﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile" returnVersion="2024v5.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2025-06-11T12:12:29-05:00</ReturnTs>
    <TaxPeriodEndDt>2024-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>311427777</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>SEN &amp; ASSOCIATES INC</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>3196 BRENTWOOD CT</AddressLine1Txt>
        <CityNm>POWELL</CityNm>
        <StateAbbreviationCd>OH</StateAbbreviationCd>
        <ZIPCd>43065</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2024-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>383428303</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>A &amp; D CHARITABLE FOUNDATION INC</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>A&amp;DC</BusinessNameControlTxt>
      <PhoneNum>9892727610</PhoneNum>
      <USAddress>
        <AddressLine1Txt>3150 ENTERPRISE DRIVE 100</AddressLine1Txt>
        <CityNm>SAGINAW</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>48603</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>Michael Argyle</PersonNm>
      <PersonTitleTxt>Board Member</PersonTitleTxt>
      <PhoneNum>9892727610</PhoneNum>
      <SignatureDt>2025-06-05</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>0</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>Tuhin Sen</PreparerPersonNm>
      <PTIN>P01250177</PTIN>
      <PhoneNum>6147981950</PhoneNum>
      <PreparationDt>2025-06-05</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2024</TaxYr>
    <BuildTS>2025-03-06 01:10:19Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="6">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <DoingBusinessAsName>
        <BusinessNameLine1Txt>GREAT LAKES PACE</BusinessNameLine1Txt>
      </DoingBusinessAsName>
      <PrincipalOfficerNm>ROSELYN ARGYLE</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>3150 ENTERPRISE DRIVE</AddressLine1Txt>
        <CityNm>SAGINAW</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>48603</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>26374798</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>www.greatlakespace.org</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1999</FormationYr>
      <LegalDomicileStateCd>MI</LegalDomicileStateCd>
      <ActivityOrMissionDesc>The organization provides "All Inclusive Care for Elderly" under certification from federal PACE program</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>5</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>5</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>0</TotalEmployeeCnt>
      <TotalVolunteersCnt>0</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>94250</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>669010</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>21034700</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>25688913</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>1046</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>220</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>2809</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>5355</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>21132805</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>26363498</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>8288341</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>8969369</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>13736891</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>15637884</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>22025232</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>24607253</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>-892427</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>1756245</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>4269946</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>5162962</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>6132678</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>5269449</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>-1862732</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>-106487</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>The organization provides "All Inclusive Care for Elderly" under certification from federal PACE program</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>18510901</ExpenseAmt>
      <RevenueAmt>23407958</RevenueAmt>
      <Desc>The organization is enrolled and certified under Federal PACE program in 2015. Under this program, the organization provides all inclusive comprehensive medical care including day care services to elderly who are eligible under Federal Medicare and Medicaid program.</Desc>
      <ProgSrvcAccomActy2Grp>
        <ExpenseAmt>2489370</ExpenseAmt>
        <RevenueAmt>2280955</RevenueAmt>
        <Desc>The organization bought an Assisted Living Center in April 2020 and a new program is initiated to provide residential care services to poor and indigent elderly</Desc>
      </ProgSrvcAccomActy2Grp>
      <TotalProgramServiceExpensesAmt>21000271</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc1039100001">1</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1234500001">1</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>0</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>0</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>0</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc1040000001">0</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc1040000001">0</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc1040000001">0</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc1040000001">0</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>0</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc1040000001">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc1040000001">0</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc1040000001">0</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc1040000001">0</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc1040000001">0</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc1040000001">0</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">1</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>0</SchoolOperatingInd>
      <ForeignOfficeInd>0</ForeignOfficeInd>
      <ForeignActivitiesInd>0</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>0</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>0</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>0</FundraisingActivitiesInd>
      <GamingActivitiesInd>0</GamingActivitiesInd>
      <OperateHospitalInd>0</OperateHospitalInd>
      <GrantsToOrganizationsInd>0</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc1042400001">1</ScheduleJRequiredInd>
      <TaxExemptBondsInd>0</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>0</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>0</PYExcessBenefitTransInd>
      <LoanOutstandingInd>0</LoanOutstandingInd>
      <GrantToRelatedPersonInd>0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>0</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>0</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>0</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>0</DeductibleArtContributionInd>
      <TerminateOperationsInd>0</TerminateOperationsInd>
      <PartialLiquidationInd>0</PartialLiquidationInd>
      <DisregardedEntityInd>0</DisregardedEntityInd>
      <RelatedEntityInd>0</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>0</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>0</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>0</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <EmployeeCnt>0</EmployeeCnt>
      <UnrelatedBusIncmOverLimitInd>0</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>0</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>0</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>0</Form8282PropertyDisposedOfInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>0</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>0</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>5</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>5</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>1</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>0</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>0</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>0</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>0</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>1</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>0</ConflictOfInterestPolicyInd>
      <WhistleblowerPolicyInd>0</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>0</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>0</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>0</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>MI</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>Sen &amp; Associates Inc</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>6147981950</PhoneNum>
        <USAddress>
          <AddressLine1Txt>3196 Brentwood Ct</AddressLine1Txt>
          <CityNm>Powell</CityNm>
          <StateAbbreviationCd>OH</StateAbbreviationCd>
          <ZIPCd>43065</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROSELYN ARGYLE</PersonNm>
        <TitleTxt>Chairwoman of the Board</TitleTxt>
        <AverageHoursPerWeekRt>0.15</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LINDA PARSON</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>0.15</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JODI DAVIS JD</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>0.15</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LYDIA RIGGERT RN</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>0.15</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL ARGYLE MD</PersonNm>
        <TitleTxt>Board Member/President</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>75477</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MOHAMMED SALEEM</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>338346</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID BENJAMIN</PersonNm>
        <TitleTxt>Director of the Program</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>145769</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LAKESHIA JACKSON</PersonNm>
        <TitleTxt>Nurse Practioner</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>137507</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOSEPH CHAKO</PersonNm>
        <TitleTxt>Nurse Practioner</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>147472</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>AMANDA MOULTON</PersonNm>
        <TitleTxt>Pharmacist</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>131860</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RACHEL SMITH</PersonNm>
        <TitleTxt>Nurse Practioner</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>135034</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1111465</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>0</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>6</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <CntrctRcvdGreaterThan100KCnt>0</CntrctRcvdGreaterThan100KCnt>
      <FundraisingAmt>9100</FundraisingAmt>
      <GovernmentGrantsAmt>635551</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>24359</AllOtherContributionsAmt>
      <TotalContributionsAmt>669010</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PACE Program</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>23407958</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>23407958</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Residential Care Program</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>2280955</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2280955</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>25688913</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>220</TotalRevenueColumnAmt>
        <ExclusionAmt>220</ExclusionAmt>
      </InvestmentIncomeGrp>
      <FundraisingGrossIncomeAmt>7156</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>9100</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>11300</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>-4144</TotalRevenueColumnAmt>
        <ExclusionAmt>-4144</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>Other Miscellaneous</Desc>
        <BusinessCd>812900</BusinessCd>
        <TotalRevenueColumnAmt>9499</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>9499</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>9499</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>26363498</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>25698412</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>-3924</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1111465</TotalAmt>
        <ProgramServicesAmt>965696</ProgramServicesAmt>
        <ManagementAndGeneralAmt>145769</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>6314578</TotalAmt>
        <ProgramServicesAmt>4784391</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1530187</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>107231</TotalAmt>
        <ProgramServicesAmt>73788</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33443</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>846114</TotalAmt>
        <ProgramServicesAmt>693582</ProgramServicesAmt>
        <ManagementAndGeneralAmt>152532</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>589981</TotalAmt>
        <ProgramServicesAmt>457072</ProgramServicesAmt>
        <ManagementAndGeneralAmt>132909</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>20733</TotalAmt>
        <ManagementAndGeneralAmt>20733</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>47050</TotalAmt>
        <ManagementAndGeneralAmt>47050</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>679684</TotalAmt>
        <ProgramServicesAmt>192358</ProgramServicesAmt>
        <ManagementAndGeneralAmt>487326</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>55143</TotalAmt>
        <ManagementAndGeneralAmt>55143</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>115687</TotalAmt>
        <ManagementAndGeneralAmt>115687</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>314118</TotalAmt>
        <ManagementAndGeneralAmt>314118</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>365466</TotalAmt>
        <ProgramServicesAmt>365466</ProgramServicesAmt>
      </OccupancyGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>10140</TotalAmt>
        <ManagementAndGeneralAmt>10140</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>141290</TotalAmt>
        <ManagementAndGeneralAmt>141290</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>268587</TotalAmt>
        <ProgramServicesAmt>212986</ProgramServicesAmt>
        <ManagementAndGeneralAmt>55601</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>190103</TotalAmt>
        <ManagementAndGeneralAmt>190103</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Nursing Home &amp; Home Car</Desc>
        <TotalAmt>2647857</TotalAmt>
        <ProgramServicesAmt>2647857</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Inpatient &amp; outpatient</Desc>
        <TotalAmt>2634677</TotalAmt>
        <ProgramServicesAmt>2634677</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Assisted living costs</Desc>
        <TotalAmt>2539631</TotalAmt>
        <ProgramServicesAmt>2539631</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Prescription drugs</Desc>
        <TotalAmt>2445867</TotalAmt>
        <ProgramServicesAmt>2445867</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>3161851</TotalAmt>
        <ProgramServicesAmt>2986900</ProgramServicesAmt>
        <ManagementAndGeneralAmt>174951</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>24607253</TotalAmt>
        <ProgramServicesAmt>21000271</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3606982</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>166693</BOYAmt>
        <EOYAmt>593443</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <EOYAmt>75858</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>63188</BOYAmt>
        <EOYAmt>38395</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>279035</BOYAmt>
        <EOYAmt>295384</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>6769258</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>2609376</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3716748</BOYAmt>
        <EOYAmt>4159882</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>44282</BOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>4269946</BOYAmt>
        <EOYAmt>5162962</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>2156914</BOYAmt>
        <EOYAmt>2050595</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>3879516</BOYAmt>
        <EOYAmt>3218854</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>96248</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>6132678</BOYAmt>
        <EOYAmt>5269449</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrgDoesNotFollowFASB117Ind>X</OrgDoesNotFollowFASB117Ind>
      <CapStkTrPrinCurrentFundsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </CapStkTrPrinCurrentFundsGrp>
      <PdInCapSrplsLandBldgEqpFundGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PdInCapSrplsLandBldgEqpFundGrp>
      <RtnEarnEndowmentIncmOthFndsGrp>
        <BOYAmt>-1862732</BOYAmt>
        <EOYAmt>-106487</EOYAmt>
      </RtnEarnEndowmentIncmOthFndsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>-1862732</BOYAmt>
        <EOYAmt>-106487</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>4269946</BOYAmt>
        <EOYAmt>5162962</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>1756245</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>0</FSAuditedInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>17380810</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>17332998</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>20285744</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>21128950</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>25722372</CurrentTaxYearAmt>
        <TotalAmt>101850874</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsNonUnrltBusGrp>
        <CurrentTaxYearMinus4YearsAmt>25288</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>6139</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8512</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>7257</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>16655</CurrentTaxYearAmt>
        <TotalAmt>63851</TotalAmt>
      </GrossReceiptsNonUnrltBusGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>17406098</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>17339137</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>20294256</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>21136207</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>25739027</CurrentTaxYearAmt>
        <TotalAmt>101914725</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>101914725</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>1308</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>43187</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>249</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1046</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>220</CurrentTaxYearAmt>
        <TotalAmt>46010</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>1308</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>43187</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>249</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1046</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>220</CurrentTaxYearAmt>
        <TotalAmt>46010</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus3YearsAmt>799306</CurrentTaxYearMinus3YearsAmt>
        <TotalAmt>799306</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>17407406</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>18181630</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>20294505</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>21137253</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>25739247</CurrentTaxYearAmt>
        <TotalAmt>102760041</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.99180</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.99060</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00040</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00050</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <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="RetDoc1040000001">
      <LandGrp>
        <InvestmentCostOrOtherBasisAmt>225000</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>225000</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>4491372</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>935179</DepreciationAmt>
        <BookValueAmt>3556193</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <InvestmentCostOrOtherBasisAmt>1058276</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>934410</DepreciationAmt>
        <BookValueAmt>123866</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>994610</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>739787</DepreciationAmt>
        <BookValueAmt>254823</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>4159882</TotalBookValueLandBuildingsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>26374798</TotalRevEtcAuditedFinclStmtAmt>
      <OtherRevenueAmt>11300</OtherRevenueAmt>
      <RevenueNotReportedAmt>11300</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>26363498</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>26363498</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>24618553</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>11300</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>11300</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>24607253</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>24607253</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Fundrasing expenses - netted against revenue</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Fundraising expenses</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MOHAMMED SALEEM</PersonNm>
        <TitleTxt>Physician</TitleTxt>
        <BaseCompensationFilingOrgAmt>338346</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>338346</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Roselyn Argyle, chairwoman of the board is also mother of Michael Argyle, another board of trustee member</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>Not applicable. No committee exists to act on behalf of governing body.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>On the board meeting</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents, conflict of interest policy and financial statements is made available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>Medical supplies &amp; DME: Program service expenses 930,524. Management and general expenses 0. Fundraising expenses 0. Total expenses 930,524. Physician services: Program service expenses 656,190. Management and general expenses 0. Fundraising expenses 0. Total expenses 656,190. Meals &amp; Catering at Day Care: Program service expenses 411,618. Management and general expenses 0. Fundraising expenses 0. Total expenses 411,618. Vehicle expenses: Program service expenses 388,153. Management and general expenses 0. Fundraising expenses 0. Total expenses 388,153. Medical transportation: Program service expenses 160,833. Management and general expenses 0. Fundraising expenses 0. Total expenses 160,833. Dental &amp; vision exp: Program service expenses 159,038. Management and general expenses 0. Fundraising expenses 0. Total expenses 159,038. Labs, diagnostics &amp; imaging: Program service expenses 134,249. Management and general expenses 0. Fundraising expenses 0. Total expenses 134,249. Miscellaneous client service: Program service expenses 99,033. Management and general expenses 0. Fundraising expenses 0. Total expenses 99,033. Dues &amp; Subscription: Program service expenses 0. Management and general expenses 59,744. Fundraising expenses 0. Total expenses 59,744. Recruitment exp: Program service expenses 0. Management and general expenses 45,847. Fundraising expenses 0. Total expenses 45,847. Other miscellaneous: Program service expenses 0. Management and general expenses 44,241. Fundraising expenses 0. Total expenses 44,241. Laundry &amp; Linnen service: Program service expenses 22,350. Management and general expenses 0. Fundraising expenses 0. Total expenses 22,350. Recreational therapy: Program service expenses 22,151. Management and general expenses 0. Fundraising expenses 0. Total expenses 22,151. Employee Appreciation: Program service expenses 0. Management and general expenses 7,793. Fundraising expenses 0. Total expenses 7,793. Bank Service charges: Program service expenses 0. Management and general expenses 6,869. Fundraising expenses 0. Total expenses 6,869. Employee Meals: Program service expenses 0. Management and general expenses 5,171. Fundraising expenses 0. Total expenses 5,171. Hazardeous waste collection: Program service expenses 2,761. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,761. Minor equipment: Program service expenses 0. Management and general expenses 2,494. Fundraising expenses 0. Total expenses 2,494. Staff training: Program service expenses 0. Management and general expenses 2,306. Fundraising expenses 0. Total expenses 2,306. Employee Uniforms: Program service expenses 0. Management and general expenses 486. Fundraising expenses 0. Total expenses 486.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>