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        <RelatedOrExemptFunctionIncome>280594</RelatedOrExemptFunctionIncome>
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        <ProgramServices>1996315</ProgramServices>
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        <ManagementAndGeneral>925537</ManagementAndGeneral>
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      <FeesForServicesAccounting>
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        <ManagementAndGeneral>20268</ManagementAndGeneral>
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        <ProgramServices>7914596</ProgramServices>
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        <ManagementAndGeneral>121340</ManagementAndGeneral>
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        <ProgramServices>10576755</ProgramServices>
        <ManagementAndGeneral>647211</ManagementAndGeneral>
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        <ManagementAndGeneral>63811</ManagementAndGeneral>
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        <ProgramServices>271917</ProgramServices>
        <ManagementAndGeneral>71545</ManagementAndGeneral>
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        <ManagementAndGeneral>58746</ManagementAndGeneral>
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        <ProgramServices>1754416</ProgramServices>
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        <ProgramServices>4227855</ProgramServices>
        <ManagementAndGeneral>596711</ManagementAndGeneral>
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      <Insurance>
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        <ProgramServices>584458</ProgramServices>
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        <Description>Bad debt expense</Description>
        <Total>6482306</Total>
        <ProgramServices>6482306</ProgramServices>
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      <OtherExpenses>
        <Description>OTHER EXPENSES</Description>
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        <ProgramServices>433197</ProgramServices>
        <ManagementAndGeneral>49655</ManagementAndGeneral>
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      <OtherExpenses>
        <Description>DUES AND SUBSCRIPTIONS</Description>
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        <ProgramServices>26317</ProgramServices>
        <ManagementAndGeneral>590</ManagementAndGeneral>
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        <Description>DUE FROM REGIONAL RETIREMENT LIVING</Description>
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        <ReturnReference>Description of Intended Use of Endowment Funds:</ReturnReference>
        <Explanation>ENDOWMENT FUNDS ARE HELD BY THE HOSPITAL AND THE FOUNDATION, A SUPPORTING ORGANIZATION OF THE HOSPITAL. THE ENDOWMENTS ARE HELD FOR CAPITAL IMPROVEMENTS, EQUIPMENT ACQUISITIONS, THE EXPENSES OF INDIGENT CARE, AUXILIARY OPERATIONS, PASTORAL OPERATIONS, CANCER CENTER IMPROVEMENTS, REGIONAL RETIREMENT LIVING OPERATIONS AND IMPROVEMENTS, AND TO SUSTAIN FOUNDATION OPERATIONS.</Explanation>
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        <ReturnReference>Description of Uncertain Tax Positions Under FIN 48:</ReturnReference>
        <Explanation>The Organization and its affiliates are a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code. The Organization has received a determination letter that it is exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code, except for Regional Enterprises, Inc. which is a for-profit taxable entity. The Internal Revenue Service has established standards to be met to maintain tax-exempt status. In general, such standards require the Organization to meet a community benefit standard and comply with various laws and regulations. The Organization accounts for uncertainties in accounting for income tax assets and liabilities using the guidance included in FASB ASC Topic 740, Income Taxes. The Organization recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. At March 31, 2010, the Organization had no uncertain tax positions accrued.</Explanation>
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      <TotalCharityCare>
        <TotalCommunityBenefitExpense>12376646</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>9990799</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2385847</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.03180</PercentOfTotalExpense>
      </TotalCharityCare>
      <TotalCommunityBenefits>
        <TotalCommunityBenefitExpense>12376646</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>9990799</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2385847</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.03180</PercentOfTotalExpense>
      </TotalCommunityBenefits>
      <BadDebtExpenseReported>1</BadDebtExpenseReported>
      <BadDebtExpenseAmount>3007790</BadDebtExpenseAmount>
      <AmountAttributableTo>751950</AmountAttributableTo>
      <AmountReimbursedByMedicare>21413532</AmountReimbursedByMedicare>
      <CostOfCareReimbursedByMedicare>22922829</CostOfCareReimbursedByMedicare>
      <MedicareSurplusOrShortfall>-1509297</MedicareSurplusOrShortfall>
      <CostingMethodologyUsed>
        <CostToChargeRatio>X</CostToChargeRatio>
      </CostingMethodologyUsed>
      <WrittenDebtCollectionPolicy>1</WrittenDebtCollectionPolicy>
      <ProvisionForCharityCare>0</ProvisionForCharityCare>
      <Form990ScheduleHPartIV>
        <NameOfEntity>
          <BusinessNameLine1>SOUTHEAST IOWA RADIATION ONCOLOGY LLC</BusinessNameLine1>
        </NameOfEntity>
        <DescriptionEntPrimaryActivity>RADIATION THERAPY</DescriptionEntPrimaryActivity>
        <OrganizationProfitOrOwnership>0.50000</OrganizationProfitOrOwnership>
        <OfficersEtcProfitOrOwnership>0.00000</OfficersEtcProfitOrOwnership>
        <PhysicansProfitOrOwnership>0.50000</PhysicansProfitOrOwnership>
      </Form990ScheduleHPartIV>
      <Form990ScheduleHPartIV>
        <NameOfEntity>
          <BusinessNameLine1>COLLABORATIVE LABORATORY SERVICES LLC</BusinessNameLine1>
        </NameOfEntity>
        <DescriptionEntPrimaryActivity>LAB SERVICES</DescriptionEntPrimaryActivity>
        <OrganizationProfitOrOwnership>0.80000</OrganizationProfitOrOwnership>
        <OfficersEtcProfitOrOwnership>0.00000</OfficersEtcProfitOrOwnership>
        <PhysicansProfitOrOwnership>0.20000</PhysicansProfitOrOwnership>
      </Form990ScheduleHPartIV>
      <Form990ScheduleHPartV>
        <Name>
          <BusinessNameLine1>OTTUMWA REGIONAL HEALTH CENTER INC</BusinessNameLine1>
        </Name>
        <Address>
          <AddressLine1>1001 PENNSYLVANIA AVENUE</AddressLine1>
          <City>OTTUMWA</City>
          <State>IA</State>
          <ZIPCode>52501</ZIPCode>
        </Address>
        <LicensedHospital>X</LicensedHospital>
        <GeneralMedicalAndSurgical>X</GeneralMedicalAndSurgical>
        <Er24Hours>X</Er24Hours>
      </Form990ScheduleHPartV>
      <Form990ScheduleHPartVI>
        <IncomeBasedCriteria>Part I, Line 3c: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS.</IncomeBasedCriteria>
        <AnnualCommunityBenefitExpln>Part I, Line 6a: OTTUMWA REGIONAL HEALTH CENTER, INC.'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION.</AnnualCommunityBenefitExpln>
        <BadDebtFootnote>Part III, Line 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "PATIENT RECEIVABLES, NET":Net patient receivables consist of uncollateralized patient and third party obligations reduced by a valuation allowance for doubtful accounts and contractual adjustments from third party payors. The allowances reflect managements estimate of amounts that will not be collected in the future and are based on reviews of patient balances by aging category. Percentages are applied to each aging category based on contractual agreements and historical collection and recovery information to determine the net realizable value of the patient receivables.Payment for services is expected within thirty days of receipt of the billing on insurance accounts and within twenty days of billing on self-pay accounts. Accounts considered past due are sent to collection agencies when internal collection efforts have been unsuccessful. Any amounts deemed uncollectible are written off on a monthly basis. The Organization also maintains a charity care policy.THE OVERALL COST-TO-CHARGE RATIO WAS USED TO ESTIMATE BAD DEBT AT COST.PART III, SECTION A, LINE 2 WAS CALCULATED AS FOLLOWS:[(OPERATING EXPENSES - BAD DEBT) / (GROSS PATIENT SERVICE REVENUE + OTHER REVENUE)] X BAD DEBT.[(81,430,532 - 6,482,306) / 158,484,516 + 2,906,704] X 6,482,306 = 3,007,790.ALL INFORMATION IS FROM THE AUDITED FINANCIAL STATEMENTS.</BadDebtFootnote>
        <ShortfallAsCommunityBenefit>Part III, Line 8: THE SHORTFALL REPRESENTS ACTUAL UNREIMBURSED COSTS INCURRED BY OTTUMWA REGIONAL HEALTH CENTER, INC. IN PROVIDING SERVICES TO INDIVIDUALS ELIGIBLE FOR MEDICARE. THE COMMUNITY BENEFITS BECAUSE THE HOSPITAL APPLIES OTHER REVENUES TO COVER THE COSTS OF CARING FOR MEDICARE PATIENTS."MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT, D, E, H AND M WORKSHEETS, OR PS&amp;R.</ShortfallAsCommunityBenefit>
        <DebtCollectionPolicy>Part III, Line 9b: EACH ENCOUNTER IS REVIEWED AND PATIENTS WHO HAVE HAD FINANCIAL ASSISTANCE WITHIN THE PAST SIX MONTHS DO NOT HAVE TO REAPPLY.</DebtCollectionPolicy>
        <NumberOfFacilityTypeExpln>Part V: ALL FACILITY INFORMATION IS ADEQUATELY ADDRESSED IN PART V.</NumberOfFacilityTypeExpln>
        <NeedsAssessment>Part VI, Line 2: A COMMUNITY NEEDS ASSESSMENT IS PERFORMED EVERY 2 YEARS. AN EXTERNAL CONSULTANT IS HIRED TO PERFORM THIS FUNCTION. THEY OBTAIN THE RESULTS THROUGH A SERIES OF INTERVIEWS AND FOCUS GROUPS WITH KEY INVIDUALS IN THE COMMUNITY.</NeedsAssessment>
        <PatientEducationAssistance>Part VI, Line 3: OTTUMWA REGIONAL HEALTH CENTER, INC. EMPLOYS A FINANCIAL ASSISTANCE COUNSELOR TO ASSIST PATIENTS WITH ELIGIBILITY FOR VARIOUS PROGRAMS, AND TO HELP DETERMINE IF A PATIENT IS ELIGIBLE UNDER THE CHARITY CARE POLICY.PATIENTS ARE MADE AWARE THROUGH A PATIENT ACCOUNT BROCHURE, USUALLY OBTAINED AT ADMISSION.</PatientEducationAssistance>
        <CommunityInformation>Part VI, Line 4: WAPELLO COUNTY AND SEVEN SURROUNDING COUNTIES.</CommunityInformation>
        <CommunityBuildingActivities>Part VI, Line 5: N/A</CommunityBuildingActivities>
        <OtherInformation>Part VI, Line 6: N/A</OtherInformation>
        <AffiliatedHealthCareSystem>Part VI, Line 7: THE AFFILIATED HEALTH CARE SYSTEM INCLUDES THESE ORGANIZATIONS:OTTUMWA REGIONAL HEALTH CENTER, INC. - OWNS AND OPERATE A HOSPITAL.OTTUMWA REGIONAL HEALTH CARE FOUNDATION, INC. - SUPPORTS THE HOSPITAL BY FUND RAISING.REGIONAL RETIREMENT LIVING, INC. - OPERATES A RESIDENTIAL FACILITY FOR THE ELDERLY.COLLABORATIVE LABORATORY SERVICES, LLC - OPERATES THE ONLY LABORATORY IN THE GEOGRAPHIC AREA.</AffiliatedHealthCareSystem>
        <ReportsFiledWithStates>IA</ReportsFiledWithStates>
      </Form990ScheduleHPartVI>
    </IRS990ScheduleH>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <RecordsMaintained>1</RecordsMaintained>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>OTTUMWA REGIONAL HEALTH FOUNDATION</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>1001 PENNSYLVANIA AVENUE</AddressLine1>
          <City>OTTUMWA</City>
          <State>IA</State>
          <ZIPCode>52501</ZIPCode>
        </AddressUS>
        <EINOfRecipient>421271720</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>180742</AmountOfCashGrant>
        <AmountOfNonCashAssistance>0</AmountOfNonCashAssistance>
        <PurposeOfGrant>TO SUPPORT FUNDRAISING OPERATIONS.</PurposeOfGrant>
      </RecipientTable>
      <TotalNbrOf501C3AndGovtGrants>1</TotalNbrOf501C3AndGovtGrants>
      <Form990ScheduleIPartIV>
        <Identifier>Procedure for Monitoring Grants in the U.S.:</Identifier>
        <ReturnReference>Part I, Line 2:</ReturnReference>
        <Explanation>Schedule I, Part I, Line 2: GRANTS OR CONTRIBUTIONS ARE ONLY MADE TO OTHER 501(C)(3) ORGANIZATIONS. OTTUMWA REGIONAL HEALTH CENTER VERIFIES THE STATUS OF THE DONEE ORGANIZATION PRIOR TO MAKING A GIFT. THE FUNDS ARE RESTRICTED TO BEING USED TO SUPPORT THE DONEE ORGANIZATION'S TAX EXEMPT OPERATIONS.</Explanation>
      </Form990ScheduleIPartIV>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <CompensationCommittee>X</CompensationCommittee>
      <WrittenEmploymentContract>X</WrittenEmploymentContract>
      <CompensationSurvey>X</CompensationSurvey>
      <BoardOrCommitteeApproval>X</BoardOrCommitteeApproval>
      <SeverancePayment>0</SeverancePayment>
      <SupplementalNonqualRetirePlan>0</SupplementalNonqualRetirePlan>
      <EquityBasedCompArrangement>0</EquityBasedCompArrangement>
      <CompBasedOnRevenueOfFilingOrg>0</CompBasedOnRevenueOfFilingOrg>
      <CompBasedOnRevenueRelatedOrgs>0</CompBasedOnRevenueRelatedOrgs>
      <CompBasedNetEarningsFilingOrg>0</CompBasedNetEarningsFilingOrg>
      <CompBasedNetEarningsRelateOrgs>0</CompBasedNetEarningsRelateOrgs>
      <AnyNonFixedPayments>0</AnyNonFixedPayments>
      <InitialContractException>0</InitialContractException>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>TOM SIEMERS</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>320728</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>8575</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>20892</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>350195</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>DAN PORTER</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>225954</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>8026</DeferredCompFilingOrg>
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        <NontaxableBenefitsFilingOrg>21060</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>255040</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>EDWARD B ORTELL MD</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>794595</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>8575</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>23133</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>826303</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>GLENDA S ROEFER MD</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>367411</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>23419</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>390830</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>MARK S O'BRIEN MD</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>409665</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>15526</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>425191</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>LONNIE L LANFERMAN MD</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>349620</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>8575</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>25542</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>383737</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NameBusiness>
          <BusinessNameLine1>RAMESH REDDY MD</BusinessNameLine1>
        </NameBusiness>
        <BaseCompensationFilingOrg>348956</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>14646</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>363602</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc1053100001">
      <Form990ScheduleKPartI>
        <IssuerName>
          <BusinessNameLine1>WAPELLO COUNTY VARIABLE RATE REVENUE BONDS SERIES 2004</BusinessNameLine1>
        </IssuerName>
        <IssuerEIN>426295832</IssuerEIN>
        <CUSIPNumber>933805AA1</CUSIPNumber>
        <DateIssued>2007-11-30</DateIssued>
        <IssuePrice>21400000</IssuePrice>
        <DescriptionOfPurpose>SEE SCH. K, SUPPLEMENTAL INFORMATION, ABOVE.</DescriptionOfPurpose>
        <Defeased>0</Defeased>
        <OnBehalfOfIssuer>0</OnBehalfOfIssuer>
      </Form990ScheduleKPartI>
      <Form990ScheduleKPartI>
        <IssuerName>
          <BusinessNameLine1>WAPELLO COUNTY VARIABLE RATE DEMAND REFUND REVENUE BONDS SERIES 2006</BusinessNameLine1>
        </IssuerName>
        <IssuerEIN>426295832</IssuerEIN>
        <CUSIPNumber>933805AB9</CUSIPNumber>
        <DateIssued>2006-12-07</DateIssued>
        <IssuePrice>17005000</IssuePrice>
        <DescriptionOfPurpose>REFUND 2001 BOND ISSUE</DescriptionOfPurpose>
        <Defeased>0</Defeased>
        <OnBehalfOfIssuer>0</OnBehalfOfIssuer>
      </Form990ScheduleKPartI>
      <Form990ScheduleKPartII>
        <TotalProceeds>7040978</TotalProceeds>
        <AmountInReserveFund>2453585</AmountInReserveFund>
        <IssuanceCostsFromProceeds>1295364</IssuanceCostsFromProceeds>
        <CapitalExpenditures>3292029</CapitalExpenditures>
        <YearOfSubstCompletion>2006</YearOfSubstCompletion>
        <CurrentRefunding>1</CurrentRefunding>
        <AdvanceRefunding>0</AdvanceRefunding>
        <FinalAllocationMade>1</FinalAllocationMade>
        <AdequateBooksAndRecdsMaintaind>1</AdequateBooksAndRecdsMaintaind>
      </Form990ScheduleKPartII>
      <Form990ScheduleKPartII>
        <TotalProceeds>16717160</TotalProceeds>
        <AmountInReserveFund>1278147</AmountInReserveFund>
        <AmountDefeased>14393463</AmountDefeased>
        <IssuanceCostsFromProceeds>1042787</IssuanceCostsFromProceeds>
        <CapitalExpenditures>2763</CapitalExpenditures>
        <YearOfSubstCompletion>2007</YearOfSubstCompletion>
        <CurrentRefunding>0</CurrentRefunding>
        <AdvanceRefunding>1</AdvanceRefunding>
        <FinalAllocationMade>0</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>
      <Form990ScheduleKPartIII>
        <OwningBondFinancedProperty>0</OwningBondFinancedProperty>
        <AnyLeaseArrangements>0</AnyLeaseArrangements>
        <MngmentCntrctBondFinancdPrprty>0</MngmentCntrctBondFinancdPrprty>
        <AnyResearchAgreements>0</AnyResearchAgreements>
        <BondCounselRoutinelyEngaged>0</BondCounselRoutinelyEngaged>
        <PostIssuanceComplianceProcdrs>1</PostIssuanceComplianceProcdrs>
      </Form990ScheduleKPartIII>
      <Form990ScheduleKPartIV>
        <Form8038TFiled>0</Form8038TFiled>
        <VariableRateIssue>1</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>1</HedgeIdentifiedInBooksAndRecds>
        <NameOfHedgeProvider>
          <BusinessNameLine1>GOLDMAN SACHS</BusinessNameLine1>
          <BusinessNameLine2>CAPITAL MARKETS LP</BusinessNameLine2>
        </NameOfHedgeProvider>
        <TermOfHedge>13.100000000000</TermOfHedge>
        <GrossProceedsInvestedInGIC>0</GrossProceedsInvestedInGIC>
        <GrossProceedsInvested>1</GrossProceedsInvested>
        <ExceptionToRebate>1</ExceptionToRebate>
      </Form990ScheduleKPartIV>
      <Form990ScheduleKPartIV>
        <Form8038TFiled>0</Form8038TFiled>
        <VariableRateIssue>1</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>1</HedgeIdentifiedInBooksAndRecds>
        <NameOfHedgeProvider>
          <BusinessNameLine1>GOLDMAN SACHS</BusinessNameLine1>
          <BusinessNameLine2>CAPITAL MARKETS LP</BusinessNameLine2>
        </NameOfHedgeProvider>
        <TermOfHedge>5.000000000000</TermOfHedge>
        <GrossProceedsInvestedInGIC>0</GrossProceedsInvestedInGIC>
        <GrossProceedsInvested>0</GrossProceedsInvested>
        <ExceptionToRebate>0</ExceptionToRebate>
      </Form990ScheduleKPartIV>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <GeneralExplanation>
        <Identifier>Form 990, Part III, line 3</Identifier>
        <ReturnReference>Changes in Program Services</ReturnReference>
        <Explanation>CLOSED THE ALLERGY CLINIC AND FAMILY MEDICAL CLINIC IN ELDON, IA.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 11</Identifier>
        <Explanation>THE FORMs 990 AND 990T ALONG WITH THE RELATED SCHEDULES ARE REVIEWED AND APPROVED BY each member of the board of directors OF OTTUMWA REGIONAL LEGACY FOUNDATION, INC (ORLF) FORMERLY KNOWN AS OTTUMWA REGIONAL HEALTH CENTER, INC BEFORE THE FORMS ARE FILED. FURTHERMORE, THE FORMS 990 AND 990T ALONG WITH THE RELATED SCHEDULES ARE PRESENTED TO THE ORLF BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED BOARD MEETING AFTER THE FORMS ARE FILED.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 12c</Identifier>
        <Explanation>EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF ANY COMMITTEE WITH BOARD-DESIGNATED POWERS SHALL SIGN AN ANNUAL STATEMENT THAT THE PERSON HAS (A) RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) AGREES TO COMPLY WITH THE POLICY; (D) UNDERSTANDS THAT THE POLICY APPLIES TO COMMITTEES AND SUBCOMMITTEES; AND (E) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION THAT MUST ENGAGE PRIMARILY IN EXEMPT ACTIVITIES. THE CONFLICT OF INTEREST POLICY ALSO HAS PROVISIONS FOR DETERMINING WHETHER A CONFLICT EXISTS, ADDRESSING A CONFLICT OF INTEREST, AND ADDRESSING A PERCEIVED VIOLATION.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 15</Identifier>
        <Explanation>THE HEALTH CENTER UTILIZES PEER GROUP INFORMATION FROM OUTSIDE ORGANIZATIONS SUCH AS HAY GROUP, INTEGRATED HEALTHCARE STRATEGIES AND THE IOWA HOSPITAL ASSOCIATION. DATA FOR ESTABLISHING BASE PAY LEVELS ARE BASED ON THE 50TH PERCENTILE. BASE SALARIES FOR THE CEO AND OTHER KEY EMPLOYEES OF THE ORGANIZATION ARE EVALUATED ANNUALLY. ANY ADJUSTMENTS ARE APPROVED THROUGH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section C, line 19</Identifier>
        <Explanation>OTTUMWA REGIONAL HEALTH CENTER, INC. MAKEs ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST PRESENTED AT ORHC'S OFFICES.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>FORM 990, PART XI, LINE 2C</Identifier>
        <Explanation>THE ROLES OF THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS INCLUDE SELECTING THE INDEPENDENT PUBLIC ACCOUNTANTS AND OVERSEEING THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS. THIS PROCEDURE IS THE SAME AS IN THE FISCAL YEAR ENDED MARCH 31, 2009.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Schedule K Supplental Information</Identifier>
        <Explanation>PART I, COLUMN (F), LINE A - INITIALLY ISSUED AUGUST 19, 2004 AND USED FOR CAPITAL IMPROVEMENTS, REFUNDING OF PRIOR ISSUES (11/4/1993 &amp; 8/13/1998), AND REFINANCING TAXABLE DEBT. ON NOVEMBER 30, 2007, THE PERIODIC AUCTION RATE SECURITIES CONVERTED TO BEAR INTEREST IN THE WEEKLY RATE PERIOD AND AN IRS FORM 8038 WAS FILED. PART II, COLUMN (A), LINE 5 - ISSUANCE COSTS $382,300, CREDIT ENHANCEMENT FEE $913,064 PART II, COLUMN (B), LINE 5 - ISSUANCE COSTS $340,100, CREDIT ENHANCEMENT FEE $702,687</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>OTTUMWA REGIONAL HEALTH FOUNDATION</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1001 PENNSYLVANIA AVENUE</AddressLine1>
          <City>OTTUMWA</City>
          <State>IA</State>
          <ZIPCode>52501</ZIPCode>
        </AddressUS>
        <EIN>421271720</EIN>
        <PrimaryActivities>FOUNDATION</PrimaryActivities>
        <LegalDomicileState>IA</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>Line 11a, I</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>REGIONAL RETIREMENT LIVING INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1001 PENNSYLVANIA AVENUE</AddressLine1>
          <City>OTTUMWA</City>
          <State>IA</State>
          <ZIPCode>52501</ZIPCode>
        </AddressUS>
        <EIN>421326693</EIN>
        <PrimaryActivities>RETIREMENT COMMUNITY</PrimaryActivities>
        <LegalDomicileState>IA</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>Line 9</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartIV>
        <NameOfRelatedOrg>
          <BusinessNameLine1>REGIONAL ENTERPRISES INC</BusinessNameLine1>
        </NameOfRelatedOrg>
        <AddressUS>
          <AddressLine1>1001 PENNSYLVANIA AVE</AddressLine1>
          <City>OTTUMWA</City>
          <State>IA</State>
          <ZIPCode>52501</ZIPCode>
        </AddressUS>
        <EIN>421269387</EIN>
        <PrimaryActivity>CHEMICAL DEPENDENCY UNIT</PrimaryActivity>
        <LegalDomicileState>IA</LegalDomicileState>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <TypeOfEntity>C</TypeOfEntity>
        <ShareOfTotalIncome>1015608</ShareOfTotalIncome>
        <ShareOfEOYAssets>258470</ShareOfEOYAssets>
        <PercentageOwnership>1.00000</PercentageOwnership>
      </Form990ScheduleRPartIV>
      <ReceiptOfIntAnnRentsRoyalties>1</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>1</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>1</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>0</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>0</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>0</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>0</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>0</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>0</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>1</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>1</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>1</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>1</SharingOfFacilities>
      <SharingOfPaidEmployees>1</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>0</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>1</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>1</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>0</OtherTransferFromOtherOrg>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>OTTUMWA REGIONAL HEALTH FOUNDATION INC</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>B</TransactionType>
        <AmountInvolved>180742</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>OTTUMWA REGIONAL HEALTH FOUNDATION INC</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>C</TransactionType>
        <AmountInvolved>75029</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>REGIONAL RETIREMENT LIVING INC</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>A</TransactionType>
        <AmountInvolved>251226</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>REGIONAL ENTERPRISES INC</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>K</TransactionType>
        <AmountInvolved>222000</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>REGIONAL ENTERPRISES INC</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>Q</TransactionType>
        <AmountInvolved>200000</AmountInvolved>
      </TransactionsRelatedOrgsTable>
    </IRS990ScheduleR>
  </ReturnData>
</Return>