﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2023v5.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2024-11-15T09:14:43+00:00</ReturnTs>
    <TaxPeriodEndDt>2023-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>440160260</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>Forvis Mazars LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>1222 Demonbreun St Suite 950</AddressLine1Txt>
        <CityNm>Nashville</CityNm>
        <StateAbbreviationCd>TN</StateAbbreviationCd>
        <ZIPCd>372033357</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>610946210</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>Medical Center Ambulance Service</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>MEDI</BusinessNameControlTxt>
      <PhoneNum>2708255201</PhoneNum>
      <USAddress>
        <AddressLine1Txt>629 LAFFOON STREET</AddressLine1Txt>
        <CityNm>MADISONVILLE</CityNm>
        <StateAbbreviationCd>KY</StateAbbreviationCd>
        <ZIPCd>42431</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>ALISA COLEMAN</PersonNm>
      <PersonTitleTxt>DIRECTOR</PersonTitleTxt>
      <PhoneNum>2708255201</PhoneNum>
      <SignatureDt>2024-11-15</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>Jeff Smith</PreparerPersonNm>
      <PTIN>P00289876</PTIN>
      <PhoneNum>6154549800</PhoneNum>
      <PreparationDt>2024-11-13</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2024-10-15 13:58:12Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="7">
    <IRS990 documentId="IRS990" softwareId="23017437" softwareVersionNum="2023v5.1">
      <PrincipalOfcrBusinessName>
        <BusinessNameLine1Txt>JACK MORRIS</BusinessNameLine1Txt>
      </PrincipalOfcrBusinessName>
      <USAddress>
        <AddressLine1Txt>400 EAST MAIN ST UNIT 203</AddressLine1Txt>
        <CityNm>LOUISVILLE</CityNm>
        <StateAbbreviationCd>KY</StateAbbreviationCd>
        <ZIPCd>40202</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>3751711</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>N/A</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1978</FormationYr>
      <LegalDomicileStateCd>KY</LegalDomicileStateCd>
      <ActivityOrMissionDesc>THE PRIMARY PURPOSE OF MCAS IS TO PROVIDE ADVANCED AND BASIC LIFE SUPPORT SERVICES ON A 24 HOUR BASIS TO HOPKINS AND WEBSTER COUNTIES AND SURROUNDING AREAS.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>6</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>3</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>0</TotalEmployeeCnt>
      <TotalVolunteersCnt>0</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>542500</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>512500</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>3027603</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>3221754</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>10515</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>17457</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>91500</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>0</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>3672118</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>3751711</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <CYSalariesCompEmpBnftPaidAmt>0</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>3846738</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>3723258</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>3846738</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>3723258</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>-174620</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>28453</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>4101258</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>4259552</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>2422291</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>2543806</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>1678967</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>1715746</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>TO PROVIDE ADVANCED AND BASIC LIFE SUPPORT SERVICES ON A 24 HOUR BASIS TO HOPKINS AND WEBSTER COUNTIES AND SURROUNDING AREAS.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>3136586</ExpenseAmt>
      <RevenueAmt>3221754</RevenueAmt>
      <Desc>MEDICAL CENTER AMBULANCE SERVICE, INC. (MCAS) IS ORGANIZED AS A NOT-FOR-PROFIT KENTUCKY CORPORATION, WHICH PRIMARILY EARNS REVENUE BY PROVIDING AMBULANCE SERVICES IN HOPKINS AND WEBSTER COUNTIES IN KENTUCKY. MCAS ALSO PROVIDES TRANSPORTATION SERVICES TO OTHER AREAS THROUGH RECIPROCAL MUTUAL AID AGREEMENTS WITH ALL SURROUNDING COUNTIES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.</Desc>
      <TotalProgramServiceExpensesAmt>3136586</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="IRS990ScheduleB">true</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <DonorAdvisedFundInd>false</DonorAdvisedFundInd>
      <ConservationEasementsInd>false</ConservationEasementsInd>
      <CollectionsOfArtInd>false</CollectionsOfArtInd>
      <CreditCounselingInd>false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd>false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd>false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="IRS990ScheduleD">true</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="IRS990ScheduleD">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="IRS990ScheduleD">true</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd>false</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd>false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="IRS990ScheduleJ">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd>false</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="IRS990ScheduleR">true</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <InfoInScheduleOPartVInd>X</InfoInScheduleOPartVInd>
      <IRPDocumentCnt>3</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <EmployeeCnt>0</EmployeeCnt>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>6</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>3</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>false</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>true</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>true</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>KY</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>ALISA COLEMAN</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>2708255201</PhoneNum>
        <USAddress>
          <AddressLine1Txt>900 HOSPITAL DRIVE</AddressLine1Txt>
          <CityNm>MADISONVILLE</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42431</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>ALISA COLEMAN</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>Director / Vice President</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>ALLEN RUDD</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>DIRECTOR/TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>JACK MORRIS</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>CHAIRMAN/PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>VICKI THOMISON</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>SECRETARY / BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>Joshua Clapp MD</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>473552</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>29474</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>MOHAN RAO MD</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>395540</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>25176</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>JONATHAN LUCK</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>DIRECTOR OF MCAS OPERATIONS</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>121096</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11369</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>0</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>990188</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>66019</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>3</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <CntrctRcvdGreaterThan100KCnt>0</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>512500</GovernmentGrantsAmt>
      <TotalContributionsAmt>512500</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>AMBULANCE SERVICES</Desc>
        <BusinessCd>621910</BusinessCd>
        <TotalRevenueColumnAmt>3100028</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3100028</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER OPERATING REVENUE</Desc>
        <BusinessCd>621910</BusinessCd>
        <TotalRevenueColumnAmt>121726</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>121726</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>3221754</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>17457</TotalRevenueColumnAmt>
        <ExclusionAmt>17457</ExclusionAmt>
      </InvestmentIncomeGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>0</SecuritiesAmt>
        <OtherAmt>0</OtherAmt>
      </GainOrLossGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>0</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>3751711</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3221754</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>17457</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <FeesForServicesAccountingGrp>
        <TotalAmt>10500</TotalAmt>
        <ManagementAndGeneralAmt>10500</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>2989127</TotalAmt>
        <ProgramServicesAmt>2424183</ProgramServicesAmt>
        <ManagementAndGeneralAmt>564944</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>215103</TotalAmt>
        <ProgramServicesAmt>215103</ProgramServicesAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>15570</TotalAmt>
        <ProgramServicesAmt>15570</ProgramServicesAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>59264</TotalAmt>
        <ProgramServicesAmt>59264</ProgramServicesAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>227</TotalAmt>
        <ProgramServicesAmt>227</ProgramServicesAmt>
      </TravelGrp>
      <InterestGrp>
        <TotalAmt>1630</TotalAmt>
        <ProgramServicesAmt>1630</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>246276</TotalAmt>
        <ProgramServicesAmt>246276</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>71317</TotalAmt>
        <ProgramServicesAmt>71317</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>PROVIDER TAX</Desc>
        <TotalAmt>99471</TotalAmt>
        <ProgramServicesAmt>99471</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LINEN AND LAUNDRY</Desc>
        <TotalAmt>12238</TotalAmt>
        <ProgramServicesAmt>2937</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9301</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES AND LICENSES</Desc>
        <TotalAmt>2130</TotalAmt>
        <ProgramServicesAmt>511</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1619</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BANK FEES AND MISC</Desc>
        <TotalAmt>405</TotalAmt>
        <ProgramServicesAmt>97</ProgramServicesAmt>
        <ManagementAndGeneralAmt>308</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>3723258</TotalAmt>
        <ProgramServicesAmt>3136586</ProgramServicesAmt>
        <ManagementAndGeneralAmt>586672</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1325781</BOYAmt>
        <EOYAmt>1647724</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>547963</BOYAmt>
        <EOYAmt>569810</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>21093</BOYAmt>
        <EOYAmt>11437</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>219494</BOYAmt>
        <EOYAmt>99098</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>1293824</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>1112654</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>32694</BOYAmt>
        <EOYAmt>181170</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>0</BOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>0</BOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>1954233</BOYAmt>
        <EOYAmt>1750313</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>4101258</BOYAmt>
        <EOYAmt>4259552</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>407362</BOYAmt>
        <EOYAmt>737928</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <GrantsPayableGrp>
        <BOYAmt>0</BOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>0</BOYAmt>
      </DeferredRevenueGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>0</BOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>0</BOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>2014929</BOYAmt>
        <EOYAmt>1805878</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>2422291</BOYAmt>
        <EOYAmt>2543806</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>1678967</BOYAmt>
        <EOYAmt>1715746</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>1678967</BOYAmt>
        <EOYAmt>1715746</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>4101258</BOYAmt>
        <EOYAmt>4259552</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>28453</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>8326</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>false</FSAuditedInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA" softwareId="23017437" softwareVersionNum="2023v5.1">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContriRcvd170Grp>
        <TotalAmt>0</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TaxRevLeviedOrgnztnlBnft170Grp>
        <TotalAmt>0</TotalAmt>
      </TaxRevLeviedOrgnztnlBnft170Grp>
      <GovtFurnSrvcFcltsVl170Grp>
        <TotalAmt>0</TotalAmt>
      </GovtFurnSrvcFcltsVl170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </TotalCalendarYear170Grp>
      <SubstantialContributorsTotAmt>0</SubstantialContributorsTotAmt>
      <PublicSupportTotal170Amt>0</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <TotalAmt>0</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <UnrelatedBusinessNetIncm170Grp>
        <TotalAmt>0</TotalAmt>
      </UnrelatedBusinessNetIncm170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>0</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>0</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.0</PublicSupportPY170Pct>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>480000</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>595780</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>502500</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>542500</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>512500</CurrentTaxYearAmt>
        <TotalAmt>2633280</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>2499114</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2300538</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>2930829</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3027603</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3221754</CurrentTaxYearAmt>
        <TotalAmt>13979838</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <GrossReceiptsNonUnrltBusGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </GrossReceiptsNonUnrltBusGrp>
      <TaxRevLeviedOrgnztnlBnft509Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </TaxRevLeviedOrgnztnlBnft509Grp>
      <GovtFurnSrvcFcltsVl509Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </GovtFurnSrvcFcltsVl509Grp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>2979114</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2896318</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3433329</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3570103</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3734254</CurrentTaxYearAmt>
        <TotalAmt>16613118</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>16613118</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>7213</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>10261</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1491</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>9412</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>17457</CurrentTaxYearAmt>
        <TotalAmt>45834</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <Post1975UBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </Post1975UBTIGrp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>7213</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>10261</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1491</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>9412</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>17457</CurrentTaxYearAmt>
        <TotalAmt>45834</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <NetIncomeFromOtherUBIGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </NetIncomeFromOtherUBIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>92087</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>50</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>91500</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>183637</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>3078414</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2906579</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3434870</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3671015</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3751711</CurrentTaxYearAmt>
        <TotalAmt>16842589</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.9864</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.9791</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.0021</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <DistributableAmountGrp>
        <CYAdjNetIncomeDistributableAmt>0</CYAdjNetIncomeDistributableAmt>
        <CYPct85AdjustedNetIncomeAmt>0</CYPct85AdjustedNetIncomeAmt>
        <CYTotalMinAstDistributableAmt>0</CYTotalMinAstDistributableAmt>
        <CYGreaterAdjustedMinimumAmt>0</CYGreaterAdjustedMinimumAmt>
        <CYIncomeTaxImposedPYAmt>0</CYIncomeTaxImposedPYAmt>
        <CYDistributableAsAdjustedAmt>0</CYDistributableAsAdjustedAmt>
      </DistributableAmountGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III, Line 12 Other Income</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION - INSURANCE PROCEEDS, COLUMN A - 92087.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 91500.0, COLUMN E - 0.0, COLUMN F - 183587.0; DESCRIPTION - SEMINAR REVENUE, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 50.0, COLUMN D - 0.0, COLUMN E - 0.0, COLUMN F - 50.0;</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB" softwareId="23017437" softwareVersionNum="2023v5.1">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="IRS990ScheduleD" softwareId="23017437" softwareVersionNum="2023v5.1">
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>12028</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>12028</DepreciationAmt>
        <BookValueAmt>0</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1281796</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1100626</DepreciationAmt>
        <BookValueAmt>181170</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>181170</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Right of Use Net Asset</Desc>
        <BookValueAmt>1750313</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>1750313</TotalBookValueOtherAssetsAmt>
      <FederalIncomeTaxLiabilityAmt>0</FederalIncomeTaxLiabilityAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>PAYABLE TO BAPTIST HEALTH MADI</Desc>
        <Amt>173886</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>CURRENT FINANCING LEASE</Desc>
        <Amt>203890</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>LONG TERM FINANCING LEASE</Desc>
        <Amt>1428102</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>1805878</TotalLiabilityAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ" softwareId="23017437" softwareVersionNum="2023v5.1">
      <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>MOHAN RAO MD</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>353220</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>33064</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>9256</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>12374</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>12802</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>420716</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <BusinessName>
          <BusinessNameLine1Txt>Joshua Clapp MD</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>449008</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>24544</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>12876</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>16598</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>503026</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS COMPENSATED BY BAPTIST HEALTH MADISONVILLE, INC., A RELATED TAX EXEMPT ORGANIZATION. BAPTIST HEALTH UTILIZES A COMPENSATION COMMITTEE, INDEPENDENT CONSULTANTS, EMPLOYMENT CONTRACTS AND COMPENSATION SURVEYS AND STUDIES TO ESTABLISH COMPENSATION.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="23017437" softwareVersionNum="2023v5.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, Line 4a PROGRAM SERVICE NARRATIVE</FormAndLineReferenceDesc>
        <ExplanationTxt>DURING 2023, MCAS PERFORMED 5,168 EMERGENCY RUNS, 1,877 NON-EMERGENT, AND 1,679 OTHER RUNS. MCAS CONTRIBUTED NO COST STAND BY SERVICES AT A VARIETY OF COMMUNITY EVENTS INCLUDING HIGH SCHOOL BAND FESTIVALS, LOCAL HIGH SCHOOL AND MIDDLE SCHOOL FOOTBALL GAMES, FRIDAY NIGHT LIVE EVENTS, RELAY FOR LIFE, HOPKINS COUNTY FAIR, AND MANY OTHERS. MCAS HOSTED NUMEROUS EDUCATIONAL EVENTS INCLUDING VISITING SCHOOLS WITHIN THE COUNTIES TO CONDUCT FIRST AID AND SAFETY DEMONSTRATIONS. MCAS PERSONNEL TAUGHT CPR CLASSES TO THE STAFFS OF AREA DENTAL CLINIC AND PHYSICIAN OFFICES, ALONG WITH STUDENTS OF LOCAL HIGH SCHOOLS. SEVERAL EMPLOYEES SERVE AS ADVANCED CARDIAC LIFE SUPPORT INSTRUCTORS FOR GROUPS OF MEDICAL PROFESSIONALS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part V, Line 2a EMPLOYEES</FormAndLineReferenceDesc>
        <ExplanationTxt>EMPLOYEES OF BAPTIST HEALTH MADISONVILLE ARE LEASED TO THE MEDICAL CENTER AMBULANCE SERVICE, INC. AS A PURCHASED SERVICE. THEREFORE, THERE ARE NO EMPLOYEES REFLECTED ON THIS LINE AND THE RELATED EMPLOYEES SALARIES AND WAGES AND BENEFITS ARE REFLECTED AS A PURCHASED SERVICE EXPENSE ON THE STATEMENT OF FUNCTIONAL EXPENSES STATEMENT, PART IX.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>A COPY OF THE FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING WITH THE IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EACH BOARD MEMBER AND OFFICER. THE CHAIRMAN OF THE BOARD IS RESPONSIBLE FOR BEING FAMILIAR WITH THE STATEMENTS AND IDENTIFYING EXISTING OR CONTEMPLATED CONFLICTS. AFFECTED PARTIES ARE REQUIRED TO WITHDRAW FROM MEETINGS AND NOT VOTE ON SUCH MATTERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a Process to establish compensation of top management official</FormAndLineReferenceDesc>
        <ExplanationTxt>JONATHAN LUCK IS THE TOP MANAGEMENT OFFICIAL OF MCAS. HE IS THE OPERATIONS MANAGER AND WORKING SUPERVISOR. LUCK'S COMPENSATION IS BASED ON HIS YEARS OF SERVICE, EXPERIENCE, AND TRAINING AND INCLUDES AN ADJUSTMENT FOR HIS MANAGEMENT RESPONSIBILITIES. A SALARY SURVEY OF AREA PROVIDERS WAS CONDUCTED AND USED TO ESTABLISH HIS COMPENSATION. HE IS PAID BY BAPTIST HEALTH MADISONVILLE. NO COMPENSATION IS PAID BY MCAS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS, CONFLICT OF INTEREST STATEMENTS, AND FINANCIAL STATEMENTS ARE ON FILE IN ADMINISTRATION. COPIES WILL BE MADE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 11g Other Fees</FormAndLineReferenceDesc>
        <ExplanationTxt>LEASED EMPLOYEES/AMBULANC - Total Expense: 2773986, Program Service Expense: 2249703, Management and General Expenses: 524283, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 177055, Program Service Expense: 143592, Management and General Expenses: 33463, Fundraising Expenses: ; PURCHASED MAINTENANCE - Total Expense: 14964, Program Service Expense: 12136, Management and General Expenses: 2828, Fundraising Expenses: ; OUTSIDE PROFESSIONAL - Total Expense: 2638, Program Service Expense: 2139, Management and General Expenses: 499, Fundraising Expenses: ; LOCUMS/PHYSICIAN SERVICE - Total Expense: 11700, Program Service Expense: 9489, Management and General Expenses: 2211, Fundraising Expenses: ; COLLECTION EXPENSE - Total Expense: 8784, Program Service Expense: 7124, Management and General Expenses: 1660, Fundraising Expenses: ;</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="IRS990ScheduleR" softwareId="23017437" softwareVersionNum="2023v5.1">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>BAPTIST HEALTH MADISONVILLE INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>900 HOSPITAL DRIVE</AddressLine1Txt>
          <CityNm>MADISONVILLE</CityNm>
          <StateAbbreviationCd>KY</StateAbbreviationCd>
          <ZIPCd>42431</ZIPCd>
        </USAddress>
        <EIN>610654587</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>BAPTIST HLTH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>