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        <TitleTxt>Medical Director</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>227882</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>12478</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Regina Morris</PersonNm>
        <TitleTxt>VP Development</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>118934</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11249</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Alicia Coleman</PersonNm>
        <TitleTxt>VP Finance</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>124286</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11249</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>849855</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>99861</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>5</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Effortless Office</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5655 W Badura Ave Ste 180</AddressLine1Txt>
            <CityNm>Las Vegas</CityNm>
            <StateAbbreviationCd>NV</StateAbbreviationCd>
            <ZIPCd>89118</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>IT services</ServicesDesc>
        <CompensationAmt>321436</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>1</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>4249015</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>1601601</AllOtherContributionsAmt>
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      <TotalContributionsAmt>5850616</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Medicaid</Desc>
        <BusinessCd>621400</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>1239186</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Insurance reimbursements</Desc>
        <BusinessCd>621400</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>880510</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Patient fees</Desc>
        <BusinessCd>621400</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>47517</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>2167213</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>18765</TotalRevenueColumnAmt>
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      </InvestmentIncomeGrp>
      <TotalRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>2167213</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>18765</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
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        <ProgramServicesAmt>520203</ProgramServicesAmt>
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        <FundraisingAmt>29236</FundraisingAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
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        <ProgramServicesAmt>3534667</ProgramServicesAmt>
        <ManagementAndGeneralAmt>914291</ManagementAndGeneralAmt>
        <FundraisingAmt>198658</FundraisingAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>77337</TotalAmt>
        <ProgramServicesAmt>58817</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15214</ManagementAndGeneralAmt>
        <FundraisingAmt>3306</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>661644</TotalAmt>
        <ProgramServicesAmt>503202</ProgramServicesAmt>
        <ManagementAndGeneralAmt>130160</ManagementAndGeneralAmt>
        <FundraisingAmt>28282</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>407279</TotalAmt>
        <ProgramServicesAmt>309749</ProgramServicesAmt>
        <ManagementAndGeneralAmt>80121</ManagementAndGeneralAmt>
        <FundraisingAmt>17409</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>1693</TotalAmt>
        <ManagementAndGeneralAmt>1693</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>47230</TotalAmt>
        <ManagementAndGeneralAmt>47230</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>267101</TotalAmt>
        <ProgramServicesAmt>244162</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22939</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>53432</TotalAmt>
        <ProgramServicesAmt>580</ProgramServicesAmt>
        <ManagementAndGeneralAmt>43613</ManagementAndGeneralAmt>
        <FundraisingAmt>9239</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>154021</TotalAmt>
        <ProgramServicesAmt>67248</ProgramServicesAmt>
        <ManagementAndGeneralAmt>62346</ManagementAndGeneralAmt>
        <FundraisingAmt>24427</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>467292</TotalAmt>
        <ProgramServicesAmt>386575</ProgramServicesAmt>
        <ManagementAndGeneralAmt>68303</ManagementAndGeneralAmt>
        <FundraisingAmt>12414</FundraisingAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>440798</TotalAmt>
        <ProgramServicesAmt>347478</ProgramServicesAmt>
        <ManagementAndGeneralAmt>73831</ManagementAndGeneralAmt>
        <FundraisingAmt>19489</FundraisingAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>151307</TotalAmt>
        <ProgramServicesAmt>64828</ProgramServicesAmt>
        <ManagementAndGeneralAmt>68960</ManagementAndGeneralAmt>
        <FundraisingAmt>17519</FundraisingAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>16422</TotalAmt>
        <ProgramServicesAmt>4848</ProgramServicesAmt>
        <ManagementAndGeneralAmt>11574</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>421576</TotalAmt>
        <ProgramServicesAmt>366182</ProgramServicesAmt>
        <ManagementAndGeneralAmt>55326</ManagementAndGeneralAmt>
        <FundraisingAmt>68</FundraisingAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>291696</TotalAmt>
        <ProgramServicesAmt>262041</ProgramServicesAmt>
        <ManagementAndGeneralAmt>21133</ManagementAndGeneralAmt>
        <FundraisingAmt>8522</FundraisingAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Resident program exp.</Desc>
        <TotalAmt>370546</TotalAmt>
        <ProgramServicesAmt>369452</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1094</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Repairs &amp; maintenance</Desc>
        <TotalAmt>70550</TotalAmt>
        <ProgramServicesAmt>70550</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Licenses, permits, fees</Desc>
        <TotalAmt>67406</TotalAmt>
        <ProgramServicesAmt>61365</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6041</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Auto expenses</Desc>
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        <ProgramServicesAmt>27878</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4960</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>26342</TotalAmt>
        <ProgramServicesAmt>25982</ProgramServicesAmt>
        <ManagementAndGeneralAmt>360</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>9358123</TotalAmt>
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      <CashNonInterestBearingGrp>
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        <EOYAmt>7190</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>1217280</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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        <EOYAmt>517640</EOYAmt>
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      <AccountsReceivableGrp>
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      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>52870</EOYAmt>
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      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>2524434</EOYAmt>
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      <OtherAssetsTotalGrp>
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        <EOYAmt>407</EOYAmt>
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        <EOYAmt>227901</EOYAmt>
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      <TotalLiabilitiesGrp>
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      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
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        <EOYAmt>3931003</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
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        <EOYAmt>336050</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>4267053</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
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        <EOYAmt>5083319</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>-1321529</ReconcilationRevenueExpnssAmt>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
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      <FSAuditedBasisGrp>
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      <FederalGrantAuditRequiredInd>1</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
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        <CurrentTaxYearMinus2YearsAmt>5802646</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6450981</CurrentTaxYearMinus1YearAmt>
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      <TotalCalendarYear170Grp>
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        <CurrentTaxYearMinus2YearsAmt>5802646</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6450981</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5850616</CurrentTaxYearAmt>
        <TotalAmt>37933872</TotalAmt>
      </TotalCalendarYear170Grp>
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      <GrossInvestmentIncome170Grp>
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        <CurrentTaxYearMinus3YearsAmt>21980</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1422</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1048</CurrentTaxYearMinus1YearAmt>
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        <TotalAmt>84332</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <OtherIncome170Grp>
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      </OtherIncome170Grp>
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      <GrossReceiptsRltdActivitiesAmt>14408599</GrossReceiptsRltdActivitiesAmt>
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      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part II, Line 10, Explanation of Other Income:</FormAndLineReferenceDesc>
        <ExplanationTxt>Other income - 2018 Amount: $ 25,255.</ExplanationTxt>
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    </IRS990ScheduleA>
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        <ContributorUSAddress>
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          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
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      </ContributorInformationGrp>
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      </LandGrp>
      <BuildingsGrp>
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      </BuildingsGrp>
      <EquipmentGrp>
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      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>2524434</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Lease liability</Desc>
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      </OtherLiabilitiesOrgGrp>
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      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>8036594</TotalRevenuePerForm990Amt>
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      <TotalExpensesPerForm990Amt>9358123</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
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      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Dr Anil Swarup</PersonNm>
        <TitleTxt>Medical Director</TitleTxt>
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        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
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        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
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        <TotalCompensationFilingOrgAmt>240360</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Andrew Dutton</PersonNm>
        <TitleTxt>Chief Operating Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>182194</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <NontaxableBenefitsFilingOrgAmt>34872</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>227522</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Bart Loewen</PersonNm>
        <TitleTxt>President &amp; CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>196559</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8308</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>11249</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>216116</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>Form 990 is reviewed by the organization's CEO and Controller before it is signed and submitted to the IRS. The board of directors also receives a copy of the tax return prior to filing with the IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>All officers and directors are required to complete a conflict of interest questionnaire annually. The board of directors (or committee thereof) directly reviews all transactions presenting any potential conflict of interest, or the appearance thereof, and enforces the policy by approving such transactions only if they do not present a conflict or are independently determined to be fair, reasonable, and in the best interest of the organization. Any director or officer with a conflict of interest may not participate in or attempt to influence the board's (or committee's) deliberations or decision. Prior to entering into such transaction, the board (or committee) also considers alternative transactions to the extent available.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The President/CEO's compensation is benchmarked by a consultant and reviewed (without participation by the person being compensated) for reasonableness by the organization's board (or committee thereof), and recorded in the board meeting minutes. The procedures described above are also used to determine the compensation of other officers and key employees.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Available upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
