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        <ExclusionAmt>0</ExclusionAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>Patient Services</Desc>
        <BusinessCd>621493</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>15839554</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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      <TotalOthProgramServiceRevGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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        <ExclusionAmt>0</ExclusionAmt>
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      <IncmFromInvestBondProceedsGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <RoyaltiesRevenueGrp>
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      <ContriRptFundraisingEventAmt>0</ContriRptFundraisingEventAmt>
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      <TotalRevenueGrp>
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      <GrantsToDomesticOrgsGrp>
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      <GrantsToDomesticIndividualsGrp>
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      <BenefitsToMembersGrp>
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        <ProgramServicesAmt>588946</ProgramServicesAmt>
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        <ProgramServicesAmt>14663367</ProgramServicesAmt>
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      <FeesForServicesLegalGrp>
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        <ManagementAndGeneralAmt>169727</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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      <FeesForServicesLobbyingGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
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        <FundraisingAmt>0</FundraisingAmt>
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      <FeesForSrvcInvstMgmntFeesGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
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        <FundraisingAmt>0</FundraisingAmt>
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      <OtherExpensesGrp>
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        <FundraisingAmt>0</FundraisingAmt>
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      <OtherExpensesGrp>
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      <ReconcilationRevenueExpnssAmt>3086914</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>0</NetUnrlzdGainsLossesInvstAmt>
      <DonatedServicesAndUseFcltsAmt>0</DonatedServicesAndUseFcltsAmt>
      <InvestmentExpenseAmt>0</InvestmentExpenseAmt>
      <PriorPeriodAdjustmentsAmt>0</PriorPeriodAdjustmentsAmt>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
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      <AuditCommitteeInd>1</AuditCommitteeInd>
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      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
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    <IRS990ScheduleA documentId="R000002" softwareId="18007995" softwareVersionNum="v1.00">
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        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>73601</CurrentTaxYearMinus1YearAmt>
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        <CurrentTaxYearMinus2YearsAmt>42514906</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>42155136</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>43344742</CurrentTaxYearAmt>
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      <PublicSupportPY509Pct>0.67547</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00079</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00043</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsPY509Ind>X</ThirtyThrPctSuprtTestsPY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part II, Line 10</FormAndLineReferenceDesc>
        <ExplanationTxt>Other Income reported on line 10 consists of patient service revenue charge to their insurance and not from government grants.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III, Line 12</FormAndLineReferenceDesc>
        <ExplanationTxt>The Other Income reported on line 10 consists of patient service revenue charge to their insurance and not from government grants.</ExplanationTxt>
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        <DepreciationAmt>4827967</DepreciationAmt>
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        <BookValueAmt>453652</BookValueAmt>
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        <PersonNm>Rosa Castro Avila</PersonNm>
        <TitleTxt>Chief Executive Officer</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Carlos M Acevedo Vila</PersonNm>
        <TitleTxt>General Physician</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Miguel Gonzalez Gonzalez</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Hector Rodriguez Medina</PersonNm>
        <TitleTxt>Chief Medical Officer</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Ariel Nieves Borrero</PersonNm>
        <TitleTxt>Chief Operational Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>53831</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>2867552</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>Fair Market Value</MethodOfDeterminingRevenuesTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The form 990 is prepared by our external auditors and is reviewed by our Finance Director and Executive Director.The Finance Director presents the return draft to the Board of Directors meeting for approval and discussion. The Board of Directors approves the Form 990. Records of this meeting minutes and a copy of the Form 990 is kept on the secure Board file and is available for inspection as requested by the authorities.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization has a conflict of interest policy which is monitored by the top management and Governing Board. All members are required to complete a certification of no conflict of interest on annual basis.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>Compensation to Executive Director is determined by the Board of Directors based on experience,qualification, performance and by using comparable statistical data from similar job positions and comparable organizations. The other management positions are determined by the Executive Director using the approved Board of Directors Classification and Remuneration Plan.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 18</FormAndLineReferenceDesc>
        <ExplanationTxt>Form 990, Part VI, Section C, Line 18 - The form 990 and all related documents are available for inspection upon request to all federal and state government agencies and the general public at our main offices physical address on Street 941 Bo. Jaguas Gurabo PR 00778.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The form 990 and all related documents are available for inspection upon request to all federal and state government agencies and the general public at our main offices physical address on Street 941 Bo. Jaguas Gurabo PR 00778.</ExplanationTxt>
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    <ReasonableCauseExplanation documentId="R000007" softwareId="18007995" softwareVersionNum="v1.00">
      <ExplanationTxt>The Financial Statements Audit had not been completed by the filing deadline so Form 8868 Application for Extension of time to File an Exempt Organization Return was filed with the IRS.Furthermore due to the COVID-19 Pandemic in 2020 the IRS granted automatic postponements to filing deadlines due to the emergency declaration issued by the President Trump on March 13,2020.</ExplanationTxt>
    </ReasonableCauseExplanation>
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</Return>