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        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN KALLENBACH</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JAMES ASHWORTH</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DONALD BABB</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>K RONALD SMITH</PersonNm>
        <TitleTxt>BOARD MEMBER BEG 02/23</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KATRINA BANNER</PersonNm>
        <TitleTxt>BOARD MEMBER BEG 11/22</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BRAD JOHNSON</PersonNm>
        <TitleTxt>BOARD MEMBER END 10/22</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1818428</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>918276</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>154615</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>26</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>SHIFTKEY LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 735913</AddressLine1Txt>
            <CityNm>DALLAS</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>753735913</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT NURSING</ServicesDesc>
        <CompensationAmt>3235579</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>BRIDGEPORT CAPITAL FUNDING LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 101004</AddressLine1Txt>
            <CityNm>ATLANTA</CityNm>
            <StateAbbreviationCd>GA</StateAbbreviationCd>
            <ZIPCd>303921004</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT NURSING</ServicesDesc>
        <CompensationAmt>1196567</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>INTEGRITY ROOFING RENOVATIONS LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2733 E BATTLEFIELD ST 328</AddressLine1Txt>
            <CityNm>SPRINGFIELD</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>65804</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION SERVICE</ServicesDesc>
        <CompensationAmt>1006025</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>ALLHEALTH STAFFING GROUP LLC</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>15 SILVERCREEK LANE</AddressLine1Txt>
            <CityNm>ST LOUIS</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63011</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT NURSING</ServicesDesc>
        <CompensationAmt>439011</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>FIRST CALL OF SPRINGFIELD</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>LOCK BOX 1 PO BOX 1857</AddressLine1Txt>
            <CityNm>OWASSO</CityNm>
            <StateAbbreviationCd>OK</StateAbbreviationCd>
            <ZIPCd>740551857</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT NURSING</ServicesDesc>
        <CompensationAmt>368022</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>10</CntrctRcvdGreaterThan100KCnt>
      <FundraisingAmt>46151</FundraisingAmt>
      <RelatedOrganizationsAmt>44305</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>4529611</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>93179</AllOtherContributionsAmt>
      <TotalContributionsAmt>4713246</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>63544891</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>62379508</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>1165383</UnrelatedBusinessRevenueAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CAFETERIA</Desc>
        <BusinessCd>722210</BusinessCd>
        <TotalRevenueColumnAmt>78430</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>78430</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>RENTAL INCOME FROM AFFILIATE</Desc>
        <BusinessCd>722210</BusinessCd>
        <TotalRevenueColumnAmt>2004054</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2004054</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>TRANSIT</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>189558</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>189558</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>ALL OTHER PROGRAM SERVICE REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>31868</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>31868</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>65848801</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>253909</TotalRevenueColumnAmt>
        <ExclusionAmt>253909</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>571464</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>13476</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>557988</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>557988</TotalRevenueColumnAmt>
        <ExclusionAmt>557988</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>280590</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>268001</SecuritiesAmt>
        <OtherAmt>26840</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>12589</SecuritiesAmt>
        <OtherAmt>-26840</OtherAmt>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-14251</TotalRevenueColumnAmt>
        <ExclusionAmt>-14251</ExclusionAmt>
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      <FundraisingGrossIncomeAmt>9460</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>46151</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>41042</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>-31582</TotalRevenueColumnAmt>
        <ExclusionAmt>-31582</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <GrossSalesOfInventoryAmt>0</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>GAIN ON INVOLUNTARY CONVERSION</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1413740</TotalRevenueColumnAmt>
        <ExclusionAmt>1413740</ExclusionAmt>
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      <OtherRevenueTotalAmt>1413740</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>72741851</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>64683418</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>1165383</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>2179804</ExclusionAmt>
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      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>112538</TotalAmt>
        <ProgramServicesAmt>112538</ProgramServicesAmt>
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        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
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      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1044950</TotalAmt>
        <ManagementAndGeneralAmt>1044950</ManagementAndGeneralAmt>
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      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
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        <TotalAmt>28634727</TotalAmt>
        <ProgramServicesAmt>26267248</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2367479</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>806366</ProgramServicesAmt>
        <ManagementAndGeneralAmt>115929</ManagementAndGeneralAmt>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>5190318</ProgramServicesAmt>
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        <ProgramServicesAmt>1712190</ProgramServicesAmt>
        <ManagementAndGeneralAmt>513692</ManagementAndGeneralAmt>
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      <FeesForServicesManagementGrp>
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        <ProgramServicesAmt>76020</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1940946</ManagementAndGeneralAmt>
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      <FeesForServicesLegalGrp>
        <TotalAmt>32859</TotalAmt>
        <ManagementAndGeneralAmt>32859</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>199351</TotalAmt>
        <ManagementAndGeneralAmt>199351</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
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      </FeesForSrvcInvstMgmntFeesGrp>
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        <ProgramServicesAmt>5375726</ProgramServicesAmt>
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      <AdvertisingGrp>
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        <ManagementAndGeneralAmt>37571</ManagementAndGeneralAmt>
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      <OfficeExpensesGrp>
        <TotalAmt>3328705</TotalAmt>
        <ProgramServicesAmt>2492625</ProgramServicesAmt>
        <ManagementAndGeneralAmt>836080</ManagementAndGeneralAmt>
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      <InformationTechnologyGrp>
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        <ProgramServicesAmt>90204</ProgramServicesAmt>
        <ManagementAndGeneralAmt>303674</ManagementAndGeneralAmt>
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      <RoyaltiesGrp>
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      <OccupancyGrp>
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        <ProgramServicesAmt>2665826</ProgramServicesAmt>
        <ManagementAndGeneralAmt>361584</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>252187</ProgramServicesAmt>
        <ManagementAndGeneralAmt>382786</ManagementAndGeneralAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
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      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>97307</TotalAmt>
        <ProgramServicesAmt>30173</ProgramServicesAmt>
        <ManagementAndGeneralAmt>67134</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>696314</ProgramServicesAmt>
        <ManagementAndGeneralAmt>86737</ManagementAndGeneralAmt>
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      <PaymentsToAffiliatesGrp>
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        <ProgramServicesAmt>2205056</ProgramServicesAmt>
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        <ManagementAndGeneralAmt>272370</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>9682472</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>2400379</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>45105</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ManagementAndGeneralAmt>62518</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>152077</ProgramServicesAmt>
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        <EOYAmt>274160</EOYAmt>
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      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>29014944</EOYAmt>
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        <EOYAmt>846990</EOYAmt>
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      <InvestmentsProgramRelatedGrp>
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        <EOYAmt>0</EOYAmt>
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      <IntangibleAssetsGrp>
        <BOYAmt>983286</BOYAmt>
        <EOYAmt>983286</EOYAmt>
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      <OtherAssetsTotalGrp>
        <BOYAmt>132943</BOYAmt>
        <EOYAmt>14320647</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>45218977</BOYAmt>
        <EOYAmt>66493514</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>6357885</EOYAmt>
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      <GrantsPayableGrp>
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        <EOYAmt>0</EOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>217646</BOYAmt>
        <EOYAmt>166607</EOYAmt>
      </DeferredRevenueGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>4295000</BOYAmt>
        <EOYAmt>3875000</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>152602</BOYAmt>
        <EOYAmt>156136</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>10998196</BOYAmt>
        <EOYAmt>11939197</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
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        <ExplanationTxt>OTHER LOBBYING ACTIVITES: THE ORGANIZATION PAYS ANNUAL DUES TO THE MISSOURI HEALTH CARE ASSOCIATION (MHCA) AND THE AMERICAN HEALTH CARE ASSOCIATION (AHCA). A PORTION OF THESE DUES ARE ALLOCABLE TO LOBBYING: $866 MHCA AND $659 AHCA.</ExplanationTxt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>D MICHELLE MEENTS</PersonNm>
        <TitleTxt>BOARD MEMBER/PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>320451</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>12087</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>27690</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>3050</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>13806</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>377084</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BEVERLY DERRICKSON</PersonNm>
        <TitleTxt>CHIEF OPERATING OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>269170</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>8754</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>19944</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>2950</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>6402</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>307220</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TIM FRANCKA</PersonNm>
        <TitleTxt>ADMIN DIR-LTC EAST</TitleTxt>
        <BaseCompensationFilingOrgAmt>162797</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>7632</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>14098</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>1849</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>9308</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>195684</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHRISTOPHER MCBRATNEY</PersonNm>
        <TitleTxt>ADMINISTRATIVE DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>161211</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>7420</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>10956</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>1830</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>9600</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>191017</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CYNTHIA HADFIELD</PersonNm>
        <TitleTxt>PHARMACIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>153883</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>6848</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>690</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>1634</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>8784</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>171839</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>SETH ALLEY</PersonNm>
        <TitleTxt>PHARMACIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>146695</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>81</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>98</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>1516</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>10976</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>159366</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TIMOTHY WEST</PersonNm>
        <TitleTxt>PHARMACIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>139186</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>6155</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>690</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>1545</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>14310</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>161886</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>HEATHER FINNELL</PersonNm>
        <TitleTxt>DIRECTOR OF FINANCE</TitleTxt>
        <BaseCompensationFilingOrgAmt>125339</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>4603</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>9188</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>1417</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>10056</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>150603</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>HEALTH OR SOCIAL CLUB DUES: THE ORGANIZATION PAYS ANNUAL DUES FOR A COUNTRY CLUB MEMBERSHIP FOR THE FOLLOWING INDIVIDUALS: $1,370 TIM FRANCKA $1,382 RENEE MEYER $1,382 GARY FULBRIGHT $1,382 BEVERLY DERRICKSON $1,382 MICHAEL CALHOUN THESE AMOUNTS ARE INCLUDED IN THE EMPLOYEES W-2 AS TAXABLE WAGES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>CRITERIA TO ESTABLISH EXECUTIVE DIRECTOR COMPENSATION: THE FOUNDATION'S EXECUTIVE DIRECTOR IS PAID THROUGH CITIZENS MEM HOSPITAL DISTRICT. AT THE DISTRICT LEVEL, COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS USING COMPARABLE STATISTIC FOR SIMILAR POSITIONS IN THE HEALTHCARE INDUSTRY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART I, LINE 6A</FormAndLineReferenceDesc>
        <ExplanationTxt>CRITERIA FOR PROFIT SHARING AND BONUS PAYMENTS: EMPLOYEES ARE ELIGIBLE FOR THE EMPLOYEE BENEFIT PLAN KNOWN AS A PROFIT SHARING PLAN AFTER ONE YEAR OF SERVICE. ONE-THOUSAND (1000) HOURS OR MORE OF SERVICE SHALL BE REQUIRED TO CONSTITUTE ONE YEAR OF SERVICE. ANNUALLY, THE BOARD OF DIRECTORS SHALL DETERMINE THE AMOUNT TO CONTRIBUTE TO THE PLAN. TO BE ELIGIBLE FOR A CONTRIBUTION, THE EMPLOYEES MUST WORK AT LEAST 1000 HOURS DURING THE CALENDAR YEAR AND MUST BE EMPLOYED ON THE LAST DAY OF THE PLAN YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="IRS990ScheduleK">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>INDUSTRIAL DVLP AUTH OF DALLAS COUNTY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>431546885</BondIssuerEIN>
        <CUSIPNum>000000000</CUSIPNum>
        <BondIssuedDt>2018-12-28</BondIssuedDt>
        <IssuePriceAmt>2530000</IssuePriceAmt>
        <PurposeDesc>SEE SUPPLEMENTAL INFORMATION</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>INDUSTRIAL DVLP AUTH OF CITY OF ELDORADO SPRINGS</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>260025115</BondIssuerEIN>
        <CUSIPNum>000000000</CUSIPNum>
        <BondIssuedDt>2016-12-22</BondIssuedDt>
        <IssuePriceAmt>2365000</IssuePriceAmt>
        <PurposeDesc>SEE SUPPLEMENTAL INFORMATION</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>0</RetiredAmt>
        <BondDefeasedAmt>0</BondDefeasedAmt>
        <TotalProceedsAmt>2530000</TotalProceedsAmt>
        <InReserveFundAmt>0</InReserveFundAmt>
        <CapitalizedInterestAmt>0</CapitalizedInterestAmt>
        <RefundingEscrowAmt>0</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>0</IssuanceCostsFromProceedsAmt>
        <CreditEnhancementAmt>0</CreditEnhancementAmt>
        <WorkingCapitalExpendituresAmt>0</WorkingCapitalExpendituresAmt>
        <CapitalExpendituresAmt>0</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>2530000</OtherSpentProceedsAmt>
        <UnspentAmt>0</UnspentAmt>
        <SubstantialCompletionYr>2006</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>true</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <RetiredAmt>1020000</RetiredAmt>
        <BondDefeasedAmt>0</BondDefeasedAmt>
        <TotalProceedsAmt>2365159</TotalProceedsAmt>
        <InReserveFundAmt>0</InReserveFundAmt>
        <CapitalizedInterestAmt>0</CapitalizedInterestAmt>
        <RefundingEscrowAmt>0</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>25102</IssuanceCostsFromProceedsAmt>
        <CreditEnhancementAmt>0</CreditEnhancementAmt>
        <WorkingCapitalExpendituresAmt>0</WorkingCapitalExpendituresAmt>
        <CapitalExpendituresAmt>1252748</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>1086896</OtherSpentProceedsAmt>
        <UnspentAmt>0</UnspentAmt>
        <SubstantialCompletionYr>2017</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>true</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00000</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.00000</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ChangeInUseBondFinancedPropPct>0.00000</ChangeInUseBondFinancedPropPct>
        <RemedialActionTakenInd>false</RemedialActionTakenInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <EngageBondCounselContractsInd>false</EngageBondCounselContractsInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00000</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.00000</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ChangeInUseBondFinancedPropPct>0.00000</ChangeInUseBondFinancedPropPct>
        <RemedialActionTakenInd>false</RemedialActionTakenInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>false</RebateNotDueYetInd>
        <ExceptionToRebateInd>true</ExceptionToRebateInd>
        <NoRebateDueInd>false</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <HedgeProviderName>
          <BusinessNameLine1Txt>0</BusinessNameLine1Txt>
        </HedgeProviderName>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GICProviderName>
          <BusinessNameLine1Txt>0</BusinessNameLine1Txt>
        </GICProviderName>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>true</RebateNotDueYetInd>
        <ExceptionToRebateInd>false</ExceptionToRebateInd>
        <NoRebateDueInd>true</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <HedgeProviderName>
          <BusinessNameLine1Txt>0</BusinessNameLine1Txt>
        </HedgeProviderName>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GICProviderName>
          <BusinessNameLine1Txt>0</BusinessNameLine1Txt>
        </GICProviderName>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K, PART I, LINE A, COLUMN (F)</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION OF PURPOSE: REFUND 2014 BONDS (ORIGINALLY ISSUED 02/27/2014)</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K, PART I, LINE B, COLUMN (F)</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION OF PURPOSE: A PORTION WAS USED TO REFUND 2012 REV BONDS (ORIGINALLY ISSUED 01/27/2012)/ACQUISITION, CONSTRUCTION &amp; EQUIPMENT FOR HOSPITAL CLINIC</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K, PART IV, LINE 2C, COLUMN B</FormAndLineReferenceDesc>
        <ExplanationTxt>DATE OF REBATE COMPUTATION: THE REBATE COMPUTATION WAS PERFORMED 12/22/2021.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART I, LINE 1</FormAndLineReferenceDesc>
        <ExplanationTxt>ORGANIZATION'S MISSION: THE ORGANIZATION WAS CREATED TO SUPPORT CMH HOSPITAL DISTRICT THROUGH LONG TERM CARE SERVICES SUCH AS SKILLED NURSING FACILITIES, RESIDENTIAL CARE FACILITIES, AND INDEPENDENT LIVING APARTMENTS, AND TO PROVIDE SERVICES TO THE LOCAL RURAL COMMUNITIES, SUCH AS MEDICAL EQUIPMENT AND SUPPLIES, HOME HEALTH AND HOSPICE, HEALTH TRANSPORTATION, HOMEMAKER CHORE SERVICES AND PHARMACY SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART I, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>NUMBER OF VOLUNTEERS: THE TOTAL NUMBER OF VOLUNTEERS INCLUDES NON-COMPENSATED MEMBERS OF THE BOARD OF DIRECTORS ALONG WITH OTHER AUXILIA VOLUNTEERS WHO ASSIST WITH A VARIETY OF OPPORTUNITIES AT THE FOUNDATION'S FACILITIES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 4A, 4B, 4C &amp; 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>PROGRAM SERVICE ACTIVITY DETAIL: WE OFFER CARE AT EVERY STAGE OF LIFE BY PROVIDING HOME CARE, INDEPENDENT LIVING, RESIDENTIAL CARE AND SKILLED NURSING (LONG TERM CARE) FACILITIES. ALL FACILITIES OFFER RESIDENT AND FAMILY SERVICES INCLUDING SOCIAL SERVICES; DAILY ACTIVITIES A MONTHLY OUTINGS; BEAUTY AND BARBER SERVICES; VISITS FROM COMMUNITY AND SCHOOL ORGANIZATIONS; AND LAUNDRY, CHURCH AND PHARMACY SERVICES. MONTHLY FAMILY SUPPORT GROUPS AND RESIDENT CARE PLANNING MEETING ASSIST FAMILY MEMBERS WITH EDUCATION AND RESOURCES TO ENHANCE THE QUALITY OF TIME SHARED WITH LOVED ONES. IN ADDITION, IF PATIENTS NEED A LITTLE EXTRA HELP, HOMEMAKER PLUS CAN HELP THEM REMAIN INDEPENDENT IN THEIR HOME. OUR SERVICES ARE PROVIDED ON NONDISCRIMINATORY BASIS AND CAN BENEFIT EVERYONE, FROM THE ELDERLY AND PHYSICALLY CHALLENGED TO THE HEALTHY FAMILY ON THE GO. A CARING INDIVIDUAL WILL VISIT THE HOME AND ASSIST PATIENTS ON A LONG-TERM OR ONE-TIME BASIS WITH SKILLED NURSING, REHABILITATIVE SERVICES, HOUSEKEEPING CHORES, MEAL PLANNING, GROCERY SHOPPING AND A HOST OF OTHER IMPORTANT SERVICES. OUR SERVICES PROVIDED RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 19,468 RESIDENT DAYS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, A DRAFT OF THE 990 WILL BE REVIEWED BY TOP MANAGEMENT. A FINAL DRAFT WILL BE DISCUSSED AT A MEETING OF THE FULL BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY REVIEW: ANNUALLY, DURING THE MARCH BOARD OF DIRECTOR'S MEETING, THE OFFICERS AND DIRECTORS DISCLOSE ALL KNOWN CONFLICTS OF INTEREST. ANY BOARD MEMBER WITH A CONFLICT OF INTEREST ABSTAINS FROM VOTING ON ANY MATTER RELATED TO THAT CONFLICT. IN ADDITION, ALL CORPORATE OFFICERS AND KEY EMPLOYEES ARE ANNUALLY REQUIRED TO REPORT POTENTIAL CONFLICTS OF INTEREST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION REVIEW POLICY: THE BOARD OF DIRECTORS OF CITIZENS MEMORIAL HOSPITAL DISTRICT ESTABLISHES THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER/EXECUTIVE DIRECTOR BASED UPON COMPENSATION FOR SIMILAR POSITIONS IN THE HEALTHCARE INDUSTRY. A WRITTEN EMPLOYMENT AGREEMENT DETAILS THE SALARY AND BENEFITS FOR THE CEO/EXECUTIVE DIRECTOR. CITIZENS MEMORIAL HEALTH CARE FOUNDATION PAYS A PERCENTAGE OF THE TOTAL BASED UPON THE ESTIMATED PERCENTAGE OF TIME SPLIT BETWEEN THE TWO ORGANIZATIONS. THIS PERCENTAGE IS NOT ANNUALLY REVIEWED OR APPROVED BY THE CITIZENS MEMORIAL HOSPITAL DISTRICT BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>DOCUMENT DISCLOSURE: MANY ORGANIZATION POLICIES ARE MADE AVAILABLE TO EMPLOYEES ON THE COMPANY INTRANET, FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST TO ALL BONDHOLDERS FOR A LEGITIMATE BUSINESS PURPOSE, AND THE AUDIT REPORT IS MADE AVAILABLE TO ALL LENDERS. IN GENERAL, DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC BY ANY OTHER MEANS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII, SECTION A</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD MEMBER COMPENSATION: NO BOARD MEMBER RECEIVED COMPENSATION FOR THEIR DUTIES AS DIRECTORS. WILLIAM DONNELL IS COMPENSATED BY THE ORGANIZATION FOR SERVING AS MEDICAL DIRECTOR FOR A SKILLED NURSING FACILITY AND IS COMPENSATED BY CITIZENS MEMORIAL HOSPITAL, A RELATED ORGANIZATION, AS A PHYSICIAN. D. MICHEALE MEENTS IS COMPENSATED BY CITIZEN MEMORIAL HOSPITAL, A RELATED ORGANIZATION, AS A PHYSICIAN. K. RONALD SMITH IS COMPENSATED BY CITIZENS MEMORIAL HOSPITAL, A RELATED ORGANIZATION. GARY FULBRIGHT RECEIVES COMPENSATION FROM CITIZENS MEMORIAL HOSPITAL, A RELATED ORGANIZATION, FOR HIS ROLE AS A FINANCIAL CONSULTANT. MICHAEL CALHOUN RECEIVES COMPENSATION FROM CITIZENS MEMORIAL HOSPITAL, A RELATED ORGANIZATION, FOR HIS ROLE AS EXECUTIVE DIRECTOR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER CHANGES IN NET ASSETS: $ 87,531 CHANGE IN EQUITY INVESTMENTS</ExplanationTxt>
      </SupplementalInformationDetail>
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          <AddressLine1Txt>1500 N OAKLAND</AddressLine1Txt>
          <CityNm>BOLIVAR</CityNm>
          <StateAbbreviationCd>MO</StateAbbreviationCd>
          <ZIPCd>65613</ZIPCd>
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          <BusinessNameLine1Txt>BOLIVAR MED BLDG</BusinessNameLine1Txt>
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          <AddressLine1Txt>BOLIVAR MO 65613</AddressLine1Txt>
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          <StateAbbreviationCd>MO</StateAbbreviationCd>
          <ZIPCd>65613</ZIPCd>
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        <EIN>262797636</EIN>
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        <LegalDomicileStateCd>MO</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>CMHCF</BusinessNameLine1Txt>
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        <ShareOfEOYAssetsAmt>1764618</ShareOfEOYAssetsAmt>
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        <UBICodeVAmt>0</UBICodeVAmt>
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      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>true</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>true</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>true</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>true</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
