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        <ProgramServicesAmt>135069</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17386</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>187212</TotalAmt>
        <ProgramServicesAmt>165862</ProgramServicesAmt>
        <ManagementAndGeneralAmt>21350</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>36073</TotalAmt>
        <ProgramServicesAmt>26526</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9547</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>95444</TotalAmt>
        <ProgramServicesAmt>70184</ProgramServicesAmt>
        <ManagementAndGeneralAmt>25260</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1779963</TotalAmt>
        <ProgramServicesAmt>1673226</ProgramServicesAmt>
        <ManagementAndGeneralAmt>106737</ManagementAndGeneralAmt>
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      <AdvertisingGrp>
        <TotalAmt>28857</TotalAmt>
        <ProgramServicesAmt>126</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28731</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OccupancyGrp>
        <TotalAmt>174212</TotalAmt>
        <ProgramServicesAmt>174212</ProgramServicesAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>11205</TotalAmt>
        <ProgramServicesAmt>10175</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1030</ManagementAndGeneralAmt>
      </TravelGrp>
      <InterestGrp>
        <TotalAmt>22814</TotalAmt>
        <ProgramServicesAmt>22814</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>421533</TotalAmt>
        <ProgramServicesAmt>421533</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>129258</TotalAmt>
        <ProgramServicesAmt>129258</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>MISCELLANEOUS</Desc>
        <TotalAmt>298220</TotalAmt>
        <ProgramServicesAmt>215666</ProgramServicesAmt>
        <ManagementAndGeneralAmt>82554</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>FOOD AND MEALS</Desc>
        <TotalAmt>260642</TotalAmt>
        <ProgramServicesAmt>260505</ProgramServicesAmt>
        <ManagementAndGeneralAmt>137</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>231389</TotalAmt>
        <ProgramServicesAmt>197756</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33633</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>THERAPY SERVICES</Desc>
        <TotalAmt>161761</TotalAmt>
        <ProgramServicesAmt>161761</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>123094</TotalAmt>
        <ProgramServicesAmt>123094</ProgramServicesAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>6744549</TotalAmt>
        <ProgramServicesAmt>6118204</ProgramServicesAmt>
        <ManagementAndGeneralAmt>626345</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1000</BOYAmt>
        <EOYAmt>1000</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>3917583</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>438522</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>32411</BOYAmt>
        <EOYAmt>40696</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>10076144</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>4200048</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>6156537</BOYAmt>
        <EOYAmt>5876096</EOYAmt>
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        <BOYAmt>791513</BOYAmt>
        <EOYAmt>671014</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>10325718</BOYAmt>
        <EOYAmt>10944911</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>446647</BOYAmt>
        <EOYAmt>552910</EOYAmt>
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      <EscrowAccountLiabilityGrp>
        <BOYAmt>145451</BOYAmt>
        <EOYAmt>155962</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>574815</BOYAmt>
        <EOYAmt>505552</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>131556</BOYAmt>
        <EOYAmt>24009</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>1298469</BOYAmt>
        <EOYAmt>1238433</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>8723420</BOYAmt>
        <EOYAmt>9531189</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>303829</BOYAmt>
        <EOYAmt>175289</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>9027249</BOYAmt>
        <EOYAmt>9706478</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>10325718</BOYAmt>
        <EOYAmt>10944911</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>807769</ReconcilationRevenueExpnssAmt>
      <DonatedServicesAndUseFcltsAmt>19045</DonatedServicesAndUseFcltsAmt>
      <OtherChangesInNetAssetsAmt>-147585</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>0</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>180635</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>865539</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1086571</CurrentTaxYearMinus2YearsAmt>
        <TotalAmt>2132745</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>4923431</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5047483</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>6091436</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6753981</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7470163</CurrentTaxYearAmt>
        <TotalAmt>30286494</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <GovtFurnSrvcFcltsVl509Grp>
        <CurrentTaxYearMinus3YearsAmt>45636</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>37446</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>28600</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>19045</CurrentTaxYearAmt>
        <TotalAmt>130727</TotalAmt>
      </GovtFurnSrvcFcltsVl509Grp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>5104066</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5958658</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>7215453</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6782581</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7489208</CurrentTaxYearAmt>
        <TotalAmt>32549966</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
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        <CurrentTaxYearMinus2YearsAmt>605103</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>639917</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1070223</CurrentTaxYearAmt>
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      <SubstAndDsqlfyPrsnsTotGrp>
        <CurrentTaxYearMinus3YearsAmt>622634</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>605103</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>639917</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1070223</CurrentTaxYearAmt>
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      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>29612089</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
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        <CurrentTaxYearMinus3YearsAmt>1352</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5456</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>29175</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>74225</CurrentTaxYearAmt>
        <TotalAmt>114315</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>4107</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>1352</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5456</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>29175</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>74225</CurrentTaxYearAmt>
        <TotalAmt>114315</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>6784</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearAmt>7930</CurrentTaxYearAmt>
        <TotalAmt>14714</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>5114957</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5960010</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>7220909</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6811756</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7571363</CurrentTaxYearAmt>
        <TotalAmt>32678995</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.90620</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.93580</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00350</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00160</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <AgentTrusteeEtcInd>0</AgentTrusteeEtcInd>
      <InclEscrowCustodialAcctLiabInd>1</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>180557</OtherCostOrOtherBasisAmt>
        <BookValueAmt>180557</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
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        <DepreciationAmt>3311249</DepreciationAmt>
        <BookValueAmt>5409302</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
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        <DepreciationAmt>888799</DepreciationAmt>
        <BookValueAmt>286237</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>5876096</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>ACCRUED INTEREST RECEIVABLE</Desc>
        <BookValueAmt>1074</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>SECURITY DEPOSITS</Desc>
        <BookValueAmt>131775</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>DONATED FACILITIES RECEIVABLE</Desc>
        <BookValueAmt>175289</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>EMPLOYEE RETENTION TAX CREDIT RECEIVABLE</Desc>
        <BookValueAmt>342465</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>ACTIVITY AND RESIDENT TRUST FUNDS</Desc>
        <BookValueAmt>20411</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>671014</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>ESTIMATED THIRD PARTY PAYOR</Desc>
        <Amt>24009</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>24009</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
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      <OtherRevenueAmt>147585</OtherRevenueAmt>
      <RevenueNotReportedAmt>147585</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>7552318</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>7552318</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>6892134</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>147585</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>147585</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>6744549</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>6744549</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART IV, LINE 2B:</FormAndLineReferenceDesc>
        <ExplanationTxt>RESIDENT SECURITY DEPOSITS AND DEPOSITS FOR ACTIVITY AND RESIDENT TRUST FUNDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>MANAGEMENT BELIEVES THAT THE ORGANIZATION HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>NET ASSETS RELEASED FROM RESTRICTION 147,585.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>NET ASSETS RELEASED FROM RESTRICTION 147,585.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS PREPARED BY THE ORGANIZATION'S PUBLIC ACCOUNTING FIRM BASED ON DATA PROVIDED BY MANAGEMENT. ONCE A DRAFT OF THE FILING IS AVAILABLE, THE RETURN IS REVIEWED BY THE BOARD PRESIDENT PRIOR TO FILING WITH THE IRS. OTHER MEMBERS OF THE BOARD CAN REVIEW THE 990 UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD MEMBERS AND THE ADMINISTRATOR ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. ANY POTENTIAL CONFLICT IS REVIEWED BY THE BOARD. IF THE BOARD DETERMINES THERE IS A CONFLICT THE ENGAGEMENT MAY NOT BE ENTERED INTO AND THE MEMBER WOULD NOT BE ALLOWED TO VOTE ON THE MATTER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD PROVIDES THE FINAL APPROVAL OF THE COMPENSATION FOR THE ADMINISTRATOR. ANNUAL REVIEW AND INCREASE IS COMPLETED BY HEALTHCARE OF IOWA, INC., AN INDEPENDENT CONSULTING COMPANY. COMPARABILITY DATA IS USED. THE INITIAL HIRE PROCESS, ANNUAL REVIEW, AND COMPENSATION INCREASE IS DOCUMENTED IN THE PERSONNEL FILE. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2023. THE ORGANIZATION DOES NOT HAVE OTHER OFFICERS OR KEY EMPLOYEES. EXCEPT FOR THE ADMINISTRATOR, ALL REVIEWS AND INCREASES ARE COMPLETED AT THE FACILITY LEVEL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>CONSULTING: PROGRAM SERVICE EXPENSES 296,565. MANAGEMENT AND GENERAL EXPENSES 106,737. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 403,302. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,376,661. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,376,661.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>NET ASSETS RELEASED FROM RESTRICTIONS -147,585.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>