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        <ProgramServicesAmt>1460454</ProgramServicesAmt>
        <ManagementAndGeneralAmt>28089</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>26684</TotalAmt>
        <ProgramServicesAmt>801</ProgramServicesAmt>
        <ManagementAndGeneralAmt>25883</ManagementAndGeneralAmt>
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      <OfficeExpensesGrp>
        <TotalAmt>160144</TotalAmt>
        <ProgramServicesAmt>123741</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36403</ManagementAndGeneralAmt>
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      <InformationTechnologyGrp>
        <TotalAmt>59937</TotalAmt>
        <ProgramServicesAmt>2035</ProgramServicesAmt>
        <ManagementAndGeneralAmt>57902</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>334431</TotalAmt>
        <ProgramServicesAmt>334431</ProgramServicesAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>12195</TotalAmt>
        <ProgramServicesAmt>9798</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2397</ManagementAndGeneralAmt>
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      <ConferencesMeetingsGrp>
        <TotalAmt>7953</TotalAmt>
        <ProgramServicesAmt>7953</ProgramServicesAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>28307</TotalAmt>
        <ProgramServicesAmt>28307</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>421640</TotalAmt>
        <ProgramServicesAmt>421640</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>75329</TotalAmt>
        <ProgramServicesAmt>75329</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Food and meals</Desc>
        <TotalAmt>252296</TotalAmt>
        <ProgramServicesAmt>252296</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Medical supplies</Desc>
        <TotalAmt>144689</TotalAmt>
        <ProgramServicesAmt>144689</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Repairs and maintenance</Desc>
        <TotalAmt>92432</TotalAmt>
        <ProgramServicesAmt>92432</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Bad debt expense</Desc>
        <TotalAmt>12104</TotalAmt>
        <ProgramServicesAmt>12104</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1928</TotalAmt>
        <ProgramServicesAmt>1928</ProgramServicesAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>6092085</TotalAmt>
        <ProgramServicesAmt>5555646</ProgramServicesAmt>
        <ManagementAndGeneralAmt>536439</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1000</BOYAmt>
        <EOYAmt>1000</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>957457</BOYAmt>
        <EOYAmt>1301107</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>239808</BOYAmt>
        <EOYAmt>289615</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>14611</BOYAmt>
        <EOYAmt>69800</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>9872526</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>3356028</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>6878662</BOYAmt>
        <EOYAmt>6516498</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>636308</BOYAmt>
        <EOYAmt>1633684</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>8727846</BOYAmt>
        <EOYAmt>9811704</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>441370</BOYAmt>
        <EOYAmt>442964</EOYAmt>
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      <EscrowAccountLiabilityGrp>
        <BOYAmt>101614</BOYAmt>
        <EOYAmt>123822</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>705077</BOYAmt>
        <EOYAmt>641307</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>41342</BOYAmt>
        <EOYAmt>36344</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>1289403</BOYAmt>
        <EOYAmt>1244437</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>6905490</BOYAmt>
        <EOYAmt>8144453</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>532953</BOYAmt>
        <EOYAmt>422814</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>7438443</BOYAmt>
        <EOYAmt>8567267</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>8727846</BOYAmt>
        <EOYAmt>9811704</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>1091378</ReconcilationRevenueExpnssAmt>
      <DonatedServicesAndUseFcltsAmt>37446</DonatedServicesAndUseFcltsAmt>
      <OtherChangesInNetAssetsAmt>0</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>1202</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>1502</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>180635</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>865539</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1086571</CurrentTaxYearAmt>
        <TotalAmt>2135449</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>4481002</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4891303</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4923431</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5047483</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>6091436</CurrentTaxYearAmt>
        <TotalAmt>25434655</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <GovtFurnSrvcFcltsVl509Grp>
        <CurrentTaxYearMinus1YearAmt>45636</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>37446</CurrentTaxYearAmt>
        <TotalAmt>83082</TotalAmt>
      </GovtFurnSrvcFcltsVl509Grp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>4482204</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4892805</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5104066</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5958658</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7215453</CurrentTaxYearAmt>
        <TotalAmt>27653186</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <CurrentTaxYearMinus1YearAmt>622634</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>605103</CurrentTaxYearAmt>
        <TotalAmt>1227737</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <CurrentTaxYearMinus1YearAmt>622634</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>605103</CurrentTaxYearAmt>
        <TotalAmt>1227737</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>26425449</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>6666</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>7185</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4107</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1352</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5456</CurrentTaxYearAmt>
        <TotalAmt>24766</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>6666</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>7185</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4107</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1352</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5456</CurrentTaxYearAmt>
        <TotalAmt>24766</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>5606</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5477</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>6784</CurrentTaxYearMinus2YearsAmt>
        <TotalAmt>17867</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>4494476</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4905467</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5114957</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5960010</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>7220909</CurrentTaxYearAmt>
        <TotalAmt>27695819</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.95410</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.97300</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00090</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00120</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </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">
      <AgentTrusteeEtcInd>0</AgentTrusteeEtcInd>
      <InclEscrowCustodialAcctLiabInd>1</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>180557</OtherCostOrOtherBasisAmt>
        <BookValueAmt>180557</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>8542271</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2598677</DepreciationAmt>
        <BookValueAmt>5943594</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
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        <DepreciationAmt>757351</DepreciationAmt>
        <BookValueAmt>392347</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>6516498</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Accrued interest receivable</Desc>
        <BookValueAmt>596</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Security deposits</Desc>
        <BookValueAmt>125682</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Donated facilities receivable</Desc>
        <BookValueAmt>422814</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Employee retention tax credit receivable</Desc>
        <BookValueAmt>1084592</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>1633684</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Estimated third-party payor settlements</Desc>
        <Amt>36344</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>36344</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>7220909</TotalRevEtcAuditedFinclStmtAmt>
      <DonatedServicesAndUseFcltsAmt>37446</DonatedServicesAndUseFcltsAmt>
      <RevenueNotReportedAmt>37446</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>7183463</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>7183463</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>6092085</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>6092085</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>6092085</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV, Line 2b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Resident security deposits</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>
    </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 date 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Board members and the Administrator are required to sign a 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 and annual review and compensation increase is documented in the personnel file. 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, conflict of interest policy, and financial statements are available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Consulting: Program service expenses 316,991. Management and general expenses 28,089. Fundraising expenses 0. Total expenses 345,080. Other Healthcare Fees: Program service expenses 13,249. Management and general expenses 0. Fundraising expenses 0. Total expenses 13,249. Purchased Services: Program service expenses 1,130,214. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,130,214.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
