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      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MISCELLANEOUS</Desc>
        <TotalAmt>561488</TotalAmt>
        <ProgramServicesAmt>523245</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38243</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>260912</TotalAmt>
        <ProgramServicesAmt>256145</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4767</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>EQUIPMENT RENTAL AND MA</Desc>
        <TotalAmt>219052</TotalAmt>
        <ProgramServicesAmt>204133</ProgramServicesAmt>
        <ManagementAndGeneralAmt>14919</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>FOOD COSTS</Desc>
        <TotalAmt>65888</TotalAmt>
        <ProgramServicesAmt>61400</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4488</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>5971119</TotalAmt>
        <ProgramServicesAmt>5278918</ProgramServicesAmt>
        <ManagementAndGeneralAmt>692201</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>844634</BOYAmt>
        <EOYAmt>424470</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>107965</BOYAmt>
        <EOYAmt>110863</EOYAmt>
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      <AccountsReceivableGrp>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>7923</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>653450</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>127506</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>3449630</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>216043</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>335457</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
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        <EOYAmt>1943933</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>2399553</BOYAmt>
        <EOYAmt>2495433</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>2784365</BOYAmt>
        <EOYAmt>954197</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>2784365</BOYAmt>
        <EOYAmt>954197</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>5183918</BOYAmt>
        <EOYAmt>3449630</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-868640</ReconcilationRevenueExpnssAmt>
      <PriorPeriodAdjustmentsAmt>-50753</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>-910775</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <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>51090</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>509797</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearAmt>16000</CurrentTaxYearAmt>
        <TotalAmt>576887</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>3002885</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3594542</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4980303</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5843671</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5081487</CurrentTaxYearAmt>
        <TotalAmt>22502888</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>3053975</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4104339</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4980303</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5843671</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5097487</CurrentTaxYearAmt>
        <TotalAmt>23079775</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <TotalAmt>0</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <TotalAmt>0</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>23079775</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>3429</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2936</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>825</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1792</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4992</CurrentTaxYearAmt>
        <TotalAmt>13974</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>3429</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2936</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>825</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1792</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4992</CurrentTaxYearAmt>
        <TotalAmt>13974</TotalAmt>
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        <CurrentTaxYearMinus2YearsAmt>4981128</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5845463</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>5102479</CurrentTaxYearAmt>
        <TotalAmt>23093749</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.99940</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.99930</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00060</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00070</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>51200</OtherCostOrOtherBasisAmt>
        <BookValueAmt>51200</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>448800</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>45284</DepreciationAmt>
        <BookValueAmt>403516</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>995</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>995</DepreciationAmt>
        <BookValueAmt>0</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>125938</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>81227</DepreciationAmt>
        <BookValueAmt>44711</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>26517</OtherCostOrOtherBasisAmt>
        <BookValueAmt>26517</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>525944</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>PENSION RELATED DEFERRED OUTFLOWS</Desc>
        <BookValueAmt>1079884</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>1079884</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>PENSION RELATED DEFERRED INFLOWS</Desc>
        <Amt>12863</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>NET PENSION LIABILITY</Desc>
        <Amt>1931070</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>1943933</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>5102479</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueNotReportedAmt>0</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>5102479</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>5102479</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>5971119</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>5971119</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>5971119</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>SOUTHWEST IOWA MENTAL HEALTH SERVICES WERE MERGED INTO ZION INTEGRATED BEHAVIORAL HEALTH SERVICES AS OF 7/1/2023. BEHAVIORAL HEALTH SERVICES WERE STARTED UNDER ZION INTEGRATED BEHAVIORAL HEALTH SERVICES AT THIS TIME.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>REVIEWED BY PROGRAM DIRECTOR, FISCAL OFFICER, AND GOVERNING BOARD.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>ENFORCED BY PROGRAM DIRECTOR AND COMPLIANCE OFFICER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD OF DIRECTORS AUTHORIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST OF THE ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>TRANSFER TO CLOSE OUT SOUTHWEST IOWA MENTAL HEALTH CENTER 42-0928938 -910775.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2c</FormAndLineReferenceDesc>
        <ExplanationTxt>Consistent with prior year.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>