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      <PublicSupportTotal170Amt>413002</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>8004</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3921</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4189</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>27383</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>34138</CurrentTaxYearAmt>
        <TotalAmt>77635</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <TotalSupportAmt>1020258</TotalSupportAmt>
      <PublicSupportCY170Pct>0.40480</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.43880</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </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>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>45000</OtherCostOrOtherBasisAmt>
        <BookValueAmt>45000</BookValueAmt>
      </LandGrp>
      <TotalBookValueLandBuildingsAmt>45000</TotalBookValueLandBuildingsAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>MITCHELL COUNTY REGIONAL HEALTH CENTER</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>616 NORTH EIGHTH STREET</AddressLine1Txt>
          <CityNm>OSAGE</CityNm>
          <StateAbbreviationCd>IA</StateAbbreviationCd>
          <ZIPCd>50461</ZIPCd>
        </USAddress>
        <RecipientEIN>426006380</RecipientEIN>
        <IRCSectionDesc>GOVT</IRCSectionDesc>
        <CashGrantAmt>0</CashGrantAmt>
        <NonCashAssistanceAmt>100027</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>CLINIC BUILDING PROJECT/EXPANSION &amp; PLEDGE PAYMENT PASSTHROUGH</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>1</Total501c3OrgCnt>
      <TotalOtherOrgCnt>0</TotalOtherOrgCnt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOUNDATION PRIMARILY SUPPORTS MITCHELL COUNTY REGIONAL HEALTH CENTER WHO IS LOCATED IN OSAGE, IOWA OR OTHER LOCAL ORGANIZATIONS WHO PROMOTE AND/OR SUPPORT HEALTHCARE IN MITCHELL COUNTY, IOWA.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleM documentId="RetDoc1042900001">
      <RealEstateCommercialGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>45000</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>FMV</MethodOfDeterminingRevenuesTxt>
      </RealEstateCommercialGrp>
      <Form8283ReceivedCnt>0</Form8283ReceivedCnt>
      <AnyPropertyThatMustBeHeldInd>0</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>0</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>0</ThirdPartiesUsedInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, COLUMN (B):</FormAndLineReferenceDesc>
        <ExplanationTxt>COLUMN (B) REPORTS THE NUMBER OF CONTRIBUTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOUNDATION DOES NOT HAVE ANY COMMITEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 990 WILL BE REVIEWED IN DEPTH WITH THE PRESIDENT OF THE FOUNDATION BOARD, WITH A SUMMARY BEING PROVIDED TO THE REMAINING BOARD MEMBERS PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12</FormAndLineReferenceDesc>
        <ExplanationTxt>DIRECTORS WILL ABSTAIN FROM VOTING FROM ANY ACTION THAT MAY POSE AS A POTENTIAL CONFLICT OF INTEREST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOUNDATION'S STATEMENT OF NET POSITION AND STATEMENT OF REVENUE &amp; EXPENSES ARE INCLUDED IN MITCHELL COUNTY REGIONAL HEALTH CENTER'S AUDITED FINANCIAL STATEMENTS WHICH ARE FILED WITH THE STATE OF IOWA.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>