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            <BusinessNameLine1Txt>AMERGIS HEALTHCARE STAFFING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>230 W MONROE ST SUITES 550 AND 625</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60606</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>STAFFING</ServicesDesc>
        <CompensationAmt>674011</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ABSOLUTE REHAB &amp; CONSULTING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 497</AddressLine1Txt>
            <CityNm>GREEN</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44232</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PT, OT, &amp; ST</ServicesDesc>
        <CompensationAmt>545752</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>GORDON FOOD SERVICE INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 1787</AddressLine1Txt>
            <CityNm>GRAND RAPIDS</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49501</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>FOOD &amp; DIETARY SUPPLIES</ServicesDesc>
        <CompensationAmt>520302</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>AMERICAN MEDICAL PERSONNEL</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1440 EAST TURKEYFOOT LAKE ROAD</AddressLine1Txt>
            <CityNm>AKRON</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44312</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>STAFFING</ServicesDesc>
        <CompensationAmt>252666</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>UNITED MEDICAL SUPPLY LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2948 NATIONWIDE PKWY</AddressLine1Txt>
            <CityNm>BRUNSWICK</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>44212</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL SUPPLIES</ServicesDesc>
        <CompensationAmt>180673</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>10</CntrctRcvdGreaterThan100KCnt>
      <FundraisingAmt>25850</FundraisingAmt>
      <GovernmentGrantsAmt>15205</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>454541</AllOtherContributionsAmt>
      <TotalContributionsAmt>495596</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>RESIDENT SERVICE REVENUE</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>9371159</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>9371159</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>MEDICARE/MEDICAID PAYMENTS</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>2992531</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2992531</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>12363690</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>168645</TotalRevenueColumnAmt>
        <ExclusionAmt>168645</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>7320</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>283</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>7037</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>7037</TotalRevenueColumnAmt>
        <ExclusionAmt>7037</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>25850</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>3128</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>-3128</TotalRevenueColumnAmt>
        <ExclusionAmt>-3128</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>OTHER INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>64755</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>64755</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>64755</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>13096595</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12428445</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>172554</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>203180</TotalAmt>
        <ProgramServicesAmt>203180</ProgramServicesAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>5374541</TotalAmt>
        <ProgramServicesAmt>5374541</ProgramServicesAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>137165</TotalAmt>
        <ProgramServicesAmt>137165</ProgramServicesAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>551915</TotalAmt>
        <ProgramServicesAmt>551915</ProgramServicesAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>543533</TotalAmt>
        <ProgramServicesAmt>543533</ProgramServicesAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>2071282</TotalAmt>
        <ProgramServicesAmt>2071282</ProgramServicesAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>5270</TotalAmt>
        <ManagementAndGeneralAmt>5270</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>141961</TotalAmt>
        <ManagementAndGeneralAmt>141961</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <AdvertisingGrp>
        <TotalAmt>53128</TotalAmt>
        <ProgramServicesAmt>53128</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1226939</TotalAmt>
        <ProgramServicesAmt>1226939</ProgramServicesAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>14748</TotalAmt>
        <ProgramServicesAmt>14748</ProgramServicesAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>439555</TotalAmt>
        <ProgramServicesAmt>439555</ProgramServicesAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>17649</TotalAmt>
        <ProgramServicesAmt>17649</ProgramServicesAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>959</TotalAmt>
        <ProgramServicesAmt>959</ProgramServicesAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>257123</TotalAmt>
        <ProgramServicesAmt>257123</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>911765</TotalAmt>
        <ProgramServicesAmt>911765</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>323940</TotalAmt>
        <ProgramServicesAmt>323940</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS AND MAINTENANCE</Desc>
        <TotalAmt>794716</TotalAmt>
        <ProgramServicesAmt>794716</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>FRANCHISE FEES</Desc>
        <TotalAmt>306274</TotalAmt>
        <ProgramServicesAmt>306274</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBTS</Desc>
        <TotalAmt>80494</TotalAmt>
        <ProgramServicesAmt>80494</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>48333</TotalAmt>
        <ProgramServicesAmt>48333</ProgramServicesAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>13504470</TotalAmt>
        <ProgramServicesAmt>13357239</ProgramServicesAmt>
        <ManagementAndGeneralAmt>147231</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>542</BOYAmt>
        <EOYAmt>400</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>768658</BOYAmt>
        <EOYAmt>1996948</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>2667497</BOYAmt>
        <EOYAmt>708750</EOYAmt>
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      <InventoriesForSaleOrUseGrp>
        <BOYAmt>81199</BOYAmt>
        <EOYAmt>88235</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>21999</BOYAmt>
        <EOYAmt>35521</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>32790046</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>19903660</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>13505287</BOYAmt>
        <EOYAmt>12886386</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>1937630</EOYAmt>
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        <EOYAmt>82210</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>17736080</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1570971</BOYAmt>
        <EOYAmt>1591903</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>5571179</BOYAmt>
        <EOYAmt>4995220</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>264006</BOYAmt>
        <EOYAmt>289691</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>7406156</BOYAmt>
        <EOYAmt>6876814</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>11267141</BOYAmt>
        <EOYAmt>10859266</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>11267141</BOYAmt>
        <EOYAmt>10859266</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>18673297</BOYAmt>
        <EOYAmt>17736080</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-407875</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>56406</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2314921</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1917449</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>397039</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>495596</CurrentTaxYearAmt>
        <TotalAmt>5181411</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>13114087</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>11116055</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9480238</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10076489</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12363690</CurrentTaxYearAmt>
        <TotalAmt>56150559</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <GrossReceiptsNonUnrltBusGrp>
        <CurrentTaxYearMinus4YearsAmt>37991</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>13000</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>33891</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>21372</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>106254</TotalAmt>
      </GrossReceiptsNonUnrltBusGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>13208484</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>13443976</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11431578</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10494900</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>12859286</CurrentTaxYearAmt>
        <TotalAmt>61438224</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>61438224</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>49684</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>37775</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>21877</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>15668</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>175682</CurrentTaxYearAmt>
        <TotalAmt>300686</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>49684</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>37775</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>21877</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>15668</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>175682</CurrentTaxYearAmt>
        <TotalAmt>300686</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus1YearAmt>230471</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>64755</CurrentTaxYearAmt>
        <TotalAmt>295226</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>13258168</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>13481751</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>11453455</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10741039</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>13099723</CurrentTaxYearAmt>
        <TotalAmt>62034136</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.99040</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.99360</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00480</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00270</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER INCOME - 2022 AMOUNT: $ 230,471. 2023 AMOUNT: $ 64,755.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <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>
    <IRS990ScheduleC documentId="RetDoc1039700001">
      <VolunteersInd>0</VolunteersInd>
      <PaidStaffOrManagementInd>0</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>0</MediaAdvertisementsInd>
      <MailingsMembersInd>0</MailingsMembersInd>
      <PublicationsOrBroadcastInd>0</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>0</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>0</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>0</RalliesDemonstrationsInd>
      <OtherActivitiesInd>1</OtherActivitiesInd>
      <OtherActivitiesAmt>2213</OtherActivitiesAmt>
      <TotalLobbyingExpendituresAmt>2213</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>0</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART II-B, LINE 1, LOBBYING ACTIVITIES:</FormAndLineReferenceDesc>
        <ExplanationTxt>ST. JOSEPH CARE CENTER PAYS DUES TO THE OHIO HEALTH CARE ASSOCIATION AND LEADING AGE OHIO, OF WHICH A PORTION RELATES TO LOBBYING.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>172011</OtherCostOrOtherBasisAmt>
        <BookValueAmt>172011</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>27208976</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>15220646</DepreciationAmt>
        <BookValueAmt>11988330</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>736661</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>564579</DepreciationAmt>
        <BookValueAmt>172082</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>3742464</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3340493</DepreciationAmt>
        <BookValueAmt>401971</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>929934</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>777942</DepreciationAmt>
        <BookValueAmt>151992</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>12886386</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>ENTRANCE FEE LIABILITY</Desc>
        <Amt>205000</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>LEASE LIABILITY</Desc>
        <Amt>84691</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>289691</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>13096878</TotalRevEtcAuditedFinclStmtAmt>
      <OtherRevenueAmt>283</OtherRevenueAmt>
      <RevenueNotReportedAmt>283</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>13096595</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>13096595</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>13504753</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>283</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>283</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>13504470</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>13504470</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>RENT EXPENSES INCLUDED IN REVENUE ON THE 990 &amp; EXPENSES ON THE FINANCIAL STATEMENTS 283.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>RENT EXPENSES INCLUDED IN REVENUE ON THE 990 &amp; EXPENSES ON THE FINANCIAL STATEMENTS 283.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleK documentId="RetDoc1053100001">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>CITY OF LOUISVILLE OHIO</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>346001724</BondIssuerEIN>
        <BondIssuedDt>2018-12-21</BondIssuedDt>
        <IssuePriceAmt>8039200</IssuePriceAmt>
        <PurposeDesc>HEALTHCARE &amp; HOUSING FACILITY</PurposeDesc>
        <DefeasedInd>0</DefeasedInd>
        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>1176480</RetiredAmt>
        <TotalProceedsAmt>8039200</TotalProceedsAmt>
        <RefundingTaxExemptBondsInd>1</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>0</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>1</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>1</MgmtContractBondFincdPropInd>
        <EngageBondCounselContractsInd>1</EngageBondCounselContractsInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>1</RebateNotDueYetInd>
        <ExceptionToRebateInd>0</ExceptionToRebateInd>
        <NoRebateDueInd>0</NoRebateDueInd>
        <VariableRateIssueInd>1</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>1</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>1</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K, PART I, BOND ISSUES:</FormAndLineReferenceDesc>
        <ExplanationTxt>(A) ISSUER NAME: CITY OF LOUISVILLE, OHIO (F) DESCRIPTION OF PURPOSE: HEALTHCARE &amp; HOUSING FACILITES</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990 REVIEW - A DRAFT OF THE RETURN IS PROVIDED FIRST TO MANAGEMENT AND THEN TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL BEFORE FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING AND ENFORCEMENT OF CONFLICT POLICY - ANNUAL CONFLICT OF INTEREST STATEMENTS ARE COMPLETED AND SIGNED BY EACH DIRECTOR, OFFICER AND KEY EMPLOYEES. ALL KNOWN POTENTIAL CONFLICTS ARE LISTED AND SHARED WITHIN THE BOARD OF DIRECTORS. SHOULD A DECISION COME TO THE BOARD INVOLVING ONE OF THE STATED CONFLICTS, THE INDIVIDUAL WILL FOLLOW THE WRITTEN CONFLICT OF INTEREST POLICY AND DISCLOSE HIS OR HER CONFLICT, PROVIDE ANY INFORMATION DESIRED BY THE BOARD, AND EXCUSE HIM OR HERSELF FROM THE MEETING FOR THE DELIBERATIONS AND THE VOTE ON THE MATTER INVOLVING THE CONFLICT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION REVIEW AND APPROVAL - A SURVEY IS CONDUCTED OF REGIONAL LONG-TERM CARE POSITIONS. SALARIES ARE BASED ON COMPARABLE POSITIONS. THE PERSONS MAKING COMPENSATION DECISIONS ARE INDEPENDENT OF THE INDIVIDUALS FOR WHOM COMPENSATION IS BEING DETERMINED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>AVAILABILITY OF DOCUMENTS - GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>