﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2024v5.0">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2025-08-19T15:35:43-04:00</ReturnTs>
    <TaxPeriodEndDt>2025-01-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>541896113</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>ROBINSON FARMER COX ASSOCIATES</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>108 SOUTHPARK DRIVE</AddressLine1Txt>
        <CityNm>BLACKSBURG</CityNm>
        <StateAbbreviationCd>VA</StateAbbreviationCd>
        <ZIPCd>24060</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2024-02-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>542046110</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>SOUTHWEST VIRGINIA COMMUNITY HEALTH</BusinessNameLine1Txt>
        <BusinessNameLine2Txt>SYSTEMS INC</BusinessNameLine2Txt>
      </BusinessName>
      <BusinessNameControlTxt>SOUT</BusinessNameControlTxt>
      <PhoneNum>2769443682</PhoneNum>
      <USAddress>
        <AddressLine1Txt>PO BOX 297</AddressLine1Txt>
        <CityNm>MEADOWVIEW</CityNm>
        <StateAbbreviationCd>VA</StateAbbreviationCd>
        <ZIPCd>24361</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>BRYAN HAYNES</PersonNm>
      <PersonTitleTxt>CEO</PersonTitleTxt>
      <PhoneNum>2769443682</PhoneNum>
      <SignatureDt>2025-08-19</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>true</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>CORBIN C STONE</PreparerPersonNm>
      <PTIN>P00848231</PTIN>
      <PhoneNum>5405527322</PhoneNum>
      <PreparationDt>2025-08-19</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2024</TaxYr>
    <BuildTS>2025-03-06 01:10:19Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="6">
    <IRS990 documentId="RetDoc2" referenceDocumentId="RetDoc5">
      <PrincipalOfficerNm>BRYAN HAYNES</PrincipalOfficerNm>
      <GrossReceiptsAmt>21893937</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>WWW.SVCHS.COM</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>2002</FormationYr>
      <LegalDomicileStateCd>VA</LegalDomicileStateCd>
      <ActivityOrMissionDesc>PROVIDE COMPREHENSIVE PRIMARY MEDICAL CARE TO THE COMMUNITES SERVED.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>11</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>11</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>216</TotalEmployeeCnt>
      <TotalVolunteersCnt>11</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <PYContributionsGrantsAmt>4955860</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>9446932</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>13545999</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>12006754</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>182041</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>320649</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>109930</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>119602</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>18793830</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>21893937</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>12984481</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>14785685</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>5778629</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>7143072</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>18763110</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>21928757</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>30720</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-34820</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>24546847</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>26071628</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>2670903</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>4085692</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>21875944</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>21985936</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>PROVIDE COMPREHENSIVE PRIMARY MEDICAL CARE TO THE COMMUNITES SERVED.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>15620159</ExpenseAmt>
      <RevenueAmt>12006754</RevenueAmt>
      <Desc>PROVIDES ACCESS TO AFFORDABLE, QUALITY, COMPREHENSIVE AND PREVENTATIVE HEALTHCARE THAT IS CULTURALLY SENSITIVE FOR ALL INDIVIDUALS OF THE SOUTHWESTERN VIRGINIA AREA, WHILE MAINTAINING PARTNERSHIPS WITH THE COMMUNITY IN ORDER TO ENHANCE ECONOMIC STABILITY AND PROVIDE LOCAL EMPLOYMENT OPPORTUNITIES.</Desc>
      <TotalProgramServiceExpensesAmt>15620159</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc6">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1">false</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc3">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc3">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc3">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc3">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="RetDoc3">false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc3">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc3">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc3">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc3">false</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc3">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc3">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc3">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc3">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc4">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd>false</DisregardedEntityInd>
      <RelatedEntityInd>false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>11</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <EmployeeCnt>216</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>11</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>11</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>true</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>false</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>false</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <OtherWebsiteInd>X</OtherWebsiteInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>THE ORGANIZATION</PersonNm>
        <PhoneNum>2764964492</PhoneNum>
        <USAddress>
          <AddressLine1Txt>PO BOX 297</AddressLine1Txt>
          <CityNm>MEADOWVIEW</CityNm>
          <StateAbbreviationCd>VA</StateAbbreviationCd>
          <ZIPCd>24361</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <NoListedPersonsCompensatedInd>X</NoListedPersonsCompensatedInd>
      <Form990PartVIISectionAGrp>
        <PersonNm>BRYAN HAYNES</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>293681</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROY ANDREWS</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>274159</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KRISTIN BRESOWAR</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <AverageHoursPerWeekRt>36.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>256927</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ANDREA MCCLINTIC</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>248002</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>EDGAR CAMARGO</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>233493</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>VICENTE ORTIZ</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>230423</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT ASHLEY</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JEFF CAMPBELL</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JEAN CHAPMAN</PersonNm>
        <TitleTxt>VICE CHAIR</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>VICKIE DAVIDSON</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PATTY FULLEN</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SHANE HARRIS</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MIKE LEAKE</PersonNm>
        <TitleTxt>CHAIR</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GAIL MULLINS</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NORAH NUTTER</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID VANCE</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GEORGE WASHINGTON</PersonNm>
        <TitleTxt>MEMBER</TitleTxt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1536685</TotalReportableCompFromOrgAmt>
      <IndivRcvdGreaterThan100KCnt>33</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <GovernmentGrantsAmt>9284631</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>162301</AllOtherContributionsAmt>
      <TotalContributionsAmt>9446932</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT REVENUE</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>12006754</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12006754</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>12006754</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>320649</TotalRevenueColumnAmt>
        <ExclusionAmt>320649</ExclusionAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>115002</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>115002</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <TotalRevenueColumnAmt>4600</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>4600</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>119602</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>21893937</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12126356</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>320649</ExclusionAmt>
      </TotalRevenueGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>13994188</TotalAmt>
        <ProgramServicesAmt>9842700</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4151488</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>791497</TotalAmt>
        <ProgramServicesAmt>531715</ProgramServicesAmt>
        <ManagementAndGeneralAmt>259782</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>941021</TotalAmt>
        <ProgramServicesAmt>506836</ProgramServicesAmt>
        <ManagementAndGeneralAmt>434185</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>46251</TotalAmt>
        <ProgramServicesAmt>39002</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7249</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>51408</TotalAmt>
        <ProgramServicesAmt>35272</ProgramServicesAmt>
        <ManagementAndGeneralAmt>16136</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>577110</TotalAmt>
        <ProgramServicesAmt>314671</ProgramServicesAmt>
        <ManagementAndGeneralAmt>262439</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>350684</TotalAmt>
        <ProgramServicesAmt>275728</ProgramServicesAmt>
        <ManagementAndGeneralAmt>74956</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>76104</TotalAmt>
        <ProgramServicesAmt>39320</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36784</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>11573</TotalAmt>
        <ManagementAndGeneralAmt>11573</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>96195</TotalAmt>
        <ManagementAndGeneralAmt>96195</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>378856</TotalAmt>
        <ProgramServicesAmt>321385</ProgramServicesAmt>
        <ManagementAndGeneralAmt>57471</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>81344</TotalAmt>
        <ProgramServicesAmt>15372</ProgramServicesAmt>
        <ManagementAndGeneralAmt>65972</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>3071748</TotalAmt>
        <ProgramServicesAmt>2994005</ProgramServicesAmt>
        <ManagementAndGeneralAmt>77743</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EQUIPMENT EXPENSE</Desc>
        <TotalAmt>405766</TotalAmt>
        <ProgramServicesAmt>63970</ProgramServicesAmt>
        <ManagementAndGeneralAmt>341796</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PATIENT CARE PHARMACEUTIC</Desc>
        <TotalAmt>398292</TotalAmt>
        <ProgramServicesAmt>398292</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES AND FEES</Desc>
        <TotalAmt>253309</TotalAmt>
        <ProgramServicesAmt>7593</ProgramServicesAmt>
        <ManagementAndGeneralAmt>245716</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>403411</TotalAmt>
        <ProgramServicesAmt>234298</ProgramServicesAmt>
        <ManagementAndGeneralAmt>169113</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>21928757</TotalAmt>
        <ProgramServicesAmt>15620159</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6308598</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>8318788</BOYAmt>
        <EOYAmt>4506838</EOYAmt>
      </CashNonInterestBearingGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>166976</BOYAmt>
        <EOYAmt>142040</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>3221918</BOYAmt>
        <EOYAmt>3703853</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>220226</BOYAmt>
        <EOYAmt>364744</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>193454</BOYAmt>
        <EOYAmt>193323</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>17562138</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>4765410</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>9405080</BOYAmt>
        <EOYAmt>12796728</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>2997385</BOYAmt>
        <EOYAmt>4364102</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>23020</BOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>24546847</BOYAmt>
        <EOYAmt>26071628</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>669567</BOYAmt>
        <EOYAmt>610258</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>2001336</BOYAmt>
        <EOYAmt>3475434</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>2670903</BOYAmt>
        <EOYAmt>4085692</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>21875944</BOYAmt>
        <EOYAmt>21985936</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>21875944</BOYAmt>
        <EOYAmt>21985936</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>24546847</BOYAmt>
        <EOYAmt>26071628</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-34820</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>144812</NetUnrlzdGainsLossesInvstAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>false</FSAuditedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc6">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>11091849</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9078865</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9695948</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4955860</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>9446932</CurrentTaxYearAmt>
        <TotalAmt>44269454</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>11091849</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9078865</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9695948</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4955860</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>9446932</CurrentTaxYearAmt>
        <TotalAmt>44269454</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>44269454</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>47883</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>10261</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>116156</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>182041</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>320649</CurrentTaxYearAmt>
        <TotalAmt>676990</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus3YearsAmt>100850</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>268734</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>109930</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>119602</CurrentTaxYearAmt>
        <TotalAmt>599116</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>45545560</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>25662683</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.97200</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.97920</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART II, LINE 10</FormAndLineReferenceDesc>
        <ExplanationTxt>MISCELLANEOUS 599,116</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1">
      <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="RetDoc3">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>606386</OtherCostOrOtherBasisAmt>
        <BookValueAmt>606386</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>15412278</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3272561</DepreciationAmt>
        <BookValueAmt>12139717</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1543474</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1492849</DepreciationAmt>
        <BookValueAmt>50625</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>12796728</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>SECURED NOTES</Desc>
        <Amt>2841871</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED COMPENSATED ABSENCES</Desc>
        <Amt>338252</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED WAGES AND SALARIES</Desc>
        <Amt>269143</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>INTEREST PAYABLE</Desc>
        <Amt>21999</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>TAXES PAYABLE</Desc>
        <Amt>4169</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>3475434</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>21893937</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>21893937</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>21893937</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>21928757</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>21928757</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>21928757</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc4">
      <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>BRYAN HAYNES</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>293681</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>293681</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ROY ANDREWS</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>274159</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>274159</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KRISTIN BRESOWAR</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>256927</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>256927</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANDREA MCCLINTIC</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>248002</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>248002</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>EDGAR CAMARGO</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>233493</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>233493</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>VICENTE ORTIZ</PersonNm>
        <TitleTxt>DOCTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>230423</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>230423</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc5">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE WHO THEN MAKES A RECOMMENDATION TO THE BOARD FOR APPROVAL BEFORE IT IS FILED WITH THE IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD MEMBERS ARE ASKED ABOUT CONFLICTS OF INTEREST DURING DISCUSSIONS ABOUT THE SELECTION OF EMPLOYEES AND AWARDS FOR CONTRACT FOR SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL DOCUMENTS ARE AVAILABLE FOR PUBLIC REVIEW DURING NORMAL BUSINESS HOURS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>