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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>LISA ALEXANDER</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>BOARD MEMBER END 09/23</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>LLOYD RAINGE</BusinessNameLine1Txt>
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        <TitleTxt>BOARD MEMBER BEG 05/23</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>TAMARA TAYLOR</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>BOARD MEMBER END 05/23</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>TINA ANDERSON</BusinessNameLine1Txt>
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        <TitleTxt>BOARD MEMBER END 05/23</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>DANIEL L LEHMAN</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>CHIEF FINANCIAL OFFICER BEG 07/23</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>68652</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11950</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>JESSE S RAMIREZ</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>VICE PRESIDENT OF OPERATIONS</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>181948</ReportableCompFromOrgAmt>
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        <OtherCompensationAmt>16800</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>KERRI K MOSINSKI</BusinessNameLine1Txt>
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        <TitleTxt>CHIEF ADMINISTRATIVE OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>185736</ReportableCompFromOrgAmt>
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        <OtherCompensationAmt>28839</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>LEANNA E CHAFFEE</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>VICE PRESIDENT OF PACE SERVICES</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20093</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>MARSHA M KENT</BusinessNameLine1Txt>
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        <TitleTxt>VICE PRESIDENT OF CLINICAL SERVICES</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>179530</ReportableCompFromOrgAmt>
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        <OtherCompensationAmt>14442</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>SHAWN M SULLIVAN</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>CHIEF EXECUTIVE OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <OtherCompensationAmt>42098</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>MARK WILES MD</BusinessNameLine1Txt>
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        <TitleTxt>CHIEF MEDICAL OFFICER</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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        <OtherCompensationAmt>36732</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>CHARLES G NELSON MD</BusinessNameLine1Txt>
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      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>ERIN R LOCKE MD</BusinessNameLine1Txt>
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      <Form990PartVIISectionAGrp>
        <BusinessName>
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      <Form990PartVIISectionAGrp>
        <BusinessName>
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        <TitleTxt>VP STRATEGIC INITIATIVES</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <BusinessName>
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        <ContractorName>
          <BusinessName>
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        <ContractorAddress>
          <USAddress>
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            <StateAbbreviationCd>NJ</StateAbbreviationCd>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>STORMONT VAIL HOSPITAL</BusinessNameLine1Txt>
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      <ContractorCompensationGrp>
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      <ContractorCompensationGrp>
        <ContractorName>
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      <ContractorCompensationGrp>
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          <BusinessName>
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        <FundraisingAmt>202835</FundraisingAmt>
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        <ManagementAndGeneralAmt>8688</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>213307</ProgramServicesAmt>
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        <FundraisingAmt>2540</FundraisingAmt>
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        <ProgramServicesAmt>1158783</ProgramServicesAmt>
        <ManagementAndGeneralAmt>110429</ManagementAndGeneralAmt>
        <FundraisingAmt>30895</FundraisingAmt>
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      <InformationTechnologyGrp>
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        <ProgramServicesAmt>896308</ProgramServicesAmt>
        <ManagementAndGeneralAmt>160055</ManagementAndGeneralAmt>
        <FundraisingAmt>10670</FundraisingAmt>
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        <ProgramServicesAmt>1084312</ProgramServicesAmt>
        <ManagementAndGeneralAmt>191263</ManagementAndGeneralAmt>
        <FundraisingAmt>12751</FundraisingAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>1175764</ProgramServicesAmt>
        <ManagementAndGeneralAmt>26871</ManagementAndGeneralAmt>
        <FundraisingAmt>1791</FundraisingAmt>
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      <ConferencesMeetingsGrp>
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        <ProgramServicesAmt>14369</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2566</ManagementAndGeneralAmt>
        <FundraisingAmt>605</FundraisingAmt>
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        <ProgramServicesAmt>357115</ProgramServicesAmt>
        <ManagementAndGeneralAmt>63771</ManagementAndGeneralAmt>
        <FundraisingAmt>4251</FundraisingAmt>
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        <ProgramServicesAmt>1335465</ProgramServicesAmt>
        <ManagementAndGeneralAmt>238476</ManagementAndGeneralAmt>
        <FundraisingAmt>15898</FundraisingAmt>
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        <ProgramServicesAmt>378927</ProgramServicesAmt>
        <ManagementAndGeneralAmt>66616</ManagementAndGeneralAmt>
        <FundraisingAmt>4441</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES &amp; DRUGS</Desc>
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        <ProgramServicesAmt>10225096</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>INSTITUTIONAL CARE</Desc>
        <TotalAmt>9466316</TotalAmt>
        <ProgramServicesAmt>9466316</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
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        <NetIncomeSummaryAmt>-119487</NetIncomeSummaryAmt>
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    </IRS990ScheduleG>
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      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>SHAWN M SULLIVAN</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>CHIEF EXECUTIVE OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>213820</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>25593</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
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        <BusinessName>
          <BusinessNameLine1Txt>KERRI K MOSINSKI</BusinessNameLine1Txt>
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        <TitleTxt>CHIEF ADMINISTRATIVE OFFICER</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>MARSHA M KENT</BusinessNameLine1Txt>
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        <TitleTxt>VICE PRESIDENT OF CLINICAL SERVICES</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>LEANNA E CHAFFEE</BusinessNameLine1Txt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <TitleTxt>CHIEF MEDICAL OFFICER</TitleTxt>
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        <NontaxableBenefitsFilingOrgAmt>22357</NontaxableBenefitsFilingOrgAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>CHARLES G NELSON MD</BusinessNameLine1Txt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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          <BusinessNameLine1Txt>JEREMY WILTZ</BusinessNameLine1Txt>
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        <TitleTxt>VP STRATEGIC INITIATIVES</TitleTxt>
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        <DeferredCompensationFlngOrgAmt>14870</DeferredCompensationFlngOrgAmt>
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        <IssuerName>
          <BusinessNameLine1Txt>CITY OF TOPEKA</BusinessNameLine1Txt>
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        <BondIssuerEIN>486028701</BondIssuerEIN>
        <CUSIPNum>890585BQ4</CUSIPNum>
        <BondIssuedDt>2020-08-31</BondIssuedDt>
        <IssuePriceAmt>12495000</IssuePriceAmt>
        <PurposeDesc>REFUNDING 2013 BONDS</PurposeDesc>
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        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
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        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>1926939</RetiredAmt>
        <TotalProceedsAmt>12495000</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>249900</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>4477743</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>7767357</OtherSpentProceedsAmt>
        <RefundingTaxExemptBondsInd>true</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>false</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <TotalPrivateBusinessUsePct>0.0</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
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      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>true</RebateNotDueYetInd>
        <ExceptionToRebateInd>false</ExceptionToRebateInd>
        <NoRebateDueInd>false</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND OTHER INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE BOARD OF DIRECTORS WERE PROVIDED WITH THE DRAFT FORM 990 AND RELATED SCHEDULES. SCHEDLULE B WAS PROVIDED TO THE BOARD WITH REDACTED DONOR INFORMATION. THE FORMS AND SCHEDULES WERE REVIEWED, WITH TIME ALLOWED FOR QUESTIONS AND ANSWERS.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL STAFF AND BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT. IN THE EVENT OF A CONFLICT TO OCCUR, THE CONFLICT WOULD BE REVIEWED BY THE RISK MANAGMENT COMMITTEE (COMPRISED OF THE EXECUTIVE COMMITTEE, CEO AND SENIOR MANAGEMENT TEAM) AND A DETERMINATION OF ACTION WOULD BE MADE. A BOARD MEMBER THAT HAS A BUSINESS RELATIONSHIP THAT CREATES A CONFLICT OF INTEREST IS PROHIBITED FROM PARTICIPATING IN THE FINAL DISCUSSIONS AND DECISIONS IN THE TRANSACTION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a Process to establish compensation of top management official</FormAndLineReferenceDesc>
        <ExplanationTxt>EXECUTIVE COMPENSATION IS DETERMINED BY USING COMPENSATION RESOURCES, SUCH AS THE HOME CARE AND HOSPICE SALARY AND BENEFITS REPORT AND REGIONAL WAGE INDEXES. CEO COMPENSATION AND SALARY INCREASES ARE DETERMINED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WITHIN THE CONFINES OF THE APPROVED BUDGET.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b Process to establish compensation of other employees</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER EXECUTIVE COMPENSATION IS BASED ON BENCHMARKING REPORTS AND APPROVED WITH THE CONFINES OF THE APPROVED ANNUAL BUDGET. ALL APPROVED COMPENSATION AND SALARY INCREASES ARE DOCUMENTED IN THE EMPLOYEE'S PERSONNEL FILES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>MIDLAND CARE PROVIDES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 11g Other Fees</FormAndLineReferenceDesc>
        <ExplanationTxt>OUTPATIENT SERVICES - Total Expense: 3293072, Program Service Expense: 3293072, Management and General Expenses: , Fundraising Expenses: ; CONTRACT SERVICES - Total Expense: 1448657, Program Service Expense: 1101897, Management and General Expenses: 346111, Fundraising Expenses: 649; AGENCY STAFFING - Total Expense: 1432229, Program Service Expense: 1432229, Management and General Expenses: , Fundraising Expenses: ; DIALYSIS SERVICES - Total Expense: 1091554, Program Service Expense: 1091554, Management and General Expenses: , Fundraising Expenses: ; CONSULTING SERVICES - Total Expense: 846352, Program Service Expense: 723126, Management and General Expenses: 114618, Fundraising Expenses: 8608; INSTITUTIONAL CARE - Total Expense: 754252, Program Service Expense: 754252, Management and General Expenses: , Fundraising Expenses: ; IMAGING SERVICES - Total Expense: 730904, Program Service Expense: 730904, Management and General Expenses: , Fundraising Expenses: ; THERAPY SERVICES - Total Expense: 583422, Program Service Expense: 583422, Management and General Expenses: , Fundraising Expenses: ; EMERGENCY ROOM - Total Expense: 516418, Program Service Expense: 516418, Management and General Expenses: , Fundraising Expenses: ; LABORATORY &amp; DIAGNOSTICS - Total Expense: 516006, Program Service Expense: 516006, Management and General Expenses: , Fundraising Expenses: ; PHYSICIAN SERVICES - Total Expense: 63261, Program Service Expense: 63261, Management and General Expenses: , Fundraising Expenses: ;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9 Other changes in net assets or fund balances</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN BENEFICIAL INTEREST IN TRUST - 76947;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2c Change of oversight process or selection process</FormAndLineReferenceDesc>
        <ExplanationTxt>A CFO AND CONTROLLER WERE HIRED IN JULY TO REPLACE THE INTERIM CONTRACTED EMPLOYEES. THESE STAFF MEMBERS ALONG WITH THE FINANCE COMMITTEE MADE THE RECOMMENDATION OF THE INDEPENDENT AUDITOR. THE CFO AND CONTROLLER OVERSAW THE AUDIT PROCESS AND THE CFO REPORTED TO THE FINANCE COMMITTEE UNTIL THE FINAL AUDIT WAS PRESENTED.</ExplanationTxt>
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    </IRS990ScheduleO>
  </ReturnData>
</Return>