﻿<?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="2023v5.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2024-11-14T08:52:10-06:00</ReturnTs>
    <TaxPeriodEndDt>2023-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>390912608</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>HAWKINS ASH CPAS LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>626 SOUTH 8TH STREET</AddressLine1Txt>
        <CityNm>MEDFORD</CityNm>
        <StateAbbreviationCd>WI</StateAbbreviationCd>
        <ZIPCd>54451</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>391486000</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>HOPE HOSPICE &amp; PALLIATIVE CARE INC</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>HOPE</BusinessNameControlTxt>
      <PhoneNum>7157483434</PhoneNum>
      <USAddress>
        <AddressLine1Txt>537 W BROADWAY AVENUE</AddressLine1Txt>
        <CityNm>MEDFORD</CityNm>
        <StateAbbreviationCd>WI</StateAbbreviationCd>
        <ZIPCd>54451</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>NICOLE SYRYCZUK</PersonNm>
      <PersonTitleTxt>EXECUTIVE DIRECTOR</PersonTitleTxt>
      <PhoneNum>7157483434</PhoneNum>
      <SignatureDt>2024-11-13</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>1</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>CURTIS J BACH CPA</PreparerPersonNm>
      <PTIN>P01227805</PTIN>
      <PhoneNum>7157482856</PhoneNum>
      <PreparationDt>2024-11-12</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2024-10-15 13:58:12Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="6">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <PrincipalOfficerNm>NICOLE SYRYCZUK</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>537 W BROADWAY AVENUE</AddressLine1Txt>
        <CityNm>MEDFORD</CityNm>
        <StateAbbreviationCd>WI</StateAbbreviationCd>
        <ZIPCd>54451</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>4712295</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>HTTP://WWW.HHOSPICE.COM/</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1984</FormationYr>
      <LegalDomicileStateCd>WI</LegalDomicileStateCd>
      <ActivityOrMissionDesc>HOSPICE CARE - TERMINALLY ILL</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>7</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>7</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>21</TotalEmployeeCnt>
      <TotalVolunteersCnt>14</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>53455</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>90075</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>1944267</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>2268055</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>169846</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>111697</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>28690</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>4532</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>2196258</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>2474359</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>1247341</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>1331791</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>844518</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>870229</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>2091859</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>2202020</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>104399</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>272339</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>4962999</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>5789220</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>170691</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>207316</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>4792308</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>5581904</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>TO PROVIDE HOSPICE CARE FOR PERSONS AT THE END OF LIFE SO THAT THEY MAY LIVE AS FULLY AND COMFORTABLY AS POSSIBLE AND TO OFFER CONTINUING SUPPORT TO THE BEREAVED.</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>1783331</ExpenseAmt>
      <RevenueAmt>2272612</RevenueAmt>
      <Desc>PATIENT CARE - BOTH MEDICAL AND SUPPORT TO TERMINALLY ILL PATIENTS PRIOR TO DEATH. 144 PATIENTS, TOTALING 16,311 PATIENT DAYS, RECEIVED CARE DURING 2023.</Desc>
      <TotalProgramServiceExpensesAmt>1783331</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">1</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 referenceDocumentId="RetDoc1041300001">0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd referenceDocumentId="RetDoc1041300001">1</FundraisingActivitiesInd>
      <GamingActivitiesInd referenceDocumentId="RetDoc1041300001">0</GamingActivitiesInd>
      <OperateHospitalInd>0</OperateHospitalInd>
      <GrantsToOrganizationsInd>0</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd>0</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>8</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>21</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>1</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>0</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>0</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>0</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>0</Form8282PropertyDisposedOfInd>
      <PayPremiumsPrsnlBnftCntrctInd>0</PayPremiumsPrsnlBnftCntrctInd>
      <Form8899Filedind>0</Form8899Filedind>
      <Form1098CFiledInd>0</Form1098CFiledInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>0</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>0</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>7</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>7</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>0</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>0</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>0</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>0</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>1</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>1</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>1</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>1</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>1</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>1</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>1</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>1</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>1</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>WI</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>NICOLE SYRYCZUK EXECUTIVE DIRECTOR</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>7157483434</PhoneNum>
        <USAddress>
          <AddressLine1Txt>537 W BROADWAY AVENUE</AddressLine1Txt>
          <CityNm>MEDFORD</CityNm>
          <StateAbbreviationCd>WI</StateAbbreviationCd>
          <ZIPCd>54451</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>RUTHANN KOCH</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RANDI WERNER</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BECKY BROST</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JASMINE SKERVEN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHELLE DEML</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KAREN CHAPLINSKI</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RICK FLORA</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NICOLE SYRYCZUK</PersonNm>
        <TitleTxt>EXECUTIVE DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>89014</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>32450</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>89014</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>32450</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>0</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>0</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <CntrctRcvdGreaterThan100KCnt>0</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>9000</FederatedCampaignsAmt>
      <FundraisingAmt>35738</FundraisingAmt>
      <AllOtherContributionsAmt>45337</AllOtherContributionsAmt>
      <TotalContributionsAmt>90075</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT CARE - MEDICARE/MEDICAID</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>2193326</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2193326</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT CARE - OTHER</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>74729</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>74729</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>2268055</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>120255</TotalRevenueColumnAmt>
        <ExclusionAmt>120255</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>2225153</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>2233711</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>-8558</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-8558</TotalRevenueColumnAmt>
        <ExclusionAmt>-8558</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>4200</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>35738</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>4225</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>-25</TotalRevenueColumnAmt>
        <ExclusionAmt>-25</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS INCOME</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>4557</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>4557</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>4557</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>2474359</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2272612</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>111672</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>121464</TotalAmt>
        <ProgramServicesAmt>21709</ProgramServicesAmt>
        <ManagementAndGeneralAmt>99755</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>954289</TotalAmt>
        <ProgramServicesAmt>847557</ProgramServicesAmt>
        <ManagementAndGeneralAmt>106732</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>25992</TotalAmt>
        <ProgramServicesAmt>21330</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4662</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>156660</TotalAmt>
        <ProgramServicesAmt>128556</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28104</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>73386</TotalAmt>
        <ProgramServicesAmt>60221</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13165</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>8705</TotalAmt>
        <ManagementAndGeneralAmt>8705</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>28561</TotalAmt>
        <ManagementAndGeneralAmt>28561</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>27329</TotalAmt>
        <ManagementAndGeneralAmt>27329</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>76255</TotalAmt>
        <ProgramServicesAmt>76255</ProgramServicesAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>57684</TotalAmt>
        <ProgramServicesAmt>5536</ProgramServicesAmt>
        <ManagementAndGeneralAmt>52148</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>10541</TotalAmt>
        <ManagementAndGeneralAmt>10541</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>87081</TotalAmt>
        <ProgramServicesAmt>85598</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1483</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>7803</TotalAmt>
        <ProgramServicesAmt>956</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6847</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>22381</TotalAmt>
        <ProgramServicesAmt>330</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22051</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>21493</TotalAmt>
        <ProgramServicesAmt>12887</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8606</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>PATIENT CARE</Desc>
        <TotalAmt>514226</TotalAmt>
        <ProgramServicesAmt>514226</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBTS</Desc>
        <TotalAmt>8170</TotalAmt>
        <ProgramServicesAmt>8170</ProgramServicesAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>2202020</TotalAmt>
        <ProgramServicesAmt>1783331</ProgramServicesAmt>
        <ManagementAndGeneralAmt>418689</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>309640</BOYAmt>
        <EOYAmt>190223</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>203396</BOYAmt>
        <EOYAmt>241927</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>189777</BOYAmt>
        <EOYAmt>291406</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>21821</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>510230</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>295600</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>237012</BOYAmt>
        <EOYAmt>214630</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>4023174</BOYAmt>
        <EOYAmt>4829213</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <TotalAssetsGrp>
        <BOYAmt>4962999</BOYAmt>
        <EOYAmt>5789220</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>170691</BOYAmt>
        <EOYAmt>207316</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>170691</BOYAmt>
        <EOYAmt>207316</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>4792308</BOYAmt>
        <EOYAmt>5581904</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>4792308</BOYAmt>
        <EOYAmt>5581904</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>4962999</BOYAmt>
        <EOYAmt>5789220</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>272339</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>424200</NetUnrlzdGainsLossesInvstAmt>
      <PriorPeriodAdjustmentsAmt>93057</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>84004</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>356772</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>53947</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>53455</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>90075</CurrentTaxYearAmt>
        <TotalAmt>638253</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>84004</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>356772</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>53947</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>53455</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>90075</CurrentTaxYearAmt>
        <TotalAmt>638253</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>638253</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>69383</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>84943</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>98843</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>98573</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>120255</CurrentTaxYearAmt>
        <TotalAmt>471997</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>53453</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8187</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>33503</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>8757</CurrentTaxYearAmt>
        <TotalAmt>103900</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>1214150</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>9693726</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.52570</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.54090</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:</FormAndLineReferenceDesc>
        <ExplanationTxt>MISCELLANEOUS INCOME - 2019 AMOUNT: $ 53,453. 2020 AMOUNT: $ 0. 2021 AMOUNT: $ 0. 2022 AMOUNT: $ 1,800. 2023 AMOUNT: $ 4,557. GROSS FUNDRAISING INCOME - 2019 AMOUNT: $ 0. 2020 AMOUNT: $ 0. 2021 AMOUNT: $ 8,187. 2022 AMOUNT: $ 31,703. 2023 AMOUNT: $ 4,200.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </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>
        <OtherCostOrOtherBasisAmt>70282</OtherCostOrOtherBasisAmt>
        <BookValueAmt>70282</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>394230</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>254106</DepreciationAmt>
        <BookValueAmt>140124</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>45718</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>41494</DepreciationAmt>
        <BookValueAmt>4224</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>214630</TotalBookValueLandBuildingsAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>2875455</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>424200</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>4225</OtherRevenueAmt>
      <RevenueNotReportedAmt>428425</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>2447030</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>27329</InvestmentExpensesNotIncldAmt>
      <RevenueNotReportedFinclStmtAmt>27329</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>2474359</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>2178916</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>4225</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>4225</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>2174691</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>27329</InvestmentExpensesNotIncld2Amt>
      <ExpensesNotRptFinclStmtAmt>27329</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>2202020</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>U.S. GAAP, "ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES" REQUIRES MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY A TAXING AUTHORITY. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLSOSURE IN THE FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>DIRECT FUNDRAISING EXPENSES - FORM 990, PART VIII, LINE 8B 4,225.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>DIRECT FUNDRAISING EXPENSES - FORM 990, PART VIII, LINE 8B 4,225.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="RetDoc1041300001">
      <FundraisingEventInformationGrp>
        <Event1Nm>FISH BOIL</Event1Nm>
        <GrossReceiptsEvent1Amt>39938</GrossReceiptsEvent1Amt>
        <CharitableContriEvent1Amt>35738</CharitableContriEvent1Amt>
        <GrossRevenueEvent1Amt>4200</GrossRevenueEvent1Amt>
        <OtherDirectExpensesEvent1Amt>4225</OtherDirectExpensesEvent1Amt>
        <GrossReceiptsTotalAmt>39938</GrossReceiptsTotalAmt>
        <CharitableContributionsTotAmt>35738</CharitableContributionsTotAmt>
        <GrossRevenueTotalEventsAmt>4200</GrossRevenueTotalEventsAmt>
        <OthDirectExpnssTotalEventsAmt>4225</OthDirectExpnssTotalEventsAmt>
        <DirectExpenseSummaryEventsAmt>4225</DirectExpenseSummaryEventsAmt>
        <NetIncomeSummaryAmt>-25</NetIncomeSummaryAmt>
      </FundraisingEventInformationGrp>
    </IRS990ScheduleG>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND BOARD OF DIRECTORS PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD MEMBERS ARE REQUIRED ANNUALLY TO COMPLETE A DISCLOSURE OF THEIR CONFLICTS OF INTEREST AND SIGN A CONFLICT OF INTEREST STATEMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>EXECUTIVE DIRECTOR SALARY IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNMENT DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE DIRECTOR IS RESPONSIBLE FOR OVERSEEING THE AUDIT AND THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SELECTING THE AUDITOR. NO SIGNIFICANT CHANGE FROM PRIOR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>