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      <Form990PartVIISectionAGrp>
        <PersonNm>JOSHUA FITZGIBBON</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.75</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>FR JOHN FLECKENSTEIN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>REV BOBETTE HAMPTON</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL JONES</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DANIEL LIEHR</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MOLLY PETERSEN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SUSAN SPRINGGATE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.75</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID WARREN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>0.50</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>3161402</TotalReportableCompFromOrgAmt>
      <TotalOtherCompensationAmt>193575</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>11</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BRONSON COMMONS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>23332 RED ARROW HIGHWAY</AddressLine1Txt>
            <CityNm>MATTAWAN</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49071</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SKILLED CARE</ServicesDesc>
        <CompensationAmt>986276</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>TRANSCEND STRATEGY GROUP</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1500 TIMBERWOLF DR</AddressLine1Txt>
            <CityNm>HOLLAND</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>43528</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSULTING</ServicesDesc>
        <CompensationAmt>913285</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ALAMO NURSING HOME</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>8290 WEST C AVE</AddressLine1Txt>
            <CityNm>KALAMAZOO</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49009</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SKILLED CARE</ServicesDesc>
        <CompensationAmt>837462</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>HERITAGE COMMUNITY OF KALAMAZOO</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2400 PORTAGE ST</AddressLine1Txt>
            <CityNm>KALAMAZOO</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49001</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SKILLED CARE</ServicesDesc>
        <CompensationAmt>683858</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CMIT SOLUTIONS OF SOUTHWEST MI</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>8750 PORTAGE INDUSTRIAL DR</AddressLine1Txt>
            <CityNm>PORTAGE</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49024</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SOFTWARE</ServicesDesc>
        <CompensationAmt>493934</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>24</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>12271</FederatedCampaignsAmt>
      <FundraisingAmt>170047</FundraisingAmt>
      <AllOtherContributionsAmt>742957</AllOtherContributionsAmt>
      <NoncashContributionsAmt>7939</NoncashContributionsAmt>
      <TotalContributionsAmt>925275</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>MEDICAL SERVICES</Desc>
        <BusinessCd>623110</BusinessCd>
        <TotalRevenueColumnAmt>43341057</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>43341057</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>SOCIAL WORK AND COUNSELING</Desc>
        <BusinessCd>624190</BusinessCd>
        <TotalRevenueColumnAmt>2461043</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2461043</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER PROGRAM SERVICES</Desc>
        <BusinessCd>624190</BusinessCd>
        <TotalRevenueColumnAmt>397217</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>397217</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>46199317</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>958649</TotalRevenueColumnAmt>
        <ExclusionAmt>958649</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>5035179</SecuritiesAmt>
        <OtherAmt>3231993</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>4751361</SecuritiesAmt>
        <OtherAmt>5173978</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>283818</SecuritiesAmt>
        <OtherAmt>-1941985</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-1658167</TotalRevenueColumnAmt>
        <ExclusionAmt>-1658167</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>45737</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>170047</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>18059</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>27678</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>15926</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>7007</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>8919</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>8919</RelatedOrExemptFuncIncomeAmt>
      </NetIncomeFromGamingGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>-45147</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueTotalAmt>-45147</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>46163089</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>-699518</ExclusionAmt>
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      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1106750</TotalAmt>
        <ManagementAndGeneralAmt>1106750</ManagementAndGeneralAmt>
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      <OtherSalariesAndWagesGrp>
        <TotalAmt>27422233</TotalAmt>
        <ProgramServicesAmt>22984176</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4192431</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>431999</ProgramServicesAmt>
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      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2986565</TotalAmt>
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        <ManagementAndGeneralAmt>555967</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
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        <ProgramServicesAmt>1666901</ProgramServicesAmt>
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        <FundraisingAmt>18073</FundraisingAmt>
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      <FeesForServicesLegalGrp>
        <TotalAmt>247429</TotalAmt>
        <ManagementAndGeneralAmt>247429</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>57225</TotalAmt>
        <ManagementAndGeneralAmt>57225</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
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        <ManagementAndGeneralAmt>184489</ManagementAndGeneralAmt>
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      <FeesForServicesOtherGrp>
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        <ManagementAndGeneralAmt>743501</ManagementAndGeneralAmt>
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      <AdvertisingGrp>
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        <ProgramServicesAmt>22512</ProgramServicesAmt>
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      <OfficeExpensesGrp>
        <TotalAmt>264084</TotalAmt>
        <ProgramServicesAmt>97872</ProgramServicesAmt>
        <ManagementAndGeneralAmt>156727</ManagementAndGeneralAmt>
        <FundraisingAmt>9485</FundraisingAmt>
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      <InformationTechnologyGrp>
        <TotalAmt>798026</TotalAmt>
        <ProgramServicesAmt>10873</ProgramServicesAmt>
        <ManagementAndGeneralAmt>787153</ManagementAndGeneralAmt>
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      <OccupancyGrp>
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        <ProgramServicesAmt>210205</ProgramServicesAmt>
        <ManagementAndGeneralAmt>247924</ManagementAndGeneralAmt>
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      <ConferencesMeetingsGrp>
        <TotalAmt>9636</TotalAmt>
        <ProgramServicesAmt>6703</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2933</ManagementAndGeneralAmt>
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      <DepreciationDepletionGrp>
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        <ProgramServicesAmt>371093</ProgramServicesAmt>
        <ManagementAndGeneralAmt>355627</ManagementAndGeneralAmt>
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      <InsuranceGrp>
        <TotalAmt>183342</TotalAmt>
        <ManagementAndGeneralAmt>183342</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
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        <TotalAmt>5747318</TotalAmt>
        <ProgramServicesAmt>5747318</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>PRESCRIPTION DRUGS</Desc>
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        <ProgramServicesAmt>2559640</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PATIENT SERVICE EXPENSE</Desc>
        <TotalAmt>1878472</TotalAmt>
        <ProgramServicesAmt>1878472</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>988515</TotalAmt>
        <ProgramServicesAmt>988515</ProgramServicesAmt>
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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>1178917</ProgramServicesAmt>
        <ManagementAndGeneralAmt>308749</ManagementAndGeneralAmt>
        <FundraisingAmt>2145</FundraisingAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>41372405</ProgramServicesAmt>
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      <CashNonInterestBearingGrp>
        <BOYAmt>148365</BOYAmt>
        <EOYAmt>342489</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
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      <AccountsReceivableGrp>
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      <PrepaidExpensesDefrdChargesGrp>
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      <DonorRestrictionNetAssetsGrp>
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      <TotalNetAssetsFundBalanceGrp>
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      <TotLiabNetAssetsFundBalanceGrp>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
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      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
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      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART II, LINE 10</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER INCOME 134,628</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1">
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        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
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        <PersonNm>DR TODD WELTON</PersonNm>
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        <ExplanationTxt>THE FINANCE COMMITTEE REVIEWS THE 990 PRIOR TO FILING. THE TREASURER SIGNS THE RETURN. ADDITIONALLY, ALL MEMBERS OF THE BOARD RECEIVE A COPY OF THE 990 PRIOR TO FILING.</ExplanationTxt>
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        <ExplanationTxt>THE ORGANIZATION CONSULTS WITH A COMPENSATION CONSULTANT TO CONDUCT A MARKET ANALYSIS OF COMPENSATION FOR ALL POSITIONS, INCLUDING THE CEO AND OTHER TOP MANAGEMENT POSITIONS. THE CHIEF HUMAN RESOURCES OFFICER PROVIDES THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY DATA FOR THE CEO ALONG WITH DATA OBTAINED FROM THE COMPENSATION CONSULTANT. ON AN ANNUAL BASIS, THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES THE CEO'S COMPENSATION PACKAGE. THE INFORMATION IS MADE AVAILABLE TO THE BOARD IF REQUESTED. THE EXECUTIVE COMMITTEE ALSO COMPLETES A FORMAL EVALUATION OF THE CEO.</ExplanationTxt>
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        <ExplanationTxt>THE ORGANIZATION CONSULTS WITH A COMPENSATION CONSULTANT TO CONDUCT A MARKET ANALYSIS OF COMPENSATION FOR ALL POSITIONS, INCLUDING TOP MANAGEMENT POSITIONS. THE CHIEF HUMAN RESOURCES OFFICER AND CEO REVIEW THE SALARY DATA PROVIDED BY THE COMPENSATION CONSULTANT. THE INFORMATION IS MADE AVAILABLE TO THE BOARD IF REQUESTED.</ExplanationTxt>
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