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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>JOHN HEAVENS</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>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN BRANDT</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>MICHELLE BEISKER</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>AMY GRUNEWALDT</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>
      <TotalReportableCompFromOrgAmt>2160223</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>244628</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>13</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>true</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>114393</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Ryan Companies US Inc</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>625 First St SE</AddressLine1Txt>
            <CityNm>Cedar Rapids</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
            <ZIPCd>52401</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Construction</ServicesDesc>
        <CompensationAmt>241289</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>145555</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>3</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>3701835</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>519839</AllOtherContributionsAmt>
      <TotalContributionsAmt>4221674</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>11397816</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>11397816</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>MEANINGFUL USE REV</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>110500</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>110500</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>INCENTIVES</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>134506</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>134506</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>11642822</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>8421</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>8421</RelatedOrExemptFuncIncomeAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISC INCOME</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>156475</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>156475</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>IA HLTH ACO JT VENT</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>252453</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>252453</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>CRPHO &amp; GCRCF</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>-2679</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>-2679</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>406249</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>16279166</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12057492</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompDisqualPersonsGrp>
        <TotalAmt>2160223</TotalAmt>
        <ProgramServicesAmt>1713471</ProgramServicesAmt>
        <ManagementAndGeneralAmt>446752</ManagementAndGeneralAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>5909130</TotalAmt>
        <ProgramServicesAmt>5161591</ProgramServicesAmt>
        <ManagementAndGeneralAmt>691458</ManagementAndGeneralAmt>
        <FundraisingAmt>56081</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>270535</TotalAmt>
        <ProgramServicesAmt>230113</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38183</ManagementAndGeneralAmt>
        <FundraisingAmt>2239</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1089753</TotalAmt>
        <ProgramServicesAmt>942692</ProgramServicesAmt>
        <ManagementAndGeneralAmt>139847</ManagementAndGeneralAmt>
        <FundraisingAmt>7214</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>534786</TotalAmt>
        <ProgramServicesAmt>435143</ProgramServicesAmt>
        <ManagementAndGeneralAmt>95696</ManagementAndGeneralAmt>
        <FundraisingAmt>3947</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>36000</TotalAmt>
        <ProgramServicesAmt>975</ProgramServicesAmt>
        <ManagementAndGeneralAmt>35025</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>192342</TotalAmt>
        <ManagementAndGeneralAmt>192342</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1412090</TotalAmt>
        <ProgramServicesAmt>1276642</ProgramServicesAmt>
        <ManagementAndGeneralAmt>132186</ManagementAndGeneralAmt>
        <FundraisingAmt>3262</FundraisingAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>51644</TotalAmt>
        <ProgramServicesAmt>37596</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13544</ManagementAndGeneralAmt>
        <FundraisingAmt>504</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>110406</TotalAmt>
        <ProgramServicesAmt>62770</ProgramServicesAmt>
        <ManagementAndGeneralAmt>47532</ManagementAndGeneralAmt>
        <FundraisingAmt>104</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>107727</TotalAmt>
        <ProgramServicesAmt>80584</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27143</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>680724</TotalAmt>
        <ProgramServicesAmt>511275</ProgramServicesAmt>
        <ManagementAndGeneralAmt>169449</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>8851</TotalAmt>
        <ProgramServicesAmt>2488</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6363</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>26572</TotalAmt>
        <ProgramServicesAmt>17419</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9153</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>59581</TotalAmt>
        <ProgramServicesAmt>13534</ProgramServicesAmt>
        <ManagementAndGeneralAmt>46047</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>314246</TotalAmt>
        <ProgramServicesAmt>312413</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1833</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>45836</TotalAmt>
        <ManagementAndGeneralAmt>45836</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITMENT</Desc>
        <TotalAmt>66449</TotalAmt>
        <ProgramServicesAmt>20238</ProgramServicesAmt>
        <ManagementAndGeneralAmt>46211</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>723970</TotalAmt>
        <ProgramServicesAmt>643178</ProgramServicesAmt>
        <ManagementAndGeneralAmt>80792</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>ALL OTHER</Desc>
        <TotalAmt>78626</TotalAmt>
        <ProgramServicesAmt>45911</ProgramServicesAmt>
        <ManagementAndGeneralAmt>30961</ManagementAndGeneralAmt>
        <FundraisingAmt>1754</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUESSUBSBOOKSLIC</Desc>
        <TotalAmt>124425</TotalAmt>
        <ProgramServicesAmt>76390</ProgramServicesAmt>
        <ManagementAndGeneralAmt>47700</ManagementAndGeneralAmt>
        <FundraisingAmt>335</FundraisingAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>14003916</TotalAmt>
        <ProgramServicesAmt>11584423</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2344053</ManagementAndGeneralAmt>
        <FundraisingAmt>75440</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <JointCostsInd>X</JointCostsInd>
      <CashNonInterestBearingGrp>
        <BOYAmt>1625404</BOYAmt>
        <EOYAmt>3776362</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>1443641</BOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>330993</BOYAmt>
        <EOYAmt>374159</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1056552</BOYAmt>
        <EOYAmt>1697996</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>55799</BOYAmt>
        <EOYAmt>67830</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>198356</BOYAmt>
        <EOYAmt>174111</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>4655040</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>1470407</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>2987256</BOYAmt>
        <EOYAmt>3184633</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>273058</BOYAmt>
        <EOYAmt>555226</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>7971059</BOYAmt>
        <EOYAmt>9830317</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1324461</BOYAmt>
        <EOYAmt>1042501</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1563172</BOYAmt>
        <EOYAmt>1429140</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>2887633</BOYAmt>
        <EOYAmt>2471641</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>4891970</BOYAmt>
        <EOYAmt>7226746</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>191456</BOYAmt>
        <EOYAmt>131930</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>5083426</BOYAmt>
        <EOYAmt>7358676</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>7971059</BOYAmt>
        <EOYAmt>9830317</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>2275250</ReconcilationRevenueExpnssAmt>
      <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">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>3055916</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2051861</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>2235499</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3193571</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4221674</CurrentTaxYearAmt>
        <TotalAmt>14758521</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>8488261</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>11055238</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11279019</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10905081</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>11642822</CurrentTaxYearAmt>
        <TotalAmt>53370421</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>11544177</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>13107099</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>13514518</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>14098652</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>15864496</CurrentTaxYearAmt>
        <TotalAmt>68128942</TotalAmt>
      </Total509Grp>
      <PublicSupportTotal509Amt>68128942</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>6742</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>1593</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>27735</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>30968</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>8421</CurrentTaxYearAmt>
        <TotalAmt>75459</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>6742</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>1593</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>27735</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>30968</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>8421</CurrentTaxYearAmt>
        <TotalAmt>75459</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>29327</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>77611</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>117129</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>148615</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>406249</CurrentTaxYearAmt>
        <TotalAmt>778931</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>11580246</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>13186303</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>13659382</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>14278235</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>16279166</CurrentTaxYearAmt>
        <TotalAmt>68983332</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.98760</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.98810</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00000</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.01000</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>3311155</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>796257</DepreciationAmt>
        <BookValueAmt>2514898</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1092384</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>674150</DepreciationAmt>
        <BookValueAmt>418234</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>3184633</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>IOWA HEALTH CNTRS FOR ACC LLC</Desc>
        <BookValueAmt>486280</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>NOTE RECEIVABLE</Desc>
        <BookValueAmt>35360</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INTEREST IN ASSETS HELD BY GREATER</Desc>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>CEDAR RAPIDS COMMUNITY FOUNDATION</Desc>
        <BookValueAmt>33586</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>555226</TotalBookValueOtherAssetsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>16279166</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>16279166</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>16279166</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>14003916</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>14003916</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>14003916</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>354747</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>14190</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>19409</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>388346</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BASSELL EID</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>460221</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>18409</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>27569</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>506199</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>URSULA LIVERMORE</PersonNm>
        <TitleTxt>CHIEF MEDICAL OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>270035</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10801</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>24687</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>305523</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOE LOCK</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>172831</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>6913</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>23197</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>202941</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KATHERINE ABTAHI</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>289825</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>11593</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>25547</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>326965</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARCUS D BARNETT</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>338643</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>13546</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>25745</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>377934</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DANIEL T WASHBURN</PersonNm>
        <TitleTxt>FORMER CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>91016</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>3641</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>5949</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>100606</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 Services - Interpretation Services $138,807 Contracted Physician $198,705 340B Fee $145,681 Patient Claim Processing $550,110 Collections $13,384 Payroll Processing Fees $105,289 Pass Through Grant Expense $48,521 Other Purchased Services $76,145 Total $1,276,642Administrative Services - Consultants $9,718 Payroll Processing $31,529 IT $7,831 Other $83,108 Total $132,186Fund Raising - IT $3,262</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>