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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>directors. These designated directors are (1) a member</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Madison County, Inc. The remaining two or more directors are</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>independent members of the community and are elected by the</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Community LTC, Inc. Board of Directors.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The board of directors and key employees are required to</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>sign the conflict of interest policy and disclose any</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>conflicts at the beginning of every Board Meeting and</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>on an annual basis.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>Top management compensation of Community Long Term Care</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>is determined by related organization Community Hospital of</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>Community LTC, Inc. participates in a state and national</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>industry trade association which conducts an annual wage</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>survey - this survey is utilized for evaluation of salaries</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>and wages.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>Other officers compensation of Community Long Term care</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15b</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15b</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15b</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15b</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>and are available to the public upon request to the Indiana</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
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        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>B) Community LTC, Inc. conflict of interest policy is</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>available to the public upon request.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>financial statements. Its financial results are included</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>in the consolidated financial statements of Community</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Health Network, Inc. and Affiliates, which are</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
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        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
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        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
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        <FormAndLineReferenceDesc>Pt VI, Line 11b</FormAndLineReferenceDesc>
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        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Pillars Community Housing Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>3500 South Lafountain Street</AddressLine1Txt>
          <CityNm>Kokomo</CityNm>
          <StateAbbreviationCd>IN</StateAbbreviationCd>
          <ZIPCd>46902</ZIPCd>
        </USAddress>
        <EIN>161652666</EIN>
        <PrimaryActivitiesTxt>HOUSING</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IN</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Visionary Enterprises Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>6626 East 75th Street</AddressLine1Txt>
          <CityNm>Indianapolis</CityNm>
          <StateAbbreviationCd>IN</StateAbbreviationCd>
          <ZIPCd>46250</ZIPCd>
        </USAddress>
        <EIN>351538433</EIN>
        <PrimaryActivitiesTxt>MGMT SRVCS</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IN</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>VEI Michigan Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>940 N Main Street</AddressLine1Txt>
          <CityNm>Ann Harbor</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>48104</ZIPCd>
        </USAddress>
        <EIN>300097377</EIN>
        <PrimaryActivitiesTxt>MGMT SRVCS</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MI</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Midwest Racquetball Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>3500 S Lafountain Street</AddressLine1Txt>
          <CityNm>Kokomo</CityNm>
          <StateAbbreviationCd>IN</StateAbbreviationCd>
          <ZIPCd>46902</ZIPCd>
        </USAddress>
        <EIN>351396016</EIN>
        <PrimaryActivitiesTxt>HEALTH</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IN</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
