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        <BonusFilingOrg>17500</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>7889</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>157455</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>Steven Gosik</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>153154</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>0</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>153154</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartIII>
        <ReturnReference>Part I, Line 1a</ReturnReference>
        <Explanation>Country Club dues are provided to select Senior Officers of the corporation. The company pays the dues and amounts are included in taxable wages of the individual whom pay taxes on such. The Country Club membership provides marketing benefits and referral sources to our organization for all services covered in our mission. Additionally, the members of such clubs are potential customers for our services.</Explanation>
      </Form990ScheduleJPartIII>
      <Form990ScheduleJPartIII>
        <ReturnReference>Part I, Line 4a</ReturnReference>
        <Explanation>Included in each employee's compensation for Country Club dues/assessments: John Rowe - $8,406, R. Kenneth Bass, JR. - $9,469, Joseph Brinker - $7,755, Katherine Joslin - $8,356, Alphonse Poelker - $7,550</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc1053100001">
      <Form990ScheduleKPartI>
        <IssuerName>
          <BusinessNameLine1>health and Education Facilities Authority of the State of Missouri</BusinessNameLine1>
        </IssuerName>
        <IssuerEIN>431178966</IssuerEIN>
        <CUSIPNumber>60635R6c6</CUSIPNumber>
        <DateIssued>2009-12-01</DateIssued>
        <IssuePrice>78270000</IssuePrice>
        <DescriptionOfPurpose>expansion of facilities and refinance existing</DescriptionOfPurpose>
        <Defeased>0</Defeased>
        <OnBehalfOfIssuer>0</OnBehalfOfIssuer>
      </Form990ScheduleKPartI>
      <Form990ScheduleKPartII>
        <TotalProceeds>78270000</TotalProceeds>
        <AmountDefeased>67687470</AmountDefeased>
        <IssuanceCostsFromProceeds>896950</IssuanceCostsFromProceeds>
        <CapitalExpenditures>9685580</CapitalExpenditures>
        <YearOfSubstCompletion>2008</YearOfSubstCompletion>
        <CurrentRefunding>1</CurrentRefunding>
        <AdvanceRefunding>0</AdvanceRefunding>
        <FinalAllocationMade>1</FinalAllocationMade>
        <AdequateBooksAndRecdsMaintaind>1</AdequateBooksAndRecdsMaintaind>
      </Form990ScheduleKPartII>
      <Form990ScheduleKPartIII>
        <OwningBondFinancedProperty>0</OwningBondFinancedProperty>
        <AnyLeaseArrangements>0</AnyLeaseArrangements>
        <MngmentCntrctBondFinancdPrprty>0</MngmentCntrctBondFinancdPrprty>
        <AnyResearchAgreements>0</AnyResearchAgreements>
        <BondCounselRoutinelyEngaged>0</BondCounselRoutinelyEngaged>
        <PostIssuanceComplianceProcdrs>1</PostIssuanceComplianceProcdrs>
      </Form990ScheduleKPartIII>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 11</Identifier>
        <Explanation>A copy of the Form 990 will be provided to the Finance and/or Executive Committee of the Board of Directors for detail review prior to filing. That Committee then makes a recommendation to the entire Board for approval of the return before filing, and the entire Board also has a copy of the return available to them for review. Upon request, a PDF copy of the return will also be e-mailed to members of the Board.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 12c</Identifier>
        <Explanation>All Directors and employees will disclose a conflict of interest on the "Conflict of Interest Form" in the following situations and in other circumstances which he/she thinks might cause a conflict between his/her personal interest and his/her fiduciary duty: Financial interests, inside information, conflicting interest other than financial, gifts and favors. The following employees are required to sign a form annually: President, CEO, COO, CFO, VPs and Directors. The Compliance Officer follows up on any conflicts of interest and documents resolution. These forms are kept by the Executive Committee. If a violation occurs, employees can report it directly to their supervisor or use the company hotline number that is posted at each location. Violations are investigated by at least two individuals who would make the final determination as to the appropriate action to be taken.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 15</Identifier>
        <Explanation>Compensation is determined from review of Form 990S from other organizations. The HUMAN RESOURCES committee regularly consults independent compensation surveys every other year. The proposed compensation is then presented to and approved by the Board.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section C, line 19</Identifier>
        <Explanation>Although not legally required to make documents and financial statements available to the public, we do make them available upon request for review.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part XI, Line 2c</Identifier>
        <Explanation>The process is consistent with prior years.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>BETHESDA HEALTH GROUP FOUNDATION INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1630 DES PERES RD STE 290</AddressLine1>
          <City>ST LOUIS</City>
          <State>MO</State>
          <ZIPCode>63131</ZIPCode>
        </AddressUS>
        <EIN>431278967</EIN>
        <PrimaryActivities>HEALTH SERV</PrimaryActivities>
        <LegalDomicileState>MO</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>Line 11b, II</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>BETHESDA LONG TERM CARE INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1630 DES PERES RD STE 290</AddressLine1>
          <City>ST LOUIS</City>
          <State>MO</State>
          <ZIPCode>63131</ZIPCode>
        </AddressUS>
        <EIN>431277070</EIN>
        <PrimaryActivities>HEALTH SERV</PrimaryActivities>
        <LegalDomicileState>MO</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>Line 9</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>BETHESDA SENIOR LIVING INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1630 DES PERES RD STE 290</AddressLine1>
          <City>ST LOUIS</City>
          <State>MO</State>
          <ZIPCode>63131</ZIPCode>
        </AddressUS>
        <EIN>431494889</EIN>
        <PrimaryActivities>HEALTH SERV</PrimaryActivities>
        <LegalDomicileState>MO</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>Line 9</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>BETHESDA SERVICES INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1630 DES PERES RD STE 290</AddressLine1>
          <City>ST LOUIS</City>
          <State>MO</State>
          <ZIPCode>63131</ZIPCode>
        </AddressUS>
        <EIN>431857630</EIN>
        <PrimaryActivities>HEALTH SERV</PrimaryActivities>
        <LegalDomicileState>MO</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>Line 9</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartIV>
        <NameOfRelatedOrg>
          <BusinessNameLine1>bethesda enterprises inc</BusinessNameLine1>
        </NameOfRelatedOrg>
        <AddressUS>
          <AddressLine1>1630 DES PERES RD STE 290</AddressLine1>
          <City>ST LOUIS</City>
          <State>MO</State>
          <ZIPCode>63131</ZIPCode>
        </AddressUS>
        <EIN>431302762</EIN>
        <PrimaryActivity>HEALTH SERVices</PrimaryActivity>
        <LegalDomicileState>MO</LegalDomicileState>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <TypeOfEntity>C</TypeOfEntity>
        <ShareOfEOYAssets>109500</ShareOfEOYAssets>
        <PercentageOwnership>1.00000</PercentageOwnership>
      </Form990ScheduleRPartIV>
      <ReceiptOfIntAnnRentsRoyalties>0</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>0</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>0</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>0</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>0</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>0</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>0</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>0</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>0</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>0</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>0</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>0</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>1</SharingOfFacilities>
      <SharingOfPaidEmployees>1</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>1</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>1</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>1</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>1</OtherTransferFromOtherOrg>
    </IRS990ScheduleR>
  </ReturnData>
</Return>