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        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DENNIS GOETTEL</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN BRANDT</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CONNIE ALT</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>AMY GRUNEWALDT</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2230893</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>258970</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>20</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>BKD LLP</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>910 E ST Louis ST Suite 200</AddressLine1Txt>
            <CityNm>Springfield</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>65806</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Accounting</ServicesDesc>
        <CompensationAmt>163386</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Modern Piping</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>500 Walford RD</AddressLine1Txt>
            <CityNm>Cedar Rapids</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
            <ZIPCd>52404</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Construction</ServicesDesc>
        <CompensationAmt>280443</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Aramark Uniforms</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>25259 Network Place</AddressLine1Txt>
            <CityNm>Chicago</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60673</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Uniforms &amp; Laundry</ServicesDesc>
        <CompensationAmt>143592</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Iowa Solutions</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1045 Sherman Rd</AddressLine1Txt>
            <CityNm>Hiawatha</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
            <ZIPCd>52233</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>IT services</ServicesDesc>
        <CompensationAmt>238484</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Hands Up Communications</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4211 Glass Rd</AddressLine1Txt>
            <CityNm>Cedar Rapids</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
            <ZIPCd>52402</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Interpretation</ServicesDesc>
        <CompensationAmt>126122</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>2751533</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>1126799</AllOtherContributionsAmt>
      <TotalContributionsAmt>3878332</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>12089420</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12089420</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>INCENTIVES</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>351022</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>351022</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>12440442</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>6294</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>6294</RelatedOrExemptFuncIncomeAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <Desc>IA HLTH ACO JT VENT K1</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>97594</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>97594</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISC INCOME</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>21571</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>21571</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>CRPHO &amp; GCRCF</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>17513</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>17513</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>136678</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>16461746</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12583414</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2230893</TotalAmt>
        <ProgramServicesAmt>1776191</ProgramServicesAmt>
        <ManagementAndGeneralAmt>454702</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>6028756</TotalAmt>
        <ProgramServicesAmt>5568211</ProgramServicesAmt>
        <ManagementAndGeneralAmt>399364</ManagementAndGeneralAmt>
        <FundraisingAmt>61181</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>267485</TotalAmt>
        <ProgramServicesAmt>223720</ProgramServicesAmt>
        <ManagementAndGeneralAmt>43765</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1088551</TotalAmt>
        <ProgramServicesAmt>981463</ProgramServicesAmt>
        <ManagementAndGeneralAmt>104939</ManagementAndGeneralAmt>
        <FundraisingAmt>2149</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>542840</TotalAmt>
        <ProgramServicesAmt>416452</ProgramServicesAmt>
        <ManagementAndGeneralAmt>121708</ManagementAndGeneralAmt>
        <FundraisingAmt>4680</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>38423</TotalAmt>
        <ManagementAndGeneralAmt>38423</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>279687</TotalAmt>
        <ProgramServicesAmt>95972</ProgramServicesAmt>
        <ManagementAndGeneralAmt>183715</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1587047</TotalAmt>
        <ProgramServicesAmt>1358197</ProgramServicesAmt>
        <ManagementAndGeneralAmt>225423</ManagementAndGeneralAmt>
        <FundraisingAmt>3427</FundraisingAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>44452</TotalAmt>
        <ProgramServicesAmt>17217</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27235</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>94243</TotalAmt>
        <ProgramServicesAmt>36937</ProgramServicesAmt>
        <ManagementAndGeneralAmt>48214</ManagementAndGeneralAmt>
        <FundraisingAmt>9092</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>161577</TotalAmt>
        <ProgramServicesAmt>42614</ProgramServicesAmt>
        <ManagementAndGeneralAmt>118963</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>519327</TotalAmt>
        <ProgramServicesAmt>334515</ProgramServicesAmt>
        <ManagementAndGeneralAmt>184812</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>31957</TotalAmt>
        <ProgramServicesAmt>9407</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22550</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>21927</TotalAmt>
        <ProgramServicesAmt>14427</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7500</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>52188</TotalAmt>
        <ProgramServicesAmt>10885</ProgramServicesAmt>
        <ManagementAndGeneralAmt>41303</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>291163</TotalAmt>
        <ProgramServicesAmt>290157</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1006</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>66104</TotalAmt>
        <ManagementAndGeneralAmt>66104</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITMENT</Desc>
        <TotalAmt>47631</TotalAmt>
        <ProgramServicesAmt>6040</ProgramServicesAmt>
        <ManagementAndGeneralAmt>41591</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>1023945</TotalAmt>
        <ProgramServicesAmt>1015279</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8666</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>ALL OTHER</Desc>
        <TotalAmt>142569</TotalAmt>
        <ProgramServicesAmt>68491</ProgramServicesAmt>
        <ManagementAndGeneralAmt>74078</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUESSUBSBOOKSLIC</Desc>
        <TotalAmt>155083</TotalAmt>
        <ProgramServicesAmt>62207</ProgramServicesAmt>
        <ManagementAndGeneralAmt>92876</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>14715848</TotalAmt>
        <ProgramServicesAmt>12328382</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2306937</ManagementAndGeneralAmt>
        <FundraisingAmt>80529</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <JointCostsInd>X</JointCostsInd>
      <CashNonInterestBearingGrp>
        <BOYAmt>3776362</BOYAmt>
        <EOYAmt>2456351</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <EOYAmt>1638049</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>374159</BOYAmt>
        <EOYAmt>1137939</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1697996</BOYAmt>
        <EOYAmt>2277243</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>67830</BOYAmt>
        <EOYAmt>73001</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>174111</BOYAmt>
        <EOYAmt>229392</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>4862237</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>1701216</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3184633</BOYAmt>
        <EOYAmt>3161021</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>555226</BOYAmt>
        <EOYAmt>705634</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>9830317</BOYAmt>
        <EOYAmt>11678630</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1042501</BOYAmt>
        <EOYAmt>1075458</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1429140</BOYAmt>
        <EOYAmt>1833155</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>2471641</BOYAmt>
        <EOYAmt>2908613</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>7226746</BOYAmt>
        <EOYAmt>7836386</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>131930</BOYAmt>
        <EOYAmt>933631</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>7358676</BOYAmt>
        <EOYAmt>8770017</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>9830317</BOYAmt>
        <EOYAmt>11678630</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>1745898</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-334557</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="990A">
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      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>2051861</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2235499</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3193571</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4221674</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3878332</CurrentTaxYearAmt>
        <TotalAmt>15580937</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
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        <CurrentTaxYearMinus3YearsAmt>11279019</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>10905081</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>11642822</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12440442</CurrentTaxYearAmt>
        <TotalAmt>57322602</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>13107099</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>13514518</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>14098652</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>15864496</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>16318774</CurrentTaxYearAmt>
        <TotalAmt>72903539</TotalAmt>
      </Total509Grp>
      <PublicSupportTotal509Amt>72903539</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>1593</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>27735</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>30968</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8421</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>6294</CurrentTaxYearAmt>
        <TotalAmt>75011</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
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        <CurrentTaxYearMinus2YearsAmt>30968</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8421</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>6294</CurrentTaxYearAmt>
        <TotalAmt>75011</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
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        <CurrentTaxYearMinus3YearsAmt>117129</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>148615</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>406249</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>136678</CurrentTaxYearAmt>
        <TotalAmt>886282</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
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        <CurrentTaxYearMinus3YearsAmt>13659382</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>14278235</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>16279166</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>16461746</CurrentTaxYearAmt>
        <TotalAmt>73864832</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.98700</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.98760</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00000</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00000</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="990B">
      <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>
    <IRS990ScheduleC documentId="990C">
      <VolunteersInd>false</VolunteersInd>
      <PaidStaffOrManagementInd>false</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>false</MediaAdvertisementsInd>
      <MailingsMembersInd>false</MailingsMembersInd>
      <PublicationsOrBroadcastInd>false</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>false</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>false</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>false</RalliesDemonstrationsInd>
      <OtherActivitiesInd>false</OtherActivitiesInd>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="990D">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>251501</OtherCostOrOtherBasisAmt>
        <BookValueAmt>251501</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>3563566</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>969452</DepreciationAmt>
        <BookValueAmt>2594114</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1047170</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>731764</DepreciationAmt>
        <BookValueAmt>315406</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>3161021</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>IOWA HEALTH CNTRS FOR ACC LLC</Desc>
        <BookValueAmt>583782</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>NOTE RECEIVABLE</Desc>
        <BookValueAmt>12500</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INTEREST IN ASSETS HELD BY GREATER</Desc>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>CEDAR RAPIDS COMMUNITY FOUNDATION</Desc>
        <BookValueAmt>27582</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>DEPOSIT ON EQUIPMENT</Desc>
        <BookValueAmt>81770</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>705634</TotalBookValueOtherAssetsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>16461746</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>16461746</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>16461746</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>14715848</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>14715848</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>14715848</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="990G" />
    <IRS990ScheduleJ documentId="990J">
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <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>SIDNEY J SMITH</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>376187</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>15047</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>22891</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>414125</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BASSELL EID</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>486769</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>19471</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>34894</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>541134</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>URSULA LIVERMORE</PersonNm>
        <TitleTxt>CHIEF MEDICAL OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>282200</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>11288</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>27436</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>320924</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOE LOCK</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>178979</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>7159</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>31258</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>217396</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>AMY LYNN SMOLUCHA</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>296277</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>11851</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>12006</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>320134</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARCUS D BARNETT</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>334758</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>13390</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>29873</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>378021</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ELLY J STEFFEN</PersonNm>
        <TitleTxt>CHIEF OPERATING OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>143905</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>5756</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>1700</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>151361</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="990O">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>Form 990 will be presented to board of directors</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Board would discuss any conflict of interest</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>CEO executive director top management comp Part VI line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>Executive committee and finance committee review and make recommendation to board for CEO salary</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other officer or key employee compensation Part VI line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>CEO makes recommendation for compensation, executive committee and finance committee review and make recommendation to board for overall organizations wage increases.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents, conflict of interest policy, and financial statements are not available to the general public. Public officials serve on the board and would share documents with their governmental entities.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>List of other fees for services expenses Part IX line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Program ServicesPatient Claim Processing $521,389 Collection Fees 6,834 Interpretation Services $202,146 Physician Services $78,240 Recruiting $34,000 Other $46,644 Pharmacy $12,628 IT $139,569 340B Fees $194,191 Consulting 122,556 Total $1,358,197Management and GeneralAccounting $31,360 Consulting $1,683 Grant Application $40,845 Human Resources $42,328 IT Services $39,193Medication Consulting $62,408 Other $7,606 Total $225,423Fundraising IT Services $3,427</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
