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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>238168</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>AUDREY STRYKER MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>220000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>25821</OtherCompensationAmt>
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      <TotalReportableCompFromOrgAmt>2503234</TotalReportableCompFromOrgAmt>
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      <IndivRcvdGreaterThan100KCnt>61</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
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      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>PUMFORD CONSTRUCTION INC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1674 CHAMPAGNE DRIVE</AddressLine1Txt>
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            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48604</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>1306459</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>SANTINO ENTERPRISES INC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5360 DIXIE HWY</AddressLine1Txt>
            <CityNm>SAGINAW</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48601</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CLEANING</ServicesDesc>
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      <CntrctRcvdGreaterThan100KCnt>1</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>9336805</GovernmentGrantsAmt>
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      <NoncashContributionsAmt>624959</NoncashContributionsAmt>
      <TotalContributionsAmt>10764476</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>38323372</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>323000</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>RENTAL</Desc>
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      <GrossAmountSalesAssetsGrp>
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      <GainOrLossGrp>
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      <NetGainOrLossInvestmentsGrp>
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        <ExclusionAmt>7951</ExclusionAmt>
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      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
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        <ExclusionAmt>29382</ExclusionAmt>
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      <OtherRevenueTotalAmt>29382</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>38659572</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>41081</ExclusionAmt>
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      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1400507</TotalAmt>
        <ProgramServicesAmt>415359</ProgramServicesAmt>
        <ManagementAndGeneralAmt>985148</ManagementAndGeneralAmt>
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      <OtherSalariesAndWagesGrp>
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        <ProgramServicesAmt>22152450</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3975399</ManagementAndGeneralAmt>
        <FundraisingAmt>79584</FundraisingAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>1159167</TotalAmt>
        <ProgramServicesAmt>997646</ProgramServicesAmt>
        <ManagementAndGeneralAmt>161521</ManagementAndGeneralAmt>
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      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2837904</TotalAmt>
        <ProgramServicesAmt>2425319</ProgramServicesAmt>
        <ManagementAndGeneralAmt>412585</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>2100887</TotalAmt>
        <ProgramServicesAmt>1748603</ProgramServicesAmt>
        <ManagementAndGeneralAmt>345806</ManagementAndGeneralAmt>
        <FundraisingAmt>6478</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>102243</TotalAmt>
        <ManagementAndGeneralAmt>102243</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>59932</TotalAmt>
        <ManagementAndGeneralAmt>59932</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1696056</TotalAmt>
        <ProgramServicesAmt>1320543</ProgramServicesAmt>
        <ManagementAndGeneralAmt>375443</ManagementAndGeneralAmt>
        <FundraisingAmt>70</FundraisingAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>177982</TotalAmt>
        <ProgramServicesAmt>63284</ProgramServicesAmt>
        <ManagementAndGeneralAmt>80119</ManagementAndGeneralAmt>
        <FundraisingAmt>34579</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>6227594</TotalAmt>
        <ProgramServicesAmt>6093115</ProgramServicesAmt>
        <ManagementAndGeneralAmt>133583</ManagementAndGeneralAmt>
        <FundraisingAmt>896</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>696425</TotalAmt>
        <ProgramServicesAmt>44549</ProgramServicesAmt>
        <ManagementAndGeneralAmt>649908</ManagementAndGeneralAmt>
        <FundraisingAmt>1968</FundraisingAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
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        <ProgramServicesAmt>1189577</ProgramServicesAmt>
        <ManagementAndGeneralAmt>259650</ManagementAndGeneralAmt>
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      <TravelGrp>
        <TotalAmt>374441</TotalAmt>
        <ProgramServicesAmt>228141</ProgramServicesAmt>
        <ManagementAndGeneralAmt>136647</ManagementAndGeneralAmt>
        <FundraisingAmt>9653</FundraisingAmt>
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      <ConferencesMeetingsGrp>
        <TotalAmt>37613</TotalAmt>
        <ProgramServicesAmt>8719</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22773</ManagementAndGeneralAmt>
        <FundraisingAmt>6121</FundraisingAmt>
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      <InterestGrp>
        <TotalAmt>26476</TotalAmt>
        <ProgramServicesAmt>5537</ProgramServicesAmt>
        <ManagementAndGeneralAmt>20939</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
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        <ProgramServicesAmt>891701</ProgramServicesAmt>
        <ManagementAndGeneralAmt>88800</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
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        <ProgramServicesAmt>106028</ProgramServicesAmt>
        <ManagementAndGeneralAmt>45839</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>MAINTENANCE/IMPROVEMENTS</Desc>
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        <ProgramServicesAmt>581525</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>247558</ProgramServicesAmt>
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      </OtherExpensesGrp>
      <OtherExpensesGrp>
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        <FundraisingAmt>18</FundraisingAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>109804</ProgramServicesAmt>
        <ManagementAndGeneralAmt>20827</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>39071668</ProgramServicesAmt>
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      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
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      <TotalLiabilityAmt>8001783</TotalLiabilityAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DOUGLAS SAYLOR MD</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>LISA GALONSKA</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ALIAA MAKKIYA MD</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <NontaxableBenefitsFilingOrgAmt>12621</NontaxableBenefitsFilingOrgAmt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>E BERNARDINO MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <TotalCompensationFilingOrgAmt>257356</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>AUDREY STRYKER MD</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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        <DeferredCompensationFlngOrgAmt>13200</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>12621</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>245821</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleM documentId="RetDoc5">
      <DrugsAndMedicalSuppliesGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>624959</NoncashContributionsRptF990Amt>
      </DrugsAndMedicalSuppliesGrp>
      <AnyPropertyThatMustBeHeldInd>false</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>false</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>false</ThirdPartiesUsedInd>
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    <IRS990ScheduleO documentId="RetDoc6">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD REVIEWS AND APPROVES 990 PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>ANNUAL DISCLOSURE REQUIRED AND MONITORED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD COMMITTEE REVIEWS AND APPROVES CEO COMPENSATION ON AN ANNUAL BASIS. COMPENSATION STUDY IS PERFORMED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>MANAGEMENT PROCURES A COMPENSATION STRUCTURE STUDY THAT PRODUCES A COMPANY WIDE SCALE. THE SCALE IS USED ALONG WITH PERFORMANCE REVIEWS, AND IN THE CASE OF THE CEO, A SUB-COMMITTEE OF THE BOARD OF DIRECTORS, TO SET AND APPROVE COMPENSATION LEVELS ON AN ANNUAL BASIS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
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</Return>