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      <Form990PartVIISectionAGrp>
        <PersonNm>DEAN WRIGHT</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PAULA SCHLOSSER</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>3012711</TotalReportableCompFromOrgAmt>
      <TotalOtherCompensationAmt>152044</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>9</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>SHRIVER'S PHARMACY</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>406 BRIGHTEN BLVD</AddressLine1Txt>
            <CityNm>ZANESVILLE</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>43701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHARMACY</ServicesDesc>
        <CompensationAmt>1668872</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>NORTHSIDE PHARMACY</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2899 BELL STREET</AddressLine1Txt>
            <CityNm>ZANESVILLE</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>43701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHARMACY</ServicesDesc>
        <CompensationAmt>943475</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>PAUL CONSTRUCTION</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1702 CHANDLERSVILLE RD</AddressLine1Txt>
            <CityNm>ZANESVILLE</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>43701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>460575</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>OHIO PSYCHIATRIC ASSOCIATES INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>975 BETHESDA DR</AddressLine1Txt>
            <CityNm>ZANESVILLE</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>43701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYSICIAN</ServicesDesc>
        <CompensationAmt>278931</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>APG ARCHITECTS LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>3808 JAMES COURT</AddressLine1Txt>
            <CityNm>ZANESVILLE</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>43701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ARCHITECT</ServicesDesc>
        <CompensationAmt>273030</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <FundraisingAmt>71404</FundraisingAmt>
      <GovernmentGrantsAmt>7766176</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>428451</AllOtherContributionsAmt>
      <TotalContributionsAmt>8266031</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT SERVICES</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>32917527</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>32917527</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>NET 340B PRESCRIPTION DRUG PR</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>2875392</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2875392</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>COMPREHENSIVE PRIMARY CARE</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>971959</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>971959</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CONTRACT SERVICES</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>308728</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>308728</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>37073606</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>101579</TotalRevenueColumnAmt>
        <ExclusionAmt>101579</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>130642</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>135663</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>-5021</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>-5021</TotalRevenueColumnAmt>
        <ExclusionAmt>-5021</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>582088</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>624930</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>-42842</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-42842</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>21000</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>-63842</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>42186</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>71404</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>43122</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>-936</TotalRevenueColumnAmt>
        <ExclusionAmt>-936</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>OTHER REVENUE</Desc>
        <TotalRevenueColumnAmt>605430</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>605430</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>MHN DIRECT CONTRACTING</Desc>
        <TotalRevenueColumnAmt>387240</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>387240</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>OTHER INCENTIVES</Desc>
        <TotalRevenueColumnAmt>235976</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>235976</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>65511</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>65511</RelatedOrExemptFuncIncomeAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>1294157</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>46686574</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>38388763</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>31780</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>980464</TotalAmt>
        <ProgramServicesAmt>786880</ProgramServicesAmt>
        <ManagementAndGeneralAmt>193584</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>27914399</TotalAmt>
        <ProgramServicesAmt>22402930</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5511469</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>876043</TotalAmt>
        <ProgramServicesAmt>766106</ProgramServicesAmt>
        <ManagementAndGeneralAmt>109937</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2182104</TotalAmt>
        <ProgramServicesAmt>1908268</ProgramServicesAmt>
        <ManagementAndGeneralAmt>273836</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>2032134</TotalAmt>
        <ProgramServicesAmt>1777117</ProgramServicesAmt>
        <ManagementAndGeneralAmt>255017</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>135056</TotalAmt>
        <ProgramServicesAmt>34115</ProgramServicesAmt>
        <ManagementAndGeneralAmt>100941</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>54950</TotalAmt>
        <ProgramServicesAmt>13880</ProgramServicesAmt>
        <ManagementAndGeneralAmt>41070</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1855747</TotalAmt>
        <ProgramServicesAmt>468755</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1386992</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>191280</TotalAmt>
        <ProgramServicesAmt>59614</ProgramServicesAmt>
        <ManagementAndGeneralAmt>131666</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>465738</TotalAmt>
        <ProgramServicesAmt>270676</ProgramServicesAmt>
        <ManagementAndGeneralAmt>195062</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>671896</TotalAmt>
        <ProgramServicesAmt>450777</ProgramServicesAmt>
        <ManagementAndGeneralAmt>221119</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>866422</TotalAmt>
        <ProgramServicesAmt>600830</ProgramServicesAmt>
        <ManagementAndGeneralAmt>265592</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>277409</TotalAmt>
        <ProgramServicesAmt>162529</ProgramServicesAmt>
        <ManagementAndGeneralAmt>114880</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>129763</TotalAmt>
        <ProgramServicesAmt>76026</ProgramServicesAmt>
        <ManagementAndGeneralAmt>53737</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>681593</TotalAmt>
        <ProgramServicesAmt>293375</ProgramServicesAmt>
        <ManagementAndGeneralAmt>388218</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>1387362</TotalAmt>
        <ProgramServicesAmt>662163</ProgramServicesAmt>
        <ManagementAndGeneralAmt>725199</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>258157</TotalAmt>
        <ProgramServicesAmt>98992</ProgramServicesAmt>
        <ManagementAndGeneralAmt>159165</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>2058456</TotalAmt>
        <ProgramServicesAmt>1413426</ProgramServicesAmt>
        <ManagementAndGeneralAmt>645030</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LICENSES AND FEES</Desc>
        <TotalAmt>300630</TotalAmt>
        <ProgramServicesAmt>93665</ProgramServicesAmt>
        <ManagementAndGeneralAmt>206965</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIR AND MAINTENANCE</Desc>
        <TotalAmt>258240</TotalAmt>
        <ProgramServicesAmt>80457</ProgramServicesAmt>
        <ManagementAndGeneralAmt>177783</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EMPLOYEE RETENTION</Desc>
        <TotalAmt>221845</TotalAmt>
        <ProgramServicesAmt>69118</ProgramServicesAmt>
        <ManagementAndGeneralAmt>152727</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1402775</TotalAmt>
        <ProgramServicesAmt>669862</ProgramServicesAmt>
        <ManagementAndGeneralAmt>732913</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>45202463</TotalAmt>
        <ProgramServicesAmt>33159561</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12042902</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>3692236</BOYAmt>
        <EOYAmt>3197222</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>5315883</BOYAmt>
        <EOYAmt>3034559</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>277123</BOYAmt>
        <EOYAmt>176107</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>4617296</BOYAmt>
        <EOYAmt>4880303</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>602989</BOYAmt>
        <EOYAmt>593885</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>932305</BOYAmt>
        <EOYAmt>666687</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>42656266</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>7148098</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>33609596</BOYAmt>
        <EOYAmt>35508168</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>4508192</BOYAmt>
        <EOYAmt>5666487</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <OtherAssetsTotalGrp>
        <EOYAmt>855097</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>53555620</BOYAmt>
        <EOYAmt>54578515</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>2026540</BOYAmt>
        <EOYAmt>1913931</EOYAmt>
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      <DeferredRevenueGrp>
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        <EOYAmt>12289</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
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        <EOYAmt>13423747</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>1964176</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>900000</BOYAmt>
        <EOYAmt>1896708</EOYAmt>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>19210851</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>34351992</BOYAmt>
        <EOYAmt>35068864</EOYAmt>
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      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>375491</BOYAmt>
        <EOYAmt>298800</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>34727483</BOYAmt>
        <EOYAmt>35367664</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>53555620</BOYAmt>
        <EOYAmt>54578515</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>1484111</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-843930</NetUnrlzdGainsLossesInvstAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc8">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>4336975</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4228351</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11128142</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>9010951</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>8266031</CurrentTaxYearAmt>
        <TotalAmt>36970450</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>22836361</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>25895402</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>29326064</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>33028352</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>37233975</CurrentTaxYearAmt>
        <TotalAmt>148320154</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>27173336</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>30123753</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>40454206</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>42039303</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>45500006</CurrentTaxYearAmt>
        <TotalAmt>185290604</TotalAmt>
      </Total509Grp>
      <PublicSupportTotal509Amt>185290604</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>51855</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>146789</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>135267</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>192484</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>232221</CurrentTaxYearAmt>
        <TotalAmt>758616</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>51855</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>146789</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>135267</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>192484</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>232221</CurrentTaxYearAmt>
        <TotalAmt>758616</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>469378</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>312302</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>575432</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>645213</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1133788</CurrentTaxYearAmt>
        <TotalAmt>3136113</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>27694569</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>30582844</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>41164905</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>42877000</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>46866015</CurrentTaxYearAmt>
        <TotalAmt>189185333</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.97940</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.98210</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00000</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00000</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART III, LINE 12</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER INCOME 1,402,342 MEDICAID INCENTIVES 93,500 OTHER INCENTIVES 1,347,889 CALL COVERAGE 226,871 COVID INCENTIVES 58,396 VENDOR DISCOUNTS 7,115</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
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