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      <Desc>DURING 2020, CARE PROVIDED SERVICES TO A DAILY AVERAGE OF 2,170 RESIDENTS IN 44 IOWA NURSING HOMES, 8 ASSISTED LIVING FACILITIES AND 3 SENIOR LIVING APARTMENT LOCATIONS. CARE PROVIDED THESE RESIDENTS, WHICH ARE COMPRISED OF ELDERLY, INFIRMED AND FINANCIALLY LIMITED INDIVIDUALS, WITH A COMFORTABLE, CLEAN, HOME LIKE ATMOSPHERE. CARE PROVIDES HIGH QUALITY HEALTH CARE, FREE OF AS MANY RESTRAINTS AND PSYCHOTROPIC MEDICATIONS AS IS PRUDENT FOR THEIR SAFETY AND THE SAFETY OF OTHER RESIDENTS, AT THE LOWEST POSSIBLE COST. SERVICES PROVIDED INCLUDE ROOM AND BOARD, PROVISION FOR DIETARY REQUIREMENTS, ASSISTANCE WITH PERSONAL HYGIENE WHERE NEEDED, AND PHYSICAL AND SOCIAL ACTIVITIES TO MAINTAIN THE HIGHEST PHYSICAL AND MENTAL QUALITY OF LIFE ATTAINABLE. ADDITIONAL SERVICES INCLUDE OCCUPATIONAL, SPEECH AND PHYSICAL THERAPY, OUTPATIENT THERAPY SERVICES, SKILLED NURSING CARE IN ALL CARE CENTERS, SENIOR LIVING APARTMENTS AT SEVERAL LOCATIONS AND ASSISTED LIVING IN EIGHT LOCATIONS. IN ADDITION, CARE HAS INITIATED A PROGRAM OF REHAB TO HOME CARE TO HASTEN A RESIDENT'S OPPORTUNITY TO RETURN TO THEIR HOMES. IN ADDITION, CARE PROVIDES LIMITED OUTPATIENT THERAPY SERVICES IN THE COMMUNITIES IT SERVES.DURING 2020, CARE ALSO PROVIDED HOSPICE SERVICES TO A DAILY AVERAGE OF 206 PATIENTS THROUGH SIX HOSPICE LOCATIONS. CARE PROVIDES COMPASSIONATE HEALTH CARE AND PALLIATIVE SUPPORT FOR PEOPLE FACING LIFE-LIMITING ILLNESSES OR CONDITIONS. SOME OF THE SERVICES PROVIDED INCLUDE NURSING CARE, PHYSICIAN CARE, HOME HEALTH AIDE, PHYSICAL AND SPEECH THERAPY, MASSAGE THERAPY, MUSIC THERAPY, SPIRITUAL SUPPORT, AND BEREAVEMENT SUPPORT.CARE IS THE LARGEST NURSING HOME SERVICE PROVIDER FOR MEDICAID RESIDENTS IN IOWA. IN 2020, A DAILY AVERAGE OF 1,203 RESIDENTS PARTICIPATED IN THE MEDICAID PROGRAM. CARE'S COST FOR THESE RESIDENTS EXCEEDED REVENUE BY $29,293,000. NO RESIDENT OF CARE IS DENIED A MEDICATION, NURSING SUPPLY OR THERAPY, REGARDLESS OF THEIR ABILITY TO PAY. CARE HAS A HISTORY OF MODERNIZATION AND REPLACEMENT OF NURSING FACILITIES. SINCE INCEPTION, CARE HAS INVESTED MORE THAN $125 MILLION TO MODERNIZE ITS CENTERS. IMPROVEMENTS INCLUDE AIR CONDITIONING, FIRE SPRINKLERS, REPLACEMENT OF HVAC AND ELECTRICAL SYSTEMS, AND PAVED PARKING LOTS. EVERY CARE CENTER THAT HAS NOT YET BEEN REPLACED WITH A NEW REPLACEMENT BUILDING HAS HAD EXTENSIVE RENOVATIONS. SINCE INCEPTION, CARE HAS INVESTED MORE THAN $111 MILLION IN FOURTEEN NEW REPLACEMENT CENTER BUILDINGS THROUGHOUT IOWA.CARE PROMOTES ECONOMIC DEVELOPMENT IN THE COMMUNITIES IT SERVES BY ADDRESSING HOUSING, EMPLOYMENT, EDUCATIONAL OR ENVIRONMENTAL NEEDS AND CONCERNS. IN 2020, CARE CONTRIBUTED TO ITS COMMUNITIES BY PAYING PROPERTY TAX OF $2.46 MILLION. IN MANY OF ITS COMMUNITIES, CARE IS THE LARGEST EMPLOYER AND THEIR FAMILIES FORM THE LARGEST STUDENT POPULATION BASE FOR THE LOCAL SCHOOL DISTRICT.CARE FACILITIES WERE A GATHERING PLACE FOR COMMUNITY VOLUNTEERS WHO PROVIDED 6,849 HOURS TO HELP THE ELDERLY. USING THE INDEPENDENT SECTOR'S ESTIMATED DOLLAR VALUE OF VOLUNTEER TIME, THE ESTIMATED VALUE OF VOLUNTEER TIME TOTALED APPROXIMATELY $172,332. CARE'S CONTINUUM OF CARE EXTENDED INTO THE COMMUNITIES IT SERVES BY PROVIDING REDUCED OR NO-FEE SERVICES SUCH AS MEALS-ON-WHEELS, MEALS FOR COUNTY JAILS, EDUCATIONAL SERVICES AND PUBLIC AWARENESS PROGRAMS.IN 2020, $15,677 IN CHARITABLE CONTRIBUTIONS WERE MADE TO SUPPORT CHARITABLE ORGANIZATIONS THAT FURTHER CARE'S EXEMPT MISSION.</Desc>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>STEPHANIE EDWARDS</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>4.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>28000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT CONLON</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>6.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>28000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RON HARMOND</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>4.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>28000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RON NORTHUP</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>3.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>28000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2843030</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>132387</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>50</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>RELIANT PRO REHAB LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5800 GRANITE PKWY SUITE 1000</AddressLine1Txt>
            <CityNm>DALLAS</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>75024</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHYS/OCC/SP THERAPY</ServicesDesc>
        <CompensationAmt>10678126</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>GRAPE TREE MEDICAL STAFFING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1003 23RD STREET</AddressLine1Txt>
            <CityNm>MILFORD</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
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          </USAddress>
        </ContractorAddress>
        <ServicesDesc>NURSE STAFFING</ServicesDesc>
        <CompensationAmt>2253970</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>AUSTIN BUILDERS LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1205 N ANKENY BLVD</AddressLine1Txt>
            <CityNm>ANKENY</CityNm>
            <StateAbbreviationCd>IA</StateAbbreviationCd>
            <ZIPCd>50021</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION SERVICES</ServicesDesc>
        <CompensationAmt>2025188</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>FUSION MEDICAL STAFFING LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>11808 GRANT ST SUITE 100</AddressLine1Txt>
            <CityNm>OMAHA</CityNm>
            <StateAbbreviationCd>NE</StateAbbreviationCd>
            <ZIPCd>68164</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>NURSE STAFFING</ServicesDesc>
        <CompensationAmt>1685592</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CONEXUS MEDICAL STAFFING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>11750 KATY FREEWAY SUITE 750</AddressLine1Txt>
            <CityNm>HOUSTON</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>77079</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>NURSE STAFFING</ServicesDesc>
        <CompensationAmt>1664391</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>26</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>19739737</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>63543</AllOtherContributionsAmt>
      <TotalContributionsAmt>19803280</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NURSING HOME SERVICES</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>179776414</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>179776414</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>HOSPICE SERVICES</Desc>
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        <TotalRevenueColumnAmt>11284468</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>11284468</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>ASSISTED LIVING SERVIC</Desc>
        <BusinessCd>623990</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>935929</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>SENIOR LIVING APARTMEN</Desc>
        <BusinessCd>623990</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>129173</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>GUEST MEALS</Desc>
        <BusinessCd>722210</BusinessCd>
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        <ExclusionAmt>26826</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
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        <ExclusionAmt>7325</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>192234959</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>871169</TotalRevenueColumnAmt>
        <ExclusionAmt>871169</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
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      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
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      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
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      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>3639</TotalRevenueColumnAmt>
        <ExclusionAmt>3639</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <OtherRevenueMiscGrp>
        <Desc>SUBPART F INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
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        <ExclusionAmt>45122</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>45122</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>212958169</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>192200808</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
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        <ProgramServicesAmt>15677</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
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        <ProgramServicesAmt>27625</ProgramServicesAmt>
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      <PensionPlanContributionsGrp>
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        <ManagementAndGeneralAmt>576321</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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        <ManagementAndGeneralAmt>170590</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>2722448</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>6573542</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>1358781</ProgramServicesAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>1242905</ProgramServicesAmt>
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      <AllOtherExpensesGrp>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>193882091</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13238684</ManagementAndGeneralAmt>
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        <EOYAmt>22031</EOYAmt>
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        <EOYAmt>22383972</EOYAmt>
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        <EOYAmt>698510</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>254698048</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>164354165</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>90343883</EOYAmt>
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      <InvestmentsProgramRelatedGrp>
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        <EOYAmt>5644161</EOYAmt>
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      <TotalAssetsGrp>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>109083543</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
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        <CurrentTaxYearAmt>212954530</CurrentTaxYearAmt>
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      <PublicSupportCY509Pct>0.99620</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.99670</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00360</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00320</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
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    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
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        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
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          <State>RESTRICTED</State>
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        <PersonNm>MILES KING</PersonNm>
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        <DeferredCompensationFlngOrgAmt>3987</DeferredCompensationFlngOrgAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <DeferredCompensationFlngOrgAmt>4255</DeferredCompensationFlngOrgAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <TotalCompensationFilingOrgAmt>240014</TotalCompensationFilingOrgAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <FormAndLineReferenceDesc>PART II, COLUMN B (III), OTHER REPORTABLE COMPENSATION:</FormAndLineReferenceDesc>
        <ExplanationTxt>CARE INITIATIVES HAS A 457B PLAN FOR ITS EXECUTIVES, IN WHICH THE FOLLOWING PARTICIPATE: MILES KING, CHARLEEN SCHLEPP, DAVID DIXON, AND JERAMY KUHN. IN 2020, THE ORGANIZATION DID NOT FUND ANY AMOUNT TO THAT PLAN.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, 4A, SEVERANCE:</FormAndLineReferenceDesc>
        <ExplanationTxt>PRESIDENT/CEO MILES KING RETIRED EFFECTIVE 6/30/2020, AS PART OF HIS RETIREMENT HE WAS GRANTED A SEVERANCE PAYMENT OF $315,783. THAT AMOUNT IS INCLUDED IN PART II, COLUMN B (III).</ExplanationTxt>
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        <IssuerName>
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        <BondIssuerEIN>521699886</BondIssuerEIN>
        <BondIssuedDt>2014-12-11</BondIssuedDt>
        <IssuePriceAmt>41736000</IssuePriceAmt>
        <PurposeDesc>SEE PART VI</PurposeDesc>
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        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
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        <BondReferenceCd>C</BondReferenceCd>
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        <BondIssuedDt>2018-12-19</BondIssuedDt>
        <IssuePriceAmt>10592000</IssuePriceAmt>
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        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
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      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <IssuerName>
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        <BondIssuerEIN>521699886</BondIssuerEIN>
        <BondIssuedDt>2019-01-31</BondIssuedDt>
        <IssuePriceAmt>39371095</IssuePriceAmt>
        <PurposeDesc>REFUND PRIOR BONDS (05/12/16)</PurposeDesc>
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        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
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      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>4830000</RetiredAmt>
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        <OtherSpentProceedsAmt>11491171</OtherSpentProceedsAmt>
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        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
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      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <RetiredAmt>6428655</RetiredAmt>
        <TotalProceedsAmt>41736496</TotalProceedsAmt>
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        <CapitalExpendituresAmt>19915498</CapitalExpendituresAmt>
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        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
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      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>C</BondReferenceCd>
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        <IssuanceCostsFromProceedsAmt>208389</IssuanceCostsFromProceedsAmt>
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      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>D</BondReferenceCd>
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      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>1</ProcsNonqualifiedBondRemdtdInd>
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        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>1</ProcsNonqualifiedBondRemdtdInd>
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        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>1</ExceptionToRebateInd>
        <NoRebateDueInd>1</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>1</WrittenProcToMonitorReqsInd>
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        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>1</ExceptionToRebateInd>
        <NoRebateDueInd>1</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>1</WrittenProcToMonitorReqsInd>
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        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>1</ExceptionToRebateInd>
        <NoRebateDueInd>1</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>1</WrittenProcToMonitorReqsInd>
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        <BondReferenceCd>D</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>1</ExceptionToRebateInd>
        <NoRebateDueInd>1</NoRebateDueInd>
        <VariableRateIssueInd>1</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>1</WrittenProcToMonitorReqsInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>1</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>1</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <ProceduresCorrectiveActionInd>1</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <ProceduresCorrectiveActionInd>1</ProceduresCorrectiveActionInd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K, PART IV, ARBITRAGE, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>EXPLANATION: (A) ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/28/2013 (A) ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2016 (A) ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2018 (A) ISSUER NAME: IOWA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/31/2019 NOTE REGARDING THE 12/28/2013, 12/31/2018, AND 1/31/2019 REBATE COMPUTATIONS: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. NOTE REGARDING THE 12/31/2016 REBATE COMPUTATIONS: THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND AMOUNTS WERE DRAWN AS PROJECT COSTS WERE INCURRED. AS NO REBATEABLE ARBITRAGE WAS EARNED AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE ANALYSIS IS NECESSARY. PART I, LINE B, COLUMN (F): EXPLANATION: BUILDINGS, ADDITIONS, REFUND PRIOR BONDS (9/30/10) PART II, LINE 3: EXPLANATION: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART I, LINE 6, VOLUNTEERS:</FormAndLineReferenceDesc>
        <ExplanationTxt>CARE INITIATIVES HAD 6,849 RECORDED VOLUNTEER HOURS IN 2020. THE AVERAGE VOLUNTEER WORKS ONE HOUR PER WEEK RESULTING IN A CALCULATED NUMBER OF VOLUNTEERS OF 132. VOLUNTEERS MAINLY PROVIDE ENTERTAINMENT FOR, AND CONVERSE WITH, RESIDENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE DRAFT OF THE ANNUAL FORM 990 IS REVIEWED, PRIOR TO FILING, BY THE FULL BOARD OF DIRECTORS IN A REGULARLY SCHEDULED BOARD MEETING. SUBSEQUENT TO FILING, A FILED COPY OF THE 990 IS MADE AVAILABLE TO THE BOARD MEMBERS. ADDITIONALLY, THE FILED 990 IS PUBLISHED ON CARE'S PUBLIC WEBSITE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF DIRECTORS AND OFFICERS ARE REQUIRED TO READ THE CORPORATE POLICY AND COMPLETE AN ANNUAL SIGNED CERTIFICATE REGARDING THE CORPORATE CONFLICT OF INTEREST POLICY. THIS PROCESS IS ADMINISTERED BY THE CORPORATE COMPLIANCE OFFICER. ADDITIONALLY, THE BOARD AND OFFICERS RECEIVE REQUIRED ANNUAL COMPLIANCE TRAINING, INCLUDING BUSINESS PRACTICES AND CONFLICT OF INTEREST, AGAIN UNDER THE SUPERVISION OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER ALSO ATTENDS EACH BOARD MEETING AND SERVES, ALONG WITH ALL BOARD MEMBERS, TO RECOGNIZE AND IDENTIFY POTENTIAL CONFLICT OF INTEREST EVENTS. IDENTIFIED CONFLICT OF INTEREST SITUATIONS AND DELIBERATIONS, IF ANY, ARE DOCUMENTED IN FORMAL BOARD OF DIRECTOR MINUTES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>CARE'S PRESIDENT/CEO, SVP/CFO, SVP/DIRECTOR OF OPERATIONS, AND VP/HOSPICE HAVE BEEN IDENTIFIED AS DISQUALIFIED PERSONS. COMPENSATION FOR THESE POSITIONS IS DETERMINED BY INDEPENDENT DIRECTORS OF THE COMPENSATION COMMITTEE WITHOUT THE AFFECTED PARTIES BEING PRESENT AND IS SUBSEQUENTLY PROVIDED TO THE FULL BOARD FOR THEIR ACTION OR APPROVAL. FORMAL PERFORMANCE EVALUATIONS AND DOCUMENTATIONS OF EACH STEP IN THE DELIBERATION PROCESS ARE CONTAINED IN RETAINED COMPENSATION COMMITTEE REPORTS. THE DETERMINATION OF THE COMPENSATION COMMITTEE IS SUPPORTED BY A 2020 REPORT BY QUALIFIED INDEPENDENT COMPENSATION CONSULTANTS USING APPROPRIATE COMPARABILITY DATA. THE DELIBERATIONS OF THE COMPENSATION COMMITTEE AND BOARD ARE CONTEMPORANEOUSLY RECORDED IN FORMAL MEETING MINUTES THAT ARE RETAINED BY THE ORGANIZATION. OTHER EXECUTIVE COMPENSATION IS DETERMINED BY THE PRESIDENT/CEO IN CONSULTATION WITH THE MEMBERS OF THE COMPENSATION COMMITTEE AND BOARD OF DIRECTORS. THE REPORTS OF COMPENSATION CONSULTANTS UTILIZED IN THE EVALUATION OF COMPENSATION LEVELS FOR THE PRESIDENT/CEO, SVP/CFO, SVP/DIRECTOR OF OPERATIONS, AND VP/HOSPICE ARE REVIEWED, ALONG WITH PERFORMANCE EVALUATIONS, INFLATION DATA AND COMPETITIVE FACTORS, ALL TO ESTABLISH COMPENSATION LEVELS. COMPENSATION CHANGES ARE DOCUMENTED AND RETAINED BY THE CORPORATION'S HUMAN RESOURCE DEPARTMENT. OTHER MANAGEMENT COMPENSATION IS DETERMINED ACCORDING TO LONG STANDING PERSONNEL POLICIES ADMINISTERED BY THE CORPORATION'S HUMAN RESOURCES DEPARTMENT. THE COMPENSATION REVIEW PROCESS DESCRIBED ABOVE OCCURS ON AN ANNUAL BASIS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>CARE PROVIDES ITS FORM 990 ON THE ORGANIZATION'S PUBLIC WEBSITE. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENT, OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 25,376,014. MANAGEMENT AND GENERAL EXPENSES 361,203. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,737,217.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <BusinessNameLine1Txt>ODEBOLT ASSISTED LIVING LLC</BusinessNameLine1Txt>
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          <AddressLine1Txt>13520 CALIFORNIA ST SUITE 250</AddressLine1Txt>
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        <RelatedOrganizationName>
          <BusinessNameLine1Txt>PANORA ASSISTED LIVING LLC</BusinessNameLine1Txt>
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      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>DUNLAP ASSISTED LIVING LLC</BusinessNameLine1Txt>
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          <BusinessNameLine1Txt>LAMONI ASSISTED LIVING LLC</BusinessNameLine1Txt>
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      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>IOWA INDEMNITY COMPANY LTD</BusinessNameLine1Txt>
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          <AddressLine1Txt>BOX 560 BEATRICE BUTTERFIELD BUILDI</AddressLine1Txt>
          <CityNm>PROVIDENCIALES</CityNm>
          <ProvinceOrStateNm>TURKS &amp; CAICOS IS</ProvinceOrStateNm>
          <CountryCd>TK</CountryCd>
        </ForeignAddress>
        <EIN>760262402</EIN>
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        <LegalDomicileForeignCountryCd>TK</LegalDomicileForeignCountryCd>
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      <LoansOrGuaranteesToOtherOrgInd>1</LoansOrGuaranteesToOtherOrgInd>
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      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>DUNLAP ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>A</TransactionTypeTxt>
        <InvolvedAmt>18705</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>ODEBOLT ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>A</TransactionTypeTxt>
        <InvolvedAmt>18705</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>LAMONI ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>A</TransactionTypeTxt>
        <InvolvedAmt>18705</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>PANORA ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>A</TransactionTypeTxt>
        <InvolvedAmt>18705</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>DUNLAP ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>D</TransactionTypeTxt>
        <InvolvedAmt>200000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>ODEBOLT ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>D</TransactionTypeTxt>
        <InvolvedAmt>200000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>LAMONI ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>D</TransactionTypeTxt>
        <InvolvedAmt>200000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>PANORA ASSISTED LIVING LLC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>D</TransactionTypeTxt>
        <InvolvedAmt>200000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>GAAP</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART V, LINE 1</FormAndLineReferenceDesc>
        <ExplanationTxt>CARE IS THE 0.01% MANAGING MEMBER IN FOUR LIMITED LIABILITY COMPANIES PROVIDING ASSISTED LIVING SERVICES. THESE ENTITIES OWN BUILDINGS THAT ARE ATTACHED TO CARE'S RELATED SKILLED NURSING HOMES AND THEY QUALIFY FOR AN ALLOCATION OF LOW-INCOME HOUSING TAX CREDITS UNDER SECTION 42 OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, AND WERE PLACED IN SERVICE IN 2007. CARE INITIATIVES PROVIDES DAILY OPERATIONAL MANAGEMENT SERVICES AND PERMANENT FINANCING. THE AGREEMENTS PROVIDE FOR CARE INITIATIVES TO PURCHASE THE 99.99% INVESTOR MEMBER INTEREST AT THE END OF THE 15-YR TAX CREDIT COMPLIANCE PERIOD FOR AN AMOUNT BASED ON A PROCESS AS SPECIFIED IN THE AGREEMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
