPlanContributions>
      <OtherEmployeeBenefits>
        <Total>1903120</Total>
        <ProgramServices>1537378</ProgramServices>
        <ManagementAndGeneral>365742</ManagementAndGeneral>
      </OtherEmployeeBenefits>
      <PayrollTaxes>
        <Total>1466035</Total>
        <ProgramServices>1184285</ProgramServices>
        <ManagementAndGeneral>281750</ManagementAndGeneral>
      </PayrollTaxes>
      <FeesForServicesLegal>
        <Total>89723</Total>
        <ManagementAndGeneral>89723</ManagementAndGeneral>
      </FeesForServicesLegal>
      <FeesForServicesOther>
        <Total>2894840</Total>
        <ProgramServices>2727920</ProgramServices>
        <ManagementAndGeneral>166920</ManagementAndGeneral>
      </FeesForServicesOther>
      <Advertising>
        <Total>127306</Total>
        <ProgramServices>4033</ProgramServices>
        <ManagementAndGeneral>123273</ManagementAndGeneral>
      </Advertising>
      <OfficeExpenses>
        <Total>36764</Total>
        <ProgramServices>16</ProgramServices>
        <ManagementAndGeneral>36748</ManagementAndGeneral>
      </OfficeExpenses>
      <Occupancy>
        <Total>1124511</Total>
        <ProgramServices>1069898</ProgramServices>
        <ManagementAndGeneral>54613</ManagementAndGeneral>
      </Occupancy>
      <Travel>
        <Total>129791</Total>
        <ProgramServices>51050</ProgramServices>
        <ManagementAndGeneral>78741</ManagementAndGeneral>
      </Travel>
      <ConferencesMeetings>
        <Total>130734</Total>
        <ProgramServices>78454</ProgramServices>
        <ManagementAndGeneral>52280</ManagementAndGeneral>
      </ConferencesMeetings>
      <Interest>
        <Total>3526</Total>
        <ManagementAndGeneral>3526</ManagementAndGeneral>
      </Interest>
      <Insurance>
        <Total>124411</Total>
        <ProgramServices>94837</ProgramServices>
        <ManagementAndGeneral>29574</ManagementAndGeneral>
      </Insurance>
      <OtherExpenses>
        <Description>Supplies</Description>
        <Total>1831887</Total>
        <ProgramServices>1764757</ProgramServices>
        <ManagementAndGeneral>67130</ManagementAndGeneral>
      </OtherExpenses>
      <OtherExpenses>
        <Description>Repairs and Maintenance</Description>
        <Total>832976</Total>
        <ProgramServices>725992</ProgramServices>
        <ManagementAndGeneral>106984</ManagementAndGeneral>
      </OtherExpenses>
      <OtherExpenses>
        <Description>Capital Items less than $5k</Description>
        <Total>140059</Total>
        <ProgramServices>87455</ProgramServices>
        <ManagementAndGeneral>52604</ManagementAndGeneral>
      </OtherExpenses>
      <OtherExpenses>
        <Description>Telecommunications</Description>
        <Total>392924</Total>
        <ProgramServices>284452</ProgramServices>
        <ManagementAndGeneral>108472</ManagementAndGeneral>
      </OtherExpenses>
      <AllOtherExpenses>
        <Total>1456939</Total>
        <ProgramServices>1040185</ProgramServices>
        <ManagementAndGeneral>416754</ManagementAndGeneral>
      </AllOtherExpenses>
      <TotalFunctionalExpenses>
        <Total>32848889</Total>
        <ProgramServices>27249929</ProgramServices>
        <ManagementAndGeneral>5598960</ManagementAndGeneral>
        <Fundraising>0</Fundraising>
      </TotalFunctionalExpenses>
      <CashNonInterestBearing>
        <BOY>41284</BOY>
        <EOY>3394</EOY>
      </CashNonInterestBearing>
      <SavingsAndTempCashInvestments>
        <BOY>12959902</BOY>
        <EOY>18308533</EOY>
      </SavingsAndTempCashInvestments>
      <PledgesAndGrantsReceivable>
        <BOY>1681829</BOY>
        <EOY>1419507</EOY>
      </PledgesAndGrantsReceivable>
      <AccountsReceivable>
        <BOY>136250</BOY>
        <EOY>190642</EOY>
      </AccountsReceivable>
      <InventoriesForSaleOrUse>
        <BOY>21194</BOY>
        <EOY>23808</EOY>
      </InventoriesForSaleOrUse>
      <PrepaidExpensesDeferredCharges>
        <BOY>238250</BOY>
        <EOY>130131</EOY>
      </PrepaidExpensesDeferredCharges>
      <LandBuildingsEquipmentBasis>14070753</LandBuildingsEquipmentBasis>
      <LandBldgEquipmentAccumDeprec>4481144</LandBldgEquipmentAccumDeprec>
      <LandBuildingsEquipmentBasisNet>
        <BOY>7306821</BOY>
        <EOY>9589609</EOY>
      </LandBuildingsEquipmentBasisNet>
      <InvestmentsOtherSecurities>
        <BOY>467400</BOY>
        <EOY>280440</EOY>
      </InvestmentsOtherSecurities>
      <OtherAssetsTotal>
        <BOY>145990</BOY>
        <EOY>211104</EOY>
      </OtherAssetsTotal>
      <TotalAssets>
        <BOY>22998920</BOY>
        <EOY>30157168</EOY>
      </TotalAssets>
      <AccountsPayableAccruedExpenses>
        <BOY>3046025</BOY>
        <EOY>3225577</EOY>
      </AccountsPayableAccruedExpenses>
      <DeferredRevenue>
        <BOY>59780</BOY>
        <EOY>81533</EOY>
      </DeferredRevenue>
      <MortNotesPyblSecuredInvestProp>
        <BOY>345647</BOY>
        <EOY>117355</EOY>
      </MortNotesPyblSecuredInvestProp>
      <TotalLiabilities>
        <BOY>3451452</BOY>
        <EOY>3424465</EOY>
      </TotalLiabilities>
      <FollowSFAS117>X</FollowSFAS117>
      <UnrestrictedNetAssets>
        <BOY>19547468</BOY>
        <EOY>26732703</EOY>
      </UnrestrictedNetAssets>
      <TotalNetAssetsFundBalances>
        <BOY>19547468</BOY>
        <EOY>26732703</EOY>
      </TotalNetAssetsFundBalances>
      <TotalLiabNetAssetsFundBalances>
        <BOY>22998920</BOY>
        <EOY>30157168</EOY>
      </TotalLiabNetAssetsFundBalances>
      <ReconcilationRevenueExpenses>7185235</ReconcilationRevenueExpenses>
      <ReconcilationOtherChanges>0</ReconcilationOtherChanges>
      <MethodOfAccountingAccrual>X</MethodOfAccountingAccrual>
      <AccountantCompileOrReview>false</AccountantCompileOrReview>
      <FSAudited>true</FSAudited>
      <FSAuditedBasis>
        <FinancialStatementSeparate>X</FinancialStatementSeparate>
      </FSAuditedBasis>
      <AuditCommittee>true</AuditCommittee>
      <FederalGrantAuditRequired>true</FederalGrantAuditRequired>
      <FederalGrantAuditPerformed>true</FederalGrantAuditPerformed>
    </IRS990>
    <IRS990ScheduleA documentId="990A">
      <PubliclySupportedOrg170b1Avi>X</PubliclySupportedOrg170b1Avi>
      <GiftsGrantsContribReceived170>
        <CurrentTaxYearMinus4Years>23295543</CurrentTaxYearMinus4Years>
        <CurrentTaxYearMinus3Years>27523176</CurrentTaxYearMinus3Years>
        <CurrentTaxYearMinus2Years>31272781</CurrentTaxYearMinus2Years>
        <CurrentTaxYearMinus1Year>37548533</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>38795839</CurrentTaxYear>
        <Total>158435872</Total>
      </GiftsGrantsContribReceived170>
      <Total170>
        <CurrentTaxYearMinus4Years>23295543</CurrentTaxYearMinus4Years>
        <CurrentTaxYearMinus3Years>27523176</CurrentTaxYearMinus3Years>
        <CurrentTaxYearMinus2Years>31272781</CurrentTaxYearMinus2Years>
        <CurrentTaxYearMinus1Year>37548533</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>38795839</CurrentTaxYear>
        <Total>158435872</Total>
      </Total170>
      <PublicSupportTotal170>158435872</PublicSupportTotal170>
      <GrossInvestmentIncome170>
        <CurrentTaxYearMinus4Years>42616</CurrentTaxYearMinus4Years>
        <CurrentTaxYearMinus3Years>42919</CurrentTaxYearMinus3Years>
        <CurrentTaxYearMinus2Years>93039</CurrentTaxYearMinus2Years>
        <CurrentTaxYearMinus1Year>63321</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>68902</CurrentTaxYear>
        <Total>310797</Total>
      </GrossInvestmentIncome170>
      <TotalSupport>158746669</TotalSupport>
      <PublicSupportPertcentage170>0.99800</PublicSupportPertcentage170>
      <PublicSupportPertcentPriorYear>0.99800</PublicSupportPertcentPriorYear>
      <ThirtyThreePercntTestsCY170>X</ThirtyThreePercntTestsCY170>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="990D">
      <Land>
        <InvestmentCostOrOtherBasis>2612548</InvestmentCostOrOtherBasis>
        <BookValue>2612548</BookValue>
      </Land>
      <Buildings>
        <InvestmentCostOrOtherBasis>8483760</InvestmentCostOrOtherBasis>
        <Depreciation>2936961</Depreciation>
        <BookValue>5546799</BookValue>
      </Buildings>
      <LeaseholdImprovements>
        <InvestmentCostOrOtherBasis>264739</InvestmentCostOrOtherBasis>
        <Depreciation>95268</Depreciation>
        <BookValue>169471</BookValue>
      </LeaseholdImprovements>
      <Equipment>
        <InvestmentCostOrOtherBasis>2053879</InvestmentCostOrOtherBasis>
        <Depreciation>1448915</Depreciation>
        <BookValue>604964</BookValue>
      </Equipment>
      <OtherLandBuildings>
        <InvestmentCostOrOtherBasis>655827</InvestmentCostOrOtherBasis>
        <BookValue>655827</BookValue>
      </OtherLandBuildings>
      <TotalOfBookValueLandBuildings>9589609</TotalOfBookValueLandBuildings>
      <OtherSecurities>
        <Description>Prestige Health Choice LLC</Description>
        <BookValue>280440</BookValue>
        <MethodOfValuation>C</MethodOfValuation>
      </OtherSecurities>
      <TotalOfBookValueSecurities>280440</TotalOfBookValueSecurities>
      <OtherAssets>
        <Description>457b Deferred Compensation P</Description>
        <BookValue>211104</BookValue>
      </OtherAssets>
      <TotalBookValueOtherAssets>211104</TotalBookValueOtherAssets>
      <TotRevenueEtcAuditedFinclStmt>40034124</TotRevenueEtcAuditedFinclStmt>
      <RevenueSubtotal>40034124</RevenueSubtotal>
      <TotalRevenuePerForm990>40034124</TotalRevenuePerForm990>
      <TotExpensesEtcAuditedFinclStmt>32848889</TotExpensesEtcAuditedFinclStmt>
      <ExpensesSubtotal>32848889</ExpensesSubtotal>
      <TotalExpensesPerForm990>32848889</TotalExpensesPerForm990>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="990J">
      <WrittenEmploymentContract>X</WrittenEmploymentContract>
      <CompensationSurvey>X</CompensationSurvey>
      <BoardOrCommitteeApproval>X</BoardOrCommitteeApproval>
      <SeverancePayment>false</SeverancePayment>
      <SupplementalNonqualRetirePlan>false</SupplementalNonqualRetirePlan>
      <EquityBasedCompArrangement>false</EquityBasedCompArrangement>
      <CompBasedOnRevenueOfFilingOrg>false</CompBasedOnRevenueOfFilingOrg>
      <CompBasedOnRevenueRelatedOrgs>false</CompBasedOnRevenueRelatedOrgs>
      <CompBasedNetEarningsFilingOrg>false</CompBasedNetEarningsFilingOrg>
      <CompBasedNetEarningsRelateOrgs>false</CompBasedNetEarningsRelateOrgs>
      <AnyNonFixedPayments>false</AnyNonFixedPayments>
      <InitialContractException>false</InitialContractException>
      <Form990ScheduleJPartII>
        <NamePerson>Dr Frank Mazzeo Jr</NamePerson>
        <Title>PresCeo &amp; Chief</Title>
        <BaseCompensationFilingOrg>389069</BaseCompensationFilingOrg>
        <BonusFilingOrg>85000</BonusFilingOrg>
        <OtherCompensationFilingOrg>972</OtherCompensationFilingOrg>
        <DeferredCompFilingOrg>38800</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>8917</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>522758</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Dr Jorge Quinonez</NamePerson>
        <Title>Chief Medical Officer</Title>
        <BaseCompensationFilingOrg>288952</BaseCompensationFilingOrg>
        <BonusFilingOrg>33000</BonusFilingOrg>
        <OtherCompensationFilingOrg>225</OtherCompensationFilingOrg>
        <DeferredCompFilingOrg>30257</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>7482</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>359916</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Roger Ward</NamePerson>
        <Title>Chief Operating Officer</Title>
        <BaseCompensationFilingOrg>123672</BaseCompensationFilingOrg>
        <BonusFilingOrg>18000</BonusFilingOrg>
        <OtherCompensationFilingOrg>466</OtherCompensationFilingOrg>
        <DeferredCompFilingOrg>15935</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>8917</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>166990</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>John Koehler</NamePerson>
        <Title>Chief HR Officer</Title>
        <BaseCompensationFilingOrg>138042</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>26391</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>8917</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>173350</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Marie Andress</NamePerson>
        <Title>Chief Financial Officer</Title>
        <BaseCompensationFilingOrg>139607</BaseCompensationFilingOrg>
        <BonusFilingOrg>33000</BonusFilingOrg>
        <OtherCompensationFilingOrg>253</OtherCompensationFilingOrg>
        <DeferredCompFilingOrg>18817</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>4860</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>196537</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Robert Johns</NamePerson>
        <Title>Sr VP Special Projects</Title>
        <BaseCompensationFilingOrg>115817</BaseCompensationFilingOrg>
        <BonusFilingOrg>15000</BonusFilingOrg>
        <OtherCompensationFilingOrg>209</OtherCompensationFilingOrg>
        <DeferredCompFilingOrg>15291</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>7482</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>153799</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Dr Carlos Alvarado</NamePerson>
        <Title>Dentist</Title>
        <BaseCompensationFilingOrg>302924</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>17400</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>5446</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>325770</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Dr Jeffrey Garner</NamePerson>
        <Title>Physician</Title>
        <BaseCompensationFilingOrg>406694</BaseCompensationFilingOrg>
        <OtherCompensationFilingOrg>900</OtherCompensationFilingOrg>
        <DeferredCompFilingOrg>17400</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>6691</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>431685</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Dr Martin Jenkins</NamePerson>
        <Title>Dentist</Title>
        <BaseCompensationFilingOrg>309194</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>17400</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>5881</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>332475</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Dr Maximus Zand</NamePerson>
        <Title>Dentist</Title>
        <BaseCompensationFilingOrg>294044</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>13770</DeferredCompFilingOrg>
        <NontaxableBenefitsFilingOrg>5881</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>313695</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Dr Sergio Vignali</NamePerson>
        <Title>Physician</Title>
        <BaseCompensationFilingOrg>271800</BaseCompensationFilingOrg>
        <OtherCompensationFilingOrg>150</OtherCompensationFilingOrg>
        <NontaxableBenefitsFilingOrg>5881</NontaxableBenefitsFilingOrg>
        <TotalCompensationFilingOrg>277831</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
    </IRS990ScheduleJ>
    <IRS990ScheduleM documentId="990M">
      <RealEstateCommercial>
        <NonCashCheckbox>X</NonCashCheckbox>
        <NumberOfContributions>1</NumberOfContributions>
        <NoncashContribsRptdF990>36000</NoncashContribsRptdF990>
        <MethodOfDeterminingRevenues>FMV</MethodOfDeterminingRevenues>
      </RealEstateCommercial>
      <AnyPropertyThatMustBeHeld>false</AnyPropertyThatMustBeHeld>
      <ReviewProcessUnusualNCGifts>false</ReviewProcessUnusualNCGifts>
      <ThirdPartiesUsed>false</ThirdPartiesUsed>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="990O">
      <GeneralExplanation>
        <Identifier>O01</Identifier>
        <ReturnReference>Form 990 governing body review Part VI line 11</ReturnReference>
        <Explanation>The Finance Committee reviews the tax return. The tax return is then reviewed and approved by the full Board of Directors.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>O02</Identifier>
        <ReturnReference>Conflict of interest policy compliance Part VI line 12c</ReturnReference>
        <Explanation>The Organization annually reaffirms the written conflict of interest policy.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>O03</Identifier>
        <ReturnReference>CEO executive director top management comp Part VI line 15a</ReturnReference>
        <Explanation>The Board of Directors gather data from similar organizations and salary surveys to determine comparable executive compensation for the CEO.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>O04</Identifier>
        <ReturnReference>Other officer or key employee compensation Part VI line 15b</ReturnReference>
        <Explanation>Board gathers data from similar organizations and salary surveys to determine comparable executive compensation.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>O05</Identifier>
        <ReturnReference>Governing documents etc available to public Part VI line 19</ReturnReference>
        <Explanation>The governing documents, conflict of interest policy and financial statements are available upon request. The financial statements are also available to the public (via Form 990) on a third-party website.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
  </ReturnData>
</Return>