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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BJ PERCH CONSTRUCTION INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>7034 W PERSHING CT</AddressLine1Txt>
            <CityNm>VISALIA</CityNm>
            <StateAbbreviationCd>CA</StateAbbreviationCd>
            <ZIPCd>93291</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION and REPAIRS</ServicesDesc>
        <CompensationAmt>3087594</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Central California Faculty Medical Group</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2625 E Divisadero Street</AddressLine1Txt>
            <CityNm>Fresno</CityNm>
            <StateAbbreviationCd>CA</StateAbbreviationCd>
            <ZIPCd>93721</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contracted Services</ServicesDesc>
        <CompensationAmt>10393730</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Tulare Children Medical Clinic</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1062 N Cherry Street</AddressLine1Txt>
            <CityNm>Tulare</CityNm>
            <StateAbbreviationCd>CA</StateAbbreviationCd>
            <ZIPCd>93274</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contracted services</ServicesDesc>
        <CompensationAmt>1776573</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Office Pride</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5901 W Robin Ave</AddressLine1Txt>
            <CityNm>Visalia</CityNm>
            <StateAbbreviationCd>CA</StateAbbreviationCd>
            <ZIPCd>93291</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Housekeeping services</ServicesDesc>
        <CompensationAmt>1611320</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Hire up Staffing</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1736 S Central Street</AddressLine1Txt>
            <CityNm>Visalia</CityNm>
            <StateAbbreviationCd>CA</StateAbbreviationCd>
            <ZIPCd>93277</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Staffing services</ServicesDesc>
        <CompensationAmt>1630617</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>10</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>0</FederatedCampaignsAmt>
      <MembershipDuesAmt>0</MembershipDuesAmt>
      <FundraisingAmt>0</FundraisingAmt>
      <RelatedOrganizationsAmt>0</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>27627578</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>397817</AllOtherContributionsAmt>
      <NoncashContributionsAmt>0</NoncashContributionsAmt>
      <TotalContributionsAmt>28025395</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Net patient service revenue</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>151518895</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>151518895</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>14422084</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>14422084</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>165940979</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>525137</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <RoyaltiesRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>209052</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
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        <PersonalAmt>0</PersonalAmt>
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      <RentalIncomeOrLossGrp>
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        <PersonalAmt>0</PersonalAmt>
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      <NetRentalIncomeOrLossGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>209052</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>0</SecuritiesAmt>
        <OtherAmt>0</OtherAmt>
      </GainOrLossGrp>
      <ContriRptFundraisingEventAmt>0</ContriRptFundraisingEventAmt>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>14797648</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>14797648</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>14797648</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>209498211</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>180738627</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>734189</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>3489468</TotalAmt>
        <ProgramServicesAmt>382716</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3106752</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
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        <TotalAmt>90926416</TotalAmt>
        <ProgramServicesAmt>81199192</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9727224</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>6476545</TotalAmt>
        <ProgramServicesAmt>5406688</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1069857</ManagementAndGeneralAmt>
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        <TotalAmt>10209787</TotalAmt>
        <ProgramServicesAmt>8417268</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1792519</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>6319368</TotalAmt>
        <ProgramServicesAmt>5408704</ProgramServicesAmt>
        <ManagementAndGeneralAmt>910664</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>55035</TotalAmt>
        <ManagementAndGeneralAmt>55035</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>371651</TotalAmt>
        <ManagementAndGeneralAmt>371651</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>72676</TotalAmt>
        <ManagementAndGeneralAmt>72676</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>43438</TotalAmt>
        <ManagementAndGeneralAmt>43438</ManagementAndGeneralAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>35192226</TotalAmt>
        <ProgramServicesAmt>31899806</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3292420</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>767415</TotalAmt>
        <ProgramServicesAmt>381874</ProgramServicesAmt>
        <ManagementAndGeneralAmt>385541</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1717255</TotalAmt>
        <ProgramServicesAmt>1320682</ProgramServicesAmt>
        <ManagementAndGeneralAmt>396573</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>1471464</TotalAmt>
        <ProgramServicesAmt>910223</ProgramServicesAmt>
        <ManagementAndGeneralAmt>561241</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>8779751</TotalAmt>
        <ProgramServicesAmt>7492738</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1287013</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>262541</TotalAmt>
        <ProgramServicesAmt>130643</ProgramServicesAmt>
        <ManagementAndGeneralAmt>131898</ManagementAndGeneralAmt>
      </TravelGrp>
      <InterestGrp>
        <TotalAmt>1337043</TotalAmt>
        <ProgramServicesAmt>1277473</ProgramServicesAmt>
        <ManagementAndGeneralAmt>59570</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>7603187</TotalAmt>
        <ProgramServicesAmt>5307512</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2295675</ManagementAndGeneralAmt>
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      <InsuranceGrp>
        <TotalAmt>815807</TotalAmt>
        <ProgramServicesAmt>797502</ProgramServicesAmt>
        <ManagementAndGeneralAmt>18305</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Professional fees</Desc>
        <TotalAmt>623139</TotalAmt>
        <ProgramServicesAmt>310081</ProgramServicesAmt>
        <ManagementAndGeneralAmt>313058</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>Supplies</Desc>
        <TotalAmt>15960242</TotalAmt>
        <ProgramServicesAmt>15565341</ProgramServicesAmt>
        <ManagementAndGeneralAmt>394901</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1856531</TotalAmt>
        <ProgramServicesAmt>923833</ProgramServicesAmt>
        <ManagementAndGeneralAmt>932698</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>194350985</TotalAmt>
        <ProgramServicesAmt>167132276</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27218709</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>13950266</BOYAmt>
        <EOYAmt>26240765</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>10550457</BOYAmt>
        <EOYAmt>9282069</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>5301032</BOYAmt>
        <EOYAmt>7168881</EOYAmt>
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      <AccountsReceivableGrp>
        <BOYAmt>28751287</BOYAmt>
        <EOYAmt>22968038</EOYAmt>
      </AccountsReceivableGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>15076317</BOYAmt>
        <EOYAmt>18741232</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>5117795</BOYAmt>
        <EOYAmt>3900983</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>114389193</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>45062752</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>62107049</BOYAmt>
        <EOYAmt>69326441</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>4699779</EOYAmt>
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        <BOYAmt>5531735</BOYAmt>
        <EOYAmt>11450555</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>150993402</BOYAmt>
        <EOYAmt>173778743</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>24787469</EOYAmt>
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      <DeferredRevenueGrp>
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        <EOYAmt>7099479</EOYAmt>
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      <OtherLiabilitiesGrp>
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        <EOYAmt>0</EOYAmt>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>68337396</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
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        <EOYAmt>105364382</EOYAmt>
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      <DonorRestrictionNetAssetsGrp>
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        <EOYAmt>76965</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>105441347</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
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        <EOYAmt>173778743</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>15147226</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>0</NetUnrlzdGainsLossesInvstAmt>
      <DonatedServicesAndUseFcltsAmt>0</DonatedServicesAndUseFcltsAmt>
      <InvestmentExpenseAmt>0</InvestmentExpenseAmt>
      <PriorPeriodAdjustmentsAmt>0</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>1</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="R000002" softwareId="19009572" softwareVersionNum="v1.00">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>18941962</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>17500441</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>19353797</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>20127861</CurrentTaxYearMinus1YearAmt>
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      <TotalCalendarYear170Grp>
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        <CurrentTaxYearMinus2YearsAmt>19353797</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>20127861</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>27627578</CurrentTaxYearAmt>
        <TotalAmt>103551639</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>103551639</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
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        <CurrentTaxYearMinus3YearsAmt>387318</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>594938</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>294975</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>525137</CurrentTaxYearAmt>
        <TotalAmt>1974657</TotalAmt>
      </GrossInvestmentIncome170Grp>
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      <PublicSupportCY170Pct>0.98129</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.98329</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
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        <BookValueAmt>4029751</BookValueAmt>
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        <BookValueAmt>44434278</BookValueAmt>
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        <BookValueAmt>4822598</BookValueAmt>
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        <DepreciationAmt>26063060</DepreciationAmt>
        <BookValueAmt>12435620</BookValueAmt>
      </EquipmentGrp>
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        <DepreciationAmt>0</DepreciationAmt>
        <BookValueAmt>3604194</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>69326441</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
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        <BookValueAmt>2589856</BookValueAmt>
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      <OtherAssetsOrgGrp>
        <Desc>Assets limited as to use</Desc>
        <BookValueAmt>2671111</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Other assets</Desc>
        <BookValueAmt>6189588</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>11450555</TotalBookValueOtherAssetsAmt>
      <TotalLiabilityAmt>0</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>209498211</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>0</NetUnrealizedGainsInvstAmt>
      <DonatedServicesAndUseFcltsAmt>0</DonatedServicesAndUseFcltsAmt>
      <RecoveriesPriorYearGrantsAmt>0</RecoveriesPriorYearGrantsAmt>
      <OtherRevenueAmt>0</OtherRevenueAmt>
      <RevenueNotReportedAmt>0</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>209498211</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>0</InvestmentExpensesNotIncldAmt>
      <OtherRevenuesNotIncludedAmt>0</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>209498211</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>194350985</TotExpnsEtcAuditedFinclStmtAmt>
      <DonatedServicesUseFcltsAmt>0</DonatedServicesUseFcltsAmt>
      <PriorYearAdjustmentsAmt>0</PriorYearAdjustmentsAmt>
      <LossesReportedAmt>0</LossesReportedAmt>
      <OtherExpensesIncludedAmt>0</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>194350985</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>0</InvestmentExpensesNotIncld2Amt>
      <OtherExpensesNotIncludedAmt>0</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>194350985</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part X, Line 2</FormAndLineReferenceDesc>
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