﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xsi:schemaLocation="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2018v3.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2019-11-12T16:43:36-06:00</ReturnTs>
    <TaxPeriodEndDt>2018-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmName>
        <BusinessNameLine1Txt>BKD LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>910 E ST LOUIS 200/PO BOX 1190</AddressLine1Txt>
        <CityNm>SPRINGFIELD</CityNm>
        <StateAbbreviationCd>MO</StateAbbreviationCd>
        <ZIPCd>658062523</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2018-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>251505478</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>JEFFCO HEALTH SERVICES INC</BusinessNameLine1Txt>
      </BusinessName>
      <InCareOfNm>% MISTY FLEMING</InCareOfNm>
      <BusinessNameControlTxt>JEFF</BusinessNameControlTxt>
      <PhoneNum>8148498026</PhoneNum>
      <USAddress>
        <AddressLine1Txt>417 ROUTE 28</AddressLine1Txt>
        <CityNm>BROOKVILLE</CityNm>
        <StateAbbreviationCd>PA</StateAbbreviationCd>
        <ZIPCd>15825</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>MISTY FLEMING</PersonNm>
      <PersonTitleTxt>ADMINISTRATOR</PersonTitleTxt>
      <PhoneNum>8148498026</PhoneNum>
      <SignatureDt>2019-11-15</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>Brian D Todd</PreparerPersonNm>
      <PTIN>P00422601</PTIN>
      <PhoneNum>4178658701</PhoneNum>
    </PreparerPersonGrp>
    <FilingSecurityInformation>
      <IPAddress>
        <IPv4AddressTxt>167.68.126.162</IPv4AddressTxt>
      </IPAddress>
      <FederalOriginalSubmissionId>43032920193165000034</FederalOriginalSubmissionId>
      <FederalOriginalSubmissionIdDt>2019-11-12</FederalOriginalSubmissionIdDt>
      <FilingLicenseTypeCd>P</FilingLicenseTypeCd>
      <AtSubmissionCreationDeviceId>8705656393E68C4A592E0CEA227AF158EB1E06AC</AtSubmissionCreationDeviceId>
      <AtSubmissionFilingDeviceId>681DE6918415436D5479BC878DC0BC45498CDACE</AtSubmissionFilingDeviceId>
    </FilingSecurityInformation>
    <TaxYr>2018</TaxYr>
    <BuildTS>2020-03-31 21:24:44Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="5">
    <IRS990 documentId="IRS990" referenceDocumentId="IRS990ScheduleO">
      <PrincipalOfficerNm>MISTY FLEMING</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>417 ROUTE 28</AddressLine1Txt>
        <CityNm>BROOKVILLE</CityNm>
        <StateAbbreviationCd>PA</StateAbbreviationCd>
        <ZIPCd>15825</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>19240886</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>WWW.JEFFERSONMANOR.NET</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1985</FormationYr>
      <LegalDomicileStateCd>PA</LegalDomicileStateCd>
      <ActivityOrMissionDesc>JEFFCO HEALTH SERVICES OFFERS SKILLED NURSING, PERSONAL CARE, INDEPENDENT LIVING AND THERAPY SERVICES TO HELP RESIDENTS MAINTAIN THEIR HIGHEST LEVEL OF INDEPENDENCE.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>6</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>6</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>278</TotalEmployeeCnt>
      <TotalVolunteersCnt>70</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <PYContributionsGrantsAmt>8298</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>7850</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>11396446</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>10383309</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>1204401</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>866034</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>2102</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>2290</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>12611247</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>11259483</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>1048</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>980</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>7620520</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>6771997</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>4766459</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>4746359</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>12388027</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>11519336</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>223220</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-259853</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>17180868</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>15303725</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>1129752</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>925030</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>16051116</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>14378695</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>JEFFERSON MANOR HEALTH CENTER IS COMMITTED TO BEING THE MOST CARING AND PROGRESSIVE PROVIDER OF EXTENDED CARE IN THE AREA BY PROMOTING THE HIGHEST STANDARD OF CARE AND QUALITY OF LIFE FOR OUR RESIDENTS.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>8825759</ExpenseAmt>
      <GrantAmt>980</GrantAmt>
      <RevenueAmt>9099866</RevenueAmt>
      <Desc>JEFFERSON MANOR HEALTH CENTER IS AN INDEPENDENT NOT-FOR-PROFIT ONE HUNDRED SIXTY (160) BED SKILLED NURSING AND REHABILITATION FACILITY, OFFERING DEDICATED DEMENTIA AND REHABILITATION UNITS, RESPITE CARE, HOSPICE AND MOST FORMS OF LONG TERM CARE. AN IN-HOUSE REHABILITATION DEPARTMENT PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES TO RESIDENTS AND COMMUNITY MEMBERS. IN 2018, JEFFERSON MANOR STAFF PROVIDED 36,201 DAYS OF CARE TO AN AVERAGE CENSUS OF 99 RESIDENTS.</Desc>
      <ProgSrvcAccomActy2Grp>
        <ExpenseAmt>1331283</ExpenseAmt>
        <RevenueAmt>1261289</RevenueAmt>
        <Desc>JEFFERSON COURT IS A FORTY EIGHT (48) BED PERSONAL CARE FACILITY LOCATED ADJACENT TO JEFFERSON MANOR, PROVIDING CARE TO THOSE WHO NEED SOME ASSISTANCE WITH DAILY LIVING. RESIDENTS ARE ENCOURAGED TO MAINTAIN INDEPENDENCE, BUT MEALS, LAUNDRY AND HOUSEKEEPING SERVICES ARE PROVIDED. ROOMS DESIGNED FOR THOSE WITH EARLY MEMORY LOSS ARE AVAILABLE IN A SECURE UNIT.</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <ExpenseAmt>81382</ExpenseAmt>
        <RevenueAmt>22154</RevenueAmt>
        <Desc>JEFFERSON SUITES IS A FIVE (5) UNIT INDEPENDENT LIVING FACILITY, DESIGNED FOR INDEPENDENT INDIVIDUALS WHO NO LONGER WANT THE RESPONSIBILITY OF OWNING A HOME. HOUSEKEEPING AND MAINTENANCE SERVICES ARE PROVIDED. JEFFERSON SUITES HAS A PRIVATE ENTRANCE AND PARKING AREA. INDIVIDUALS LIVING ON SUITES ARE WELCOME TO PARTICIPATE IN ACTIVITIES AND OTHER EVENTS WITH JEFFERSON MANOR AND JEFFERSON COURT. COMBINED, WE PROVIDE A COMPLETE CONTINUUM OF CARE AND AS SUCH, WE ARE LICENSED TO BE A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) EFFECTIVE FEBRUARY 2009.</Desc>
      </ProgSrvcAccomActy3Grp>
      <TotalProgramServiceExpensesAmt>10238424</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="IRS990ScheduleB">true</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="IRS990ScheduleD">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="IRS990ScheduleD">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="IRS990ScheduleD">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="IRS990ScheduleD">true</CreditCounselingInd>
      <TempOrPermanentEndowmentsInd referenceDocumentId="IRS990ScheduleD">false</TempOrPermanentEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="IRS990ScheduleD">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="IRS990ScheduleD">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="IRS990ScheduleD">false</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="IRS990ScheduleD">false</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="IRS990ScheduleD">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd>false</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWithOfficerEntInd>false</BusinessRlnWithOfficerEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd>false</DisregardedEntityInd>
      <RelatedEntityInd>false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>10</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>true</BackupWthldComplianceInd>
      <EmployeeCnt>278</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>6</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>6</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>true</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>true</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>true</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>PA</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>MISTY FLEMING</PersonNm>
        <PhoneNum>8148498026</PhoneNum>
        <USAddress>
          <AddressLine1Txt>417 ROUTE 28</AddressLine1Txt>
          <CityNm>BROOKVILLE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>15825</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>JIM CURTIS</PersonNm>
        <TitleTxt>CHAIRMAN ENDING 10/2018</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JUDY GROMLEY</PersonNm>
        <TitleTxt>VICE CHAIRMAN BEGIN 10/2018</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>REV WILLIAM SAXMAN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JULIE PEER</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DIANE KIEHL</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN MESTER</PersonNm>
        <TitleTxt>TREASURER BEGIN 04/2018</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PATTY DINSMORE</PersonNm>
        <TitleTxt>DIRECTOR ENDING 12/2018</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DR H ED RICHARDS</PersonNm>
        <TitleTxt>CHAIRMAN BEGIN 10/2018</TitleTxt>
        <AverageHoursPerWeekRt>1.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MISTY FLEMING</PersonNm>
        <TitleTxt>ADMINISTRATOR</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>101095</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>28109</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JESSICA PARK</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>87326</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>677</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>188421</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>28786</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>1</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>false</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>NATIONAL HEALTHCARE</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>50 MAHONING ST</AddressLine1Txt>
            <CityNm>DUBOIS</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15801</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>TEMPORARY STAFFING</ServicesDesc>
        <CompensationAmt>773654</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>COMPASSIONATE CARE NURSING</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>809 E MAIN ST</AddressLine1Txt>
            <CityNm>REYNOLDSVILLE</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15851</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>TEMPORARY STAFFING</ServicesDesc>
        <CompensationAmt>490971</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>TLC STAFFING</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>125 CHARLES ST</AddressLine1Txt>
            <CityNm>PUNXSUTAWNEY</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15767</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>TEMPORARY STAFFING</ServicesDesc>
        <CompensationAmt>173289</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>BKD LLP</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>910 E ST LOUIS STREET</AddressLine1Txt>
            <CityNm>SPRINGFIELD</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>65801</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CPA &amp; ADVISORY</ServicesDesc>
        <CompensationAmt>120438</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>4</CntrctRcvdGreaterThan100KCnt>
      <AllOtherContributionsAmt>7850</AllOtherContributionsAmt>
      <TotalContributionsAmt>7850</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT REVENUE</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>10341871</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>10341871</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>41438</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>41438</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>10383309</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>249294</TotalRevenueColumnAmt>
        <ExclusionAmt>249294</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>4550</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>2260</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>2290</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>2290</TotalRevenueColumnAmt>
        <ExclusionAmt>2290</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>8595883</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>7979143</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>616740</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>616740</TotalRevenueColumnAmt>
        <ExclusionAmt>616740</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <GrossSalesOfInventoryAmt>0</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueTotalAmt>0</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>11259483</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>10383309</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>868324</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>980</TotalAmt>
        <ProgramServicesAmt>980</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>217207</TotalAmt>
        <ManagementAndGeneralAmt>217207</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>5169835</TotalAmt>
        <ProgramServicesAmt>4866415</ProgramServicesAmt>
        <ManagementAndGeneralAmt>303420</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>98015</TotalAmt>
        <ProgramServicesAmt>85540</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12475</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>868941</TotalAmt>
        <ProgramServicesAmt>783470</ProgramServicesAmt>
        <ManagementAndGeneralAmt>85471</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>417999</TotalAmt>
        <ProgramServicesAmt>360387</ProgramServicesAmt>
        <ManagementAndGeneralAmt>57612</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>54292</TotalAmt>
        <ManagementAndGeneralAmt>54292</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>126817</TotalAmt>
        <ManagementAndGeneralAmt>126817</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>53631</TotalAmt>
        <ManagementAndGeneralAmt>53631</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1747213</TotalAmt>
        <ProgramServicesAmt>1726149</ProgramServicesAmt>
        <ManagementAndGeneralAmt>21064</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>18392</TotalAmt>
        <ManagementAndGeneralAmt>18392</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>331853</TotalAmt>
        <ProgramServicesAmt>262082</ProgramServicesAmt>
        <ManagementAndGeneralAmt>69771</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>104303</TotalAmt>
        <ProgramServicesAmt>91028</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13275</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>416493</TotalAmt>
        <ProgramServicesAmt>363484</ProgramServicesAmt>
        <ManagementAndGeneralAmt>53009</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>35865</TotalAmt>
        <ProgramServicesAmt>32195</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3670</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>19011</TotalAmt>
        <ProgramServicesAmt>4980</ProgramServicesAmt>
        <ManagementAndGeneralAmt>14031</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>5048</TotalAmt>
        <ProgramServicesAmt>4406</ProgramServicesAmt>
        <ManagementAndGeneralAmt>642</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>521824</TotalAmt>
        <ProgramServicesAmt>455410</ProgramServicesAmt>
        <ManagementAndGeneralAmt>66414</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>89632</TotalAmt>
        <ManagementAndGeneralAmt>89632</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>DIETARY SUPPLIES</Desc>
        <TotalAmt>505633</TotalAmt>
        <ProgramServicesAmt>505633</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES &amp; DRUGS</Desc>
        <TotalAmt>488389</TotalAmt>
        <ProgramServicesAmt>488389</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT</Desc>
        <TotalAmt>184219</TotalAmt>
        <ProgramServicesAmt>184219</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LICENSES, DUES, SUBSCRIPTIONS</Desc>
        <TotalAmt>21591</TotalAmt>
        <ProgramServicesAmt>1538</ProgramServicesAmt>
        <ManagementAndGeneralAmt>20053</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>22153</TotalAmt>
        <ProgramServicesAmt>22119</ProgramServicesAmt>
        <ManagementAndGeneralAmt>34</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>11519336</TotalAmt>
        <ProgramServicesAmt>10238424</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1280912</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>7532</BOYAmt>
        <EOYAmt>7527</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>1509693</BOYAmt>
        <EOYAmt>788564</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1208154</BOYAmt>
        <EOYAmt>1511023</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>28405</BOYAmt>
        <EOYAmt>26200</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>100945</BOYAmt>
        <EOYAmt>78941</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>21414200</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>17820262</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3964917</BOYAmt>
        <EOYAmt>3593938</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>10041497</BOYAmt>
        <EOYAmt>9080771</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>319725</BOYAmt>
        <EOYAmt>216761</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>17180868</BOYAmt>
        <EOYAmt>15303725</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>814785</BOYAmt>
        <EOYAmt>870840</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <GrantsPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>6500</BOYAmt>
        <EOYAmt>8125</EOYAmt>
      </DeferredRevenueGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>238088</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>43808</BOYAmt>
        <EOYAmt>46065</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>26571</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>1129752</BOYAmt>
        <EOYAmt>925030</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>16051116</BOYAmt>
        <EOYAmt>14378695</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TemporarilyRstrNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </TemporarilyRstrNetAssetsGrp>
      <PermanentlyRstrNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PermanentlyRstrNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>16051116</BOYAmt>
        <EOYAmt>14378695</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>17180868</BOYAmt>
        <EOYAmt>15303725</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-259853</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-1412568</NetUnrlzdGainsLossesInvstAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>15151</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8298</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7850</CurrentTaxYearAmt>
        <TotalAmt>31299</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>12439435</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>12283624</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11437563</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>11396446</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10383309</CurrentTaxYearAmt>
        <TotalAmt>57940377</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <GrossReceiptsNonUnrltBusGrp>
        <TotalAmt>0</TotalAmt>
      </GrossReceiptsNonUnrltBusGrp>
      <TaxRevLeviedOrgnztnlBnft509Grp>
        <TotalAmt>0</TotalAmt>
      </TaxRevLeviedOrgnztnlBnft509Grp>
      <GovtFurnSrvcFcltsVl509Grp>
        <TotalAmt>0</TotalAmt>
      </GovtFurnSrvcFcltsVl509Grp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>12439435</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>12283624</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11452714</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>11404744</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10391159</CurrentTaxYearAmt>
        <TotalAmt>57971676</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>57971676</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>241077</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>276702</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>234042</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>226565</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>249294</CurrentTaxYearAmt>
        <TotalAmt>1227680</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <Post1975UBTIGrp>
        <TotalAmt>0</TotalAmt>
      </Post1975UBTIGrp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>241077</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>276702</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>234042</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>226565</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>249294</CurrentTaxYearAmt>
        <TotalAmt>1227680</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <NetIncomeFromOtherUBIGrp>
        <TotalAmt>0</TotalAmt>
      </NetIncomeFromOtherUBIGrp>
      <OtherIncome509Grp>
        <TotalAmt>0</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>12680512</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>12560326</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11686756</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>11631309</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10640453</CurrentTaxYearAmt>
        <TotalAmt>59199356</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.97926</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.98017</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.02074</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.01983</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
      <ArtPublicExhibitionAmountsGrp />
      <HeldWorksArtGrp />
      <AgentTrusteeEtcInd>false</AgentTrusteeEtcInd>
      <InclEscrowCustodialAcctLiabInd>true</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <CYMinus3YrEndwmtFundGrp />
      <CYMinus4YrEndwmtFundGrp />
      <LandGrp>
        <OtherCostOrOtherBasisAmt>69309</OtherCostOrOtherBasisAmt>
        <BookValueAmt>69309</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>9573551</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>8689150</DepreciationAmt>
        <BookValueAmt>884401</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>6271912</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4265012</DepreciationAmt>
        <BookValueAmt>2006900</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>5144681</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4557352</DepreciationAmt>
        <BookValueAmt>587329</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>354747</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>308748</DepreciationAmt>
        <BookValueAmt>45999</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>3593938</TotalBookValueLandBuildingsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>9849175</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>-1412568</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>-1412568</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>11261743</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-2260</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-2260</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>11259483</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>11521596</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>2260</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>2260</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>11519336</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>11519336</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART IV, LINE 2B</FormAndLineReferenceDesc>
        <ExplanationTxt>CUSTODIAL ACCOUNT RESPONSIBILITY: JEFFCO HEALTH SERVICES IS THE TRUSTEE OF FUNDS RECEIVED ON BEHALF OF VARIOUS RESIDENTS. JEFFCO HAS FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THE BANK ACCOUNTS AND THE DISTRIBUTION OF THE FUNDS TO RESIDENTS. UNDER THIS SERVICE, RESIDENTS CAN DEPOSIT FUNDS WITH JEFFCO FOR HOLDING AND THEN OBTAIN THE FUNDS WHEN NEEDED TO PAY THEIR BILLS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART X, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $(2,260) RENTAL EXPENSES</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ 2,260 RENTAL EXPENSES</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART I, LINE 1</FormAndLineReferenceDesc>
        <ExplanationTxt>ORGANIZATION MISSION: JEFFERSON MANOR HEALTH CENTER IS COMMITTED TO BEING THE MOST CARING AND PROGRESSIVE PROVIDER OF EXTENDED CARE IN THE AREA. VISION: JEFFERSON MANOR HEALTH CENTER WILL PROVIDE STATE OF THE ART ACCOMMODATIONS FOR ITS CUSTOMERS. THROUGH OUR CONTINUOUS INNOVATIVE, COLLABORATIVE EFFORTS, WITH PRIMARY FOCUS UPON RESIDENT CARE AND EDUCATION OF OUR STAKEHOLDERS, WE WILL BECOME THE RECOGNIZED LEADER IN LONG TERM CARE. THE ORGANIZATION IS DEDICATED TO PROVIDING OUR RESIDENTS WITH PROGRESSIVE QUALITY HEALTH CARE SERVICES. THE ORGANIZATION IS COMMITTED TO THE MEDICAL, PHYSICAL, SPIRITUAL, PSYCHOLOGICAL AND EMOTIONAL WELL BEING OF EVERY RESIDENT, AND IT IS A GOAL TO CREATE AND MAINTAIN A SAFE, HOMELIKE ENVIRONMENT WHERE EACH RESIDENT IS TREATED WITH DIGNITY AND RESPECT. HIGHLY TRAINED PROFESSIONAL STAFF WORKS TOGETHER WITH THE RESIDENT AND FAMILY TO ASSIST THE RESIDENT TO ATTAIN OR MAINTAIN THEIR HIGHEST LEVEL OF INDEPENDENCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART I, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>VOLUNTEERS: THE ORGANIZATION HAS 70 TOTAL VOLUNTEERS - 8 NON-COMPENSATED MEMBERS OF THE BOARD OF DIRECTORS SERVED THROUGHOUT THE YEAR AND 62 VOLUNTEERS WHO HELP OUT WITH VARIOUS ACTIVITIES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, THE ADMINISTRATOR AND CFO PERFORM A THOROUGH REVIEW OF THE RETURN. A DRAFT IS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. ANY QUESTIONS RAISED BY THE BOARD ARE REVIEWED AND FOLLOW-UP INFORMATION IS PROVIDED PRIOR TO FILING WITH THE IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>CONFLICTS OF INTEREST POLICY: THE SOLICITOR DRAFTS AN INTERNAL CONTROL POLICY THAT MUST BE SIGNED BY EACH BOARD MEMBER ANNUALLY IN WHICH ALL CONFLICTS MUST BE LISTED. EACH BOARD MEMBER THAT HAS A CONFLICT ABSTAINS FROM VOTING ON MATTERS THAT PERTAIN TO THAT CONFLICT. IN ADDITION, CORPORATE OFFICERS AND KEY EMPLOYEES ARE ALSO REQUIRED TO ANNUALLY DISCLOSE CONFLICTS OF INTEREST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>EXECUTIVE COMPENSATION DETERMINATION: IN 2014, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PERFORMED A COMPENSATION REVIEW FOR THE ADMINISTRATOR USING COMPARABILITY DATA. SINCE THEN, THE ADMINISTRATOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE COMMITTEE. THE COMMITTEE'S REVIEWS OF COMPENSATION ARE DOCUMENTED IN THE EXECUTIVE COMMITTEE BOARD MINUTES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION DETERMINATION FOR OTHER OFFICERS: A COMPENSATION REVIEW FOR OTHER OFFICERS OF THE ORGANIZATION WAS COMPLETED BY THE ADMINISTRATOR AND EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE GROUP USED STATISTICAL COMPARISONS OF OFFICERS WITH SIMILAR DUTIES AND RESPONSIBILITIES FROM LIKE ORGANIZATIONS. THIS REVIEW WAS DOCUMENTED IN THE EXECUTIVE COMMITTEE BOARD MINUTES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>DOCUMENT DISCLOSURE: THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:AGENCY NURSING FEES TOTAL FEES:1562526</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:CONTRACT SERVICES TOTAL FEES:148572</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 PART IX LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:36115</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>