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      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>4851902</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5436546</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5779744</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5739125</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5664074</CurrentTaxYearAmt>
        <TotalAmt>27471391</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>4851902</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5436546</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5779744</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5739125</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5664074</CurrentTaxYearAmt>
        <TotalAmt>27471391</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>27471391</PublicSupportTotal170Amt>
      <TotalSupportAmt>27471391</TotalSupportAmt>
      <PublicSupportCY170Pct>1.00000</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.88280</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="990D">
      <LandGrp>
        <InvestmentCostOrOtherBasisAmt>411918</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>411918</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>3350599</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>1474617</DepreciationAmt>
        <BookValueAmt>1875982</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <InvestmentCostOrOtherBasisAmt>164127</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>72151</DepreciationAmt>
        <BookValueAmt>91976</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <InvestmentCostOrOtherBasisAmt>1051900</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>829028</DepreciationAmt>
        <BookValueAmt>222872</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>2602748</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Prepaid expenses</Desc>
        <BookValueAmt>102205</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>102205</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Other liabilities</Desc>
        <Amt>17395</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Accrued salaries and wages</Desc>
        <Amt>91326</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>FIT</Desc>
        <Amt>25208</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Accrued other liabilities</Desc>
        <Amt>69295</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Compensated balances</Desc>
        <Amt>132398</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Note and lease interest payable</Desc>
        <Amt>21039</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>356661</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>17443034</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>17443034</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>17443034</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>15204118</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>15204118</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>15204118</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="990J">
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Ruben Martinez Doctor</PersonNm>
        <TitleTxt>Doctor</TitleTxt>
        <BaseCompensationFilingOrgAmt>234099</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>234099</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Frances M Mitchell</PersonNm>
        <TitleTxt>Doctor-CMO</TitleTxt>
        <BaseCompensationFilingOrgAmt>209119</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>209119</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="990O">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>The CEO and CFO provides a copy of Form 990 to the Board for their review.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The 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 review and approve the compensation and pay increases during the budget process. After the Boards approval, the CEO authorizes human resources to enter into the pay system the approved compensations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other officer or key employee compensation Part VI line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Directors review and approve the compensation and pay increases during the budget process. After the Boards approval, the CEO authorizes human resources to enter into the pay system the approved compensations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The entity provides to the public upon request information and documents that are not prohibited by local, state, or federal rules and regulations. VAC publishes the board meeting dates and times on its website.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>List of other fees for services expenses Part IX line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Pharmaceutical professional management services $90,751</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>List of other expenses Part IX line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad Debt expense 47,333Bank fees 6,095Contracted services 510,504Fundraising 25,065Lab and waste costs 467,437Membership and subscription fees 221,164Miscellaneous 10,096Patient and education programs 5,000Patient food and meals 111,756Printing &amp; publications 3,150Program supplies 51,179Rental building and equiment 338,019Supplies medical 99,471Telephone, training, transportation, utilties 656,678</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>