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        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 606</AddressLine1Txt>
            <CityNm>MOROVIS</CityNm>
            <StateAbbreviationCd>PR</StateAbbreviationCd>
            <ZIPCd>00687</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>BILLING MEDICAL PLAN</ServicesDesc>
        <CompensationAmt>226954</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>NORTH JANITORIAL</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 362617</AddressLine1Txt>
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            <StateAbbreviationCd>PR</StateAbbreviationCd>
            <ZIPCd>00936</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MAINTENANCE</ServicesDesc>
        <CompensationAmt>200193</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>EBP DESIGN GROUP</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>207 DEL PARQUE ST 4TH FLOOR</AddressLine1Txt>
            <CityNm>SAN JUAN</CityNm>
            <StateAbbreviationCd>PR</StateAbbreviationCd>
            <ZIPCd>00912</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACTOR</ServicesDesc>
        <CompensationAmt>167702</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>7</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>0</FederatedCampaignsAmt>
      <MembershipDuesAmt>0</MembershipDuesAmt>
      <FundraisingAmt>0</FundraisingAmt>
      <RelatedOrganizationsAmt>0</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>4030405</GovernmentGrantsAmt>
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      <NoncashContributionsAmt>0</NoncashContributionsAmt>
      <TotalContributionsAmt>4030405</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>CAPITATION</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>16982604</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PROGRAM INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>9787213</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>FEES AND CONTRACT</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>2828508</TotalRevenueColumnAmt>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <ProgramServiceRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>29598325</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>230784</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
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      <LessCostOthBasisSalesExpnssGrp>
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        <OtherAmt>0</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
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        <OtherAmt>0</OtherAmt>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>0</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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      <GrossSalesOfInventoryAmt>0</GrossSalesOfInventoryAmt>
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      <NetIncomeOrLossGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <OtherRevenueMiscGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <OtherRevenueMiscGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <MiscellaneousRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>0</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>33859514</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
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      <ForeignGrantsGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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      <BenefitsToMembersGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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      <CompCurrentOfcrDirectorsGrp>
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        <ManagementAndGeneralAmt>281619</ManagementAndGeneralAmt>
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      <CompDisqualPersonsGrp>
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        <ProgramServicesAmt>2340553</ProgramServicesAmt>
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      <PensionPlanContributionsGrp>
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      <PayrollTaxesGrp>
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      <FeesForServicesManagementGrp>
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      <FeesForServicesLegalGrp>
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        <ManagementAndGeneralAmt>802032</ManagementAndGeneralAmt>
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      <FeesForServicesAccountingGrp>
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      <FeesForServicesLobbyingGrp>
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      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
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        <FundraisingAmt>0</FundraisingAmt>
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      <FeesForSrvcInvstMgmntFeesGrp>
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      <AdvertisingGrp>
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      <TravelGrp>
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      <PymtTravelEntrtnmntPubOfclGrp>
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      <ConferencesMeetingsGrp>
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      <PaymentsToAffiliatesGrp>
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      <DepreciationDepletionGrp>
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      <OtherExpensesGrp>
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      <OtherExpensesGrp>
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      <OtherExpensesGrp>
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      <AllOtherExpensesGrp>
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      <TotalFunctionalExpensesGrp>
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      <TotalJointCostsGrp>
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        <EOYAmt>11756417</EOYAmt>
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        <EOYAmt>1200000</EOYAmt>
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        <EOYAmt>24484</EOYAmt>
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      <UnsecuredNotesLoansPayableGrp>
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        <EOYAmt>0</EOYAmt>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>3350203</EOYAmt>
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        <BOYAmt>24214701</BOYAmt>
        <EOYAmt>28711359</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>2493317</BOYAmt>
        <EOYAmt>2783838</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>26708018</BOYAmt>
        <EOYAmt>31495197</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>32090839</BOYAmt>
        <EOYAmt>34845400</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>4787179</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>0</NetUnrlzdGainsLossesInvstAmt>
      <DonatedServicesAndUseFcltsAmt>0</DonatedServicesAndUseFcltsAmt>
      <InvestmentExpenseAmt>0</InvestmentExpenseAmt>
      <PriorPeriodAdjustmentsAmt>0</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA1" documentName="IRS990ScheduleA">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="IRS990ScheduleD1" documentName="IRS990ScheduleD">
      <LandGrp>
        <InvestmentCostOrOtherBasisAmt>261000</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>261000</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>963000</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>622005</DepreciationAmt>
        <BookValueAmt>340995</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <InvestmentCostOrOtherBasisAmt>14232121</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>3306183</DepreciationAmt>
        <BookValueAmt>10925938</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <InvestmentCostOrOtherBasisAmt>1818331</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>1632848</DepreciationAmt>
        <BookValueAmt>185483</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>199922</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>156921</DepreciationAmt>
        <BookValueAmt>43001</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>11756417</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>ANNUITY</Desc>
        <BookValueAmt>1200000</BookValueAmt>
        <MethodValuationCd>C</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>1200000</TotalBookValueSecuritiesAmt>
      <TotalRevEtcAuditedFinclStmtAmt>33859514</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueNotReportedAmt>0</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>33859514</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>33859514</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>29072335</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>29072335</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>29072335</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ1" documentName="IRS990ScheduleJ">
      <SubstantiationRequiredInd>false</SubstantiationRequiredInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ERIC ALICEA MARTINEZ</PersonNm>
        <TitleTxt>INTERNIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>155510</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>7200</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>162710</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ERIC ALICEA</PersonNm>
        <TitleTxt>MEDICAL DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>31200</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>31200</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO1" documentName="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE DIRECTOR REVIEW AND APPROVE THE FORM 990 BEFORE FILING AND IT IS ALSO PRESENTED AND DISCUSSED WITH THE BOARD OF DIRECTORS AND FILING IS APPROVED BY THEM.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>EMPLOYEE RECORDS IS DOCUMENTED ABOVE THE COMPLIANCE WITH THE POLICY AND IT IS REVIEWED ANNUALLY THE EMPLOYEE MANUAL INCLUDES THE REQUIREMENTS TO COMPLY WITH THE POLICY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE DIRECTOR SALARY IS DETERMINED BY THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC IN THE BULLETIN BOARD IN OUR FACILITIES.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>