﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2023v6.0" xsi:schemaLocation="http://www.irs.gov/efile">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2025-03-15T08:23:27-07:00</ReturnTs>
    <TaxPeriodEndDt>2024-05-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>463893925</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>Walker Giroux &amp; Hahne LLC</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>225 1st Street N Suite 2400</AddressLine1Txt>
        <CityNm>Virginia</CityNm>
        <StateAbbreviationCd>MN</StateAbbreviationCd>
        <ZIPCd>55792</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-06-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>411344385</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>COOK AREA HEALTH SERVICES INC</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>COOK</BusinessNameControlTxt>
      <PhoneNum>2183613127</PhoneNum>
      <USAddress>
        <AddressLine1Txt>20 FIFTH STREET SE</AddressLine1Txt>
        <CityNm>COOK</CityNm>
        <StateAbbreviationCd>MN</StateAbbreviationCd>
        <ZIPCd>55723</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>KEITH HARVEY</PersonNm>
      <PersonTitleTxt>CEO</PersonTitleTxt>
      <SignatureDt>2025-03-15</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>true</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>Thomas Kelly</PreparerPersonNm>
      <PTIN>P01240546</PTIN>
      <PhoneNum>2187494880</PhoneNum>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2025-03-06 01:10:19Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="7">
    <IRS990 documentId="IRS990" referenceDocumentId="IRS990ScheduleO" softwareId="23017517" softwareVersionNum="2023v6.0">
      <USAddress>
        <AddressLine1Txt>20 FIFTH STREET SE</AddressLine1Txt>
        <CityNm>COOK</CityNm>
        <StateAbbreviationCd>MN</StateAbbreviationCd>
        <ZIPCd>55723</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>16238266</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>N/A</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1979</FormationYr>
      <LegalDomicileStateCd>MN</LegalDomicileStateCd>
      <ActivityOrMissionDesc>TO PROVIDE MEDICAL, DENTAL &amp; SUPPORTIVE SERVICES IN A REMOTE,RURAL AREA OF NORTHERN MINNESOTA. AS A FEDERALLY QUALIFIED HEALTH CENTER IN A REMOTE, RURAL AREA IT IS OUR GOAL TO BE CUSTOMER FOCUSED WITHOUT REGARD TO ECONOMIC STATUS OR ANY OTHER ARTIFICIAL BARRIER.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>10</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>10</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>169</TotalEmployeeCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <PYContributionsGrantsAmt>5149911</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>4024932</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>13621109</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>12158862</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>4</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>54472</CYInvestmentIncomeAmt>
      <CYOtherRevenueAmt>0</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>18771024</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>16238266</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>12791817</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>12853300</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>5484128</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>5813722</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>18275945</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>18667022</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>495079</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-2428756</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>6599123</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>4932877</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>1674876</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>2437386</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>4924247</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>2495491</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>OUR MISSION IS TO PROVIDE MEDICAL, DENTAL &amp; SUPPORTIVE SERVICES IN A REMOTE, RURAL AREA OF NORTHERN MINNESOTA. AS A FEDERALLY QUALIFIED HEALTH CENTER IN A REMOTE, RURAL AREA, IT IS OUR GOAL TO BE CUSTOMER FOCUSED WITHOUT REGARD TO ECONOMIC STATUS OR ANY OTHER ARTIFICIAL BARRIER. WE INTEND TO PROVIDE QUALITY PRIMARY CARE THAT MEETS THE NEEDS OF PEOPLE IN OUR DESIGNATED SERVICE AREA THROUGH COLLABORATIVE EFFORTS WITH CRITICAL ACCESS HOSPITALS, CARE CENTERS, SPECIALISTS, ASSOCIATIONS, FOUNDATIONS AND OTHER APPROPRIATE OR AVAILABLE OPPORTUNITIES. OUR CORE VALUE IS THE CARE OF FAMILIES, FRIENDS AND VISITORS WHO RESIDE IN OR TRAVEL THROUGH OUR REGION BY ASSISTING TO IMPROVE THEIR HEALTH. THIS CARE IS PROVIDED AT OUR MEDICAL CLINICS IN BIGFORK, BIG FALLS, COOK, FLOODWOOD,NORTHOME, AND TOWER MN AND AT OUR DENTAL CLINICS IN COOK, FLOODWOOD, AND TOWER, MN. CARE IS ALSO PROVIDED THROUGH CONTRACTS WITH BIGFORK VALLEY AND COOK HOSPITALS AND THEIR ASSOCIATED NURSING HOMES AS WELL AS AT NORTHOME CARE</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>9434604</ExpenseAmt>
      <Desc>PROVIDE MEDICAL SERVICES, 29,127 ENCOUNTERS</Desc>
      <ProgSrvcAccomActy2Grp>
        <ExpenseAmt>3162239</ExpenseAmt>
        <Desc>PROVIDE DENTAL SERVICES, 13,290 ENCOUNTERS</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <ExpenseAmt>252188</ExpenseAmt>
        <Desc>PROVIDE OTHER HEALTH SERVICES, 2,920 ENCOUNTERS</Desc>
      </ProgSrvcAccomActy3Grp>
      <TotalProgramServiceExpensesAmt>12849031</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="IRS990ScheduleB">true</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="IRS990ScheduleD">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="IRS990ScheduleD">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="IRS990ScheduleD">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="IRS990ScheduleD">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="IRSScheduleD">false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="IRS990ScheduleD">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="IRS990ScheduleD">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="IRS990ScheduleD">false</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="IRS990ScheduleD">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="IRS990ScheduleD">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="IRS990ScheduleJ">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd referenceDocumentId="IRS990ScheduleL">false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd referenceDocumentId="IRS990ScheduleL">false</PYExcessBenefitTransInd>
      <LoanOutstandingInd referenceDocumentId="IRS990ScheduleL">false</LoanOutstandingInd>
      <GrantToRelatedPersonInd referenceDocumentId="IRS990ScheduleL">false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd referenceDocumentId="IRS990ScheduleL">false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd referenceDocumentId="IRS990ScheduleL">true</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd referenceDocumentId="IRSScheduleL">false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd>false</DisregardedEntityInd>
      <RelatedEntityInd>false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>14</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>true</BackupWthldComplianceInd>
      <EmployeeCnt>169</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <Form8282FiledCnt>0</Form8282FiledCnt>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <Form8899Filedind>false</Form8899Filedind>
      <Form1098CFiledInd>false</Form1098CFiledInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>10</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>10</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>false</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>true</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>true</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>MN</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>KEITH HARVEY</PersonNm>
        <PhoneNum>2183613135</PhoneNum>
        <USAddress>
          <AddressLine1Txt>20 FIFTH STREET SE</AddressLine1Txt>
          <CityNm>COOK</CityNm>
          <StateAbbreviationCd>MN</StateAbbreviationCd>
          <ZIPCd>55723</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>ERIC ELLEBY</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <ReportableCompFromOrgAmt>361637</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20540</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>NICHOLAS VIDOR</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <ReportableCompFromOrgAmt>356065</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>12200</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MATTHEW HOLMES</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <ReportableCompFromOrgAmt>320653</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>19948</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ERIC SCRIVNER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <ReportableCompFromOrgAmt>282997</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27775</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BARRET MYERS WOLFSON</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <ReportableCompFromOrgAmt>290361</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11080</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KEITH HARVEY</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>139283</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>29775</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAN HEINECKE</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>102914</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBIN HARKONEN</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WENDE NELSON</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GAIL BLACKMER</PersonNm>
        <TitleTxt>SEC'Y/TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LIZ STORM</PersonNm>
        <TitleTxt>President</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KAREN LORENZEN</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARIAN SWANG</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT WALKER</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM H TIBBETTS</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARCI MAPLE</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOEL KARELS</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1853910</TotalReportableCompFromOrgAmt>
      <TotalOtherCompensationAmt>121318</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>7</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>NATIONAL MEDICAL RESOURCES</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2792 E BROADWAY AVE</AddressLine1Txt>
            <CityNm>BISMARCK</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58501</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>LOCUM PHSYICIAN COVERAGE</ServicesDesc>
        <CompensationAmt>342791</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CONSOLIDATED COMMUNICATIONS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 66523</AddressLine1Txt>
            <CityNm>ST LOUIS</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>63166</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PHONE/COMPUTER</ServicesDesc>
        <CompensationAmt>284168</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>NORTHEAST SERVICES COOPERATIVE</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5525 EMERALD AVE</AddressLine1Txt>
            <CityNm>MT IRON</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>55768</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>INSURANCE</ServicesDesc>
        <CompensationAmt>1180913</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BREAKWATER HEALTH NETWORK</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1324 ARROWHEAD RD STE 332</AddressLine1Txt>
            <CityNm>DULUTH</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>55811</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CLINICAL/BUS/PAT SVC</ServicesDesc>
        <CompensationAmt>398952</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MCKESSON MEDICAL</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 634404</AddressLine1Txt>
            <CityNm>CINCINNATI</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45263</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL SUPPLIES</ServicesDesc>
        <CompensationAmt>364562</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>3905922</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>119010</AllOtherContributionsAmt>
      <TotalContributionsAmt>4024932</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>MEDICAL &amp; DENTAL REVENUE</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>12158862</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12158862</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>12158862</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>54472</TotalRevenueColumnAmt>
        <ExclusionAmt>54472</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetRentalIncomeOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetGainOrLossInvestmentsGrp>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueTotalAmt>0</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>16238266</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12158862</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>54472</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>272975</TotalAmt>
        <ManagementAndGeneralAmt>272975</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>10674531</TotalAmt>
        <ProgramServicesAmt>7946523</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2728008</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>0</TotalAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1187782</TotalAmt>
        <ProgramServicesAmt>887337</ProgramServicesAmt>
        <ManagementAndGeneralAmt>300445</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>718012</TotalAmt>
        <ProgramServicesAmt>522845</ProgramServicesAmt>
        <ManagementAndGeneralAmt>195167</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1200417</TotalAmt>
        <ProgramServicesAmt>684128</ProgramServicesAmt>
        <ManagementAndGeneralAmt>516289</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>0</TotalAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1816110</TotalAmt>
        <ProgramServicesAmt>1254453</ProgramServicesAmt>
        <ManagementAndGeneralAmt>561657</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>934327</TotalAmt>
        <ManagementAndGeneralAmt>934327</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>813539</TotalAmt>
        <ProgramServicesAmt>780063</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33476</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>132419</TotalAmt>
        <ProgramServicesAmt>94954</ProgramServicesAmt>
        <ManagementAndGeneralAmt>37465</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>197350</TotalAmt>
        <ProgramServicesAmt>170025</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27325</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>0</TotalAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>63725</TotalAmt>
        <ProgramServicesAmt>24049</ProgramServicesAmt>
        <ManagementAndGeneralAmt>39676</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>134443</TotalAmt>
        <ProgramServicesAmt>99917</ProgramServicesAmt>
        <ManagementAndGeneralAmt>34526</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>DENTAL LABORATORY</Desc>
        <TotalAmt>139639</TotalAmt>
        <ProgramServicesAmt>139639</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITMENT</Desc>
        <TotalAmt>135540</TotalAmt>
        <ProgramServicesAmt>6</ProgramServicesAmt>
        <ManagementAndGeneralAmt>135534</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>CREDIT LOSSES</Desc>
        <TotalAmt>133216</TotalAmt>
        <ProgramServicesAmt>133216</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>OSHA COMPLIANCE AND SAFETY</Desc>
        <TotalAmt>112997</TotalAmt>
        <ProgramServicesAmt>111876</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1121</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>0</TotalAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>18667022</TotalAmt>
        <ProgramServicesAmt>12849031</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5817991</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1996747</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2115</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>21988</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1243749</BOYAmt>
        <EOYAmt>1823746</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <EOYAmt>0</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>132632</BOYAmt>
        <EOYAmt>42427</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>6559280</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>3495058</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3099983</BOYAmt>
        <EOYAmt>3064222</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <EOYAmt>0</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <EOYAmt>0</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <EOYAmt>0</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>101909</BOYAmt>
        <EOYAmt>2482</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>6599123</BOYAmt>
        <EOYAmt>4932877</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1182265</BOYAmt>
        <EOYAmt>1832667</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <EOYAmt>3805</EOYAmt>
      </DeferredRevenueGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>390702</BOYAmt>
        <EOYAmt>364741</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>101909</BOYAmt>
        <EOYAmt>236173</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>1674876</BOYAmt>
        <EOYAmt>2437386</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>4924247</BOYAmt>
        <EOYAmt>2495491</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>4924247</BOYAmt>
        <EOYAmt>2495491</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>6599123</BOYAmt>
        <EOYAmt>4932877</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-2428756</ReconcilationRevenueExpnssAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>false</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA" softwareId="23017517" softwareVersionNum="2023v6.0">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>4982571</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5307918</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5316364</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5149911</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3937419</CurrentTaxYearAmt>
        <TotalAmt>24694183</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TaxRevLeviedOrgnztnlBnft170Grp>
        <TotalAmt>0</TotalAmt>
      </TaxRevLeviedOrgnztnlBnft170Grp>
      <GovtFurnSrvcFcltsVl170Grp>
        <TotalAmt>0</TotalAmt>
      </GovtFurnSrvcFcltsVl170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>4982571</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>5307918</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>5316364</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>5149911</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3937419</CurrentTaxYearAmt>
        <TotalAmt>24694183</TotalAmt>
      </TotalCalendarYear170Grp>
      <SubstantialContributorsTotAmt>0</SubstantialContributorsTotAmt>
      <PublicSupportTotal170Amt>24694183</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>4</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>2</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>54472</CurrentTaxYearAmt>
        <TotalAmt>54484</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <UnrelatedBusinessNetIncm170Grp>
        <TotalAmt>0</TotalAmt>
      </UnrelatedBusinessNetIncm170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus3YearsAmt>1606732</CurrentTaxYearMinus3YearsAmt>
        <TotalAmt>1606732</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>26355399</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>58008670</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.93700</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.94100</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB" softwareId="23017517" softwareVersionNum="2023v6.0">
      <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="IRS990ScheduleD" softwareId="23017517" softwareVersionNum="2023v6.0">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>19500</OtherCostOrOtherBasisAmt>
        <BookValueAmt>19500</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>3152825</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1205896</DepreciationAmt>
        <BookValueAmt>1946929</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>1778130</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>991961</DepreciationAmt>
        <BookValueAmt>786169</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1523528</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1297201</DepreciationAmt>
        <BookValueAmt>226327</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>85297</OtherCostOrOtherBasisAmt>
        <BookValueAmt>85297</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>3064222</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>BANK OVERDRAFT</Desc>
        <Amt>233691</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>LEASE LIABILITY</Desc>
        <Amt>2482</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>236173</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>16238266</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>16238266</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>16238266</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>18667022</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>18667022</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>18667022</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ" softwareId="23017517" softwareVersionNum="2023v6.0">
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BARRET MYERS WOLFSON</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>290361</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>11080</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>301441</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ERIC ELLEBY</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>361637</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>12200</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>8340</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>382177</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ERIC SCRIVNER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>282997</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10831</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>16944</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>310772</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KEITH HARVEY</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>139283</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>4557</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>25218</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>169058</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MATTHEW HOLMES</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>320653</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>12200</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>7748</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>340601</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NICHOLAS VIDOR</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>356065</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>12200</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>368265</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="IRS990ScheduleL" softwareId="23017517" softwareVersionNum="2023v6.0">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>CARMEN HEINECKE</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>CFO'S WIFE</RelationshipDescriptionTxt>
        <TransactionAmt>92338</TransactionAmt>
        <TransactionDesc>WAGES AND BENEFITS</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="23017517" softwareVersionNum="2023v6.0">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS UPON RECEIPT FROM THE PREPARER. THE COPY WAS INCLUDED WITH THE STANDARD MATERIALS (MEETING MINUTES, FINANCIAL REPORTS, ETC.) PROVIDED TO THE BOARD PRIOR TO THEIR MONTHLY MEETING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>CAHS REQUIRES ANNUAL REPORTING FROM ALL DIRECTORS AND KEY EMPLOYEES REGARDING ANY CONFLICTS OF INTEREST WITH RELATED ORGANIZATIONS AND VENDORS WITH WHOM THE ORGANIZATION TRANSACTS BUSINESS. CAHS MONITORS DISCLOSURES PROVIDED TO ANY AFFIRMATIVE REPONSES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD'S FINANCE COMMITTEE CONDUCTS AN ANNUAL COMPENSATION REVIEW OF CAHS KEY EMPLOYEES USING SALARY SURVEYS FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, THE MN DEPT. OF EMPLOYMENT AND ECONOMIC DEVELOPMENT, AND OTHER AVAILABLE SALARY SURVEYS. THE COMMITTEE DOCUMENTS EACH EMPLOYEE'S COMPENSATION RELATIVE TO SURVEY DATA AND SUBSTANTIATES REASONS FOR SUBSTANTIAL VARIANCES FROM AVAILABLE DATA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD'S FINANCE COMMITTEE CONDUCTS AN ANNUAL COMPENSATION REVIEW OF CAHS KEY EMPLOYEES USING SALARY SURVEYS FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, THE MN DEPT. OF EMPLOYMENT AND ECONOMIC DEVELOPMENT, AND OTHER AVAILABLE SALARY SURVEYS. THE COMMITTEE DOCUMENTS EACH EMPLOYEE'S COMPENSATION RELATIVE TO SURVEY DATA AND SUBSTANTIATES REASONS FOR SUBSTANTIAL VARIANCES FROM AVAILABLE DATA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>NO DOCUMENTS AVAILABLE TO THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>