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        <DepreciationAmt>788538</DepreciationAmt>
        <BookValueAmt>135534</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>2919821</TotalBookValueLandBuildingsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>25010115</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>25010115</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>25010115</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>24827525</TotExpnsEtcAuditedFinclStmtAmt>
      <PriorYearAdjustmentsAmt>314965</PriorYearAdjustmentsAmt>
      <ExpensesNotReportedAmt>314965</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>24512560</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>24512560</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="990O">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>The CEO and CFO provide a copy to the Board of Directors after its completed and filed.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The Entitys Board of Directors approved a written conflict of interest policy.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>CEO executive director top management comp Part VI line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Directors during the budget process review and approve compensation increases for the CEO and employees. After the board approves the budget and compensations, the CEO authorizes the compensation approved by the Board of Directors.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other officer or key employee compensation Part VI line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Directors during the budget process review and approve compensation increases for the CEO and employees. After the board approves the budget and compensations, the CEO authorizes the compensation approved by the Board of Directors.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>If the local, state, and federal rules and regulations do not prohibit access to the Entitys information or documents, the entity provides the information or document upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>List of other fees for services expenses Part IX line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Pharmaceutical professional management services $177,720</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>List of other expenses Part IX line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad debt expense 537,157Bank fees and charges 6,286Contracted services 574,154Lab and waste costs 470,820Membership and subscription fees 174,920Miscellaneous 4,761Patient education programs 28,433Patient food and meals 104,867Printing and publications 1,443Program supplies 115,574Rental building and equipment 373,804Supplies-medical 145,098Telephone 100,628Training, webinars, meetings 275,162Transportation-patients 78,997Utilities 60,074 Management and general expensesBad debt expense 27,800Bank fees and charges 19,528Patient education programs 7,765Printing and publications 211Program supplies 4,900Training, webinars, meetings 8,590Transportation patients 4,548Contracted services 36,093Rental building and equipment 8,316Lab and waste costs 2,478 Total 120,229</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>