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        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>true</NondisEmergencyCarePolicyInd>
        <LookBackMedicarePrivateInd>X</LookBackMedicarePrivateInd>
        <LookBackMedicaidMedcrPrvtInd>X</LookBackMedicaidMedcrPrvtInd>
        <AmountsGenerallyBilledInd>false</AmountsGenerallyBilledInd>
        <GrossChargesInd>false</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, HURON REGIONAL MEDICAL CENTER - PART V, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>A CHNA SURVEY WAS DEPLOYED TO THE HOPITAL'S LOCAL EXPERT ADVISORS AND OFFERED TO THE COMMUNITY TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED ACCORDING TO CRITERIA REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS AND THE HOSPITAL'S DESIRE TO REPRESENT THE REGION'S GEOGRAPHICALLY DIVERSE POPULATION. COMMUNITY INPUT FROM 35 IDENTIFIED LOCAL EXPERT ADVISORS AND 76 COMMUNITY MEMBERS WERE RECIEVED. SURVEY RESPONSES STARTED IN JANUARY 2022 AND ENDED IN APRIL 2022.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, HURON REGIONAL MEDICAL CENTER - PART V, LINE 6B</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER ORGANIZATIONS WITH WHICH THE HOSPITAL FACILITY CONDUCTED ITS CHNA: OVATION HEALTHCARE - HOSPITAL FACILITY MANAGEMENT COMPANY FACILITATED CHNA. JAMES VALLEY COMMUNITY HEALTH CLINIC AND COMMUNITY COUNSELING SERVICES, CARR CHIROPRACTIC CLINIC AND VARIOUS LARGE EMPLOYERS WITH NON ENGLISH SPEAKING EMPLOYEES PARTICIPATED IN CONFIRMING SIGNIFICANT NEEDS AND DEVELOPING IMPLEMENTATION STRATEGY. PART V, SECTION B, LINE 11 FACILITY 1 - HRMC SEE ATTACHED FACILITY 1 - HRMC - HRMC COMMUNITY HEALTH NEEDS ASSESSMENT GRID PART V, SECTION B, LINE 20(D) HRMC IN PROCESS OF OBTAINING AND MEETING PRESUMPTIVE ELIGIBILITY REQUIREMENTS OF STATE OF SOUTH DAKOTA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART I, LINE 7G</FormAndLineReferenceDesc>
        <ExplanationTxt>COSTS ATTRIBUTABLE TO PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES: ORTHOPEDIC CLINIC 431,757, OB/GYN CLINIC 1,549,945, FAMILY MEDICINE CLINIC 2,120,539, SURGICAL CLINIC 1,022,001, UROLOGY CLINIC 428,035 AND IM CLINIC 2,221,787 FOR A TOTAL OF 7,774,064. BAD DEBT EXPENSE NOT REPORTED ON LINE 7G WAS 0.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART I, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>WORKSHEET 2 WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN THE TABLES ALONG WITH COST REPORT AMOUNTS WHEN APPLICABLE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART II</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE ATTACHED</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>ACCOUNTS RECEIVABLE FROM PATIENTS CONSIST OF THE FOLLOWING: ACCOUNTS RECEIVABLE AS OF JUNE 30, 2023 AND 2022 WERE 15,388,131 AND 13,711,869. ALLOWANCE FOR DOUBTFUL ACCOUNTS AS OF JUNE 30, 2023 AND 2022 WERE (3,438,495) AND (3,569,545). ACCOUNTS RECEIVABLE, NET AS OF JUNE 30, 2023 AND 2022 WERE 11,949,636 AND 10,142,324. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON AN ESTIMATE USING PAST COLLECTION EXPERIENCE,FINANCIAL CLASS, AND AGE FOR THE PATIENT ACCOUNT. ESTIMATED BAD DEBTS EXPENSE REFLECTS THIS PROVISION FOR ACTUAL OR EXPECTED DOUBTFUL ACCOUNTS. DISCOUNTS AND PAYMENTS ON ACCOUNTS REDUCES ACCOUNTS RECEIVABLE BALANCES THEREFORE REDUCING BAD DEBTS EXPENSE. A STUDY OF FINANCIAL ASSISTANCE APPLICATIONS AND EXPERIENCE OF FINANCIAL ASSISTANCE STAFF WAS USED TO REASONABLY ESTIMATE THE PERCENTAGE OF BAD DEBT FOR PATIENTS WHO WHOULD HAVE QUALIFIED FOR ASSISTANCE IF THEY APPLIED. SEE FOOTNOTE 1 PATIENT ACCOUNTS RECEIVABLES SECTION AND FOOTNOTE 4 OF AUDITED FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE ATTACHED 2</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE ATTACHED 3</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE ATTACHED 4</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE ATTACHED 5</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE ATTACHED 1 FORM 990, PART VI, LINE 2 - FAMILY/BUSINESS RELATIONSHIP ONE HOSPITAL BOARD TRUSTEE AND ONE OFFICER ARE DIRECTORS ON GREATER HURON DEVELOPMENT BOARD. TWO HOSPITAL BOARD TRUSTEES SERVE ON THE BEADLE COUNTY COMMISSION. ONE HOSPITAL BOARD TRUSTEE HAS A BUSINESS RELATIONSHIP WITH THE HOSPITAL - NOT INDEPENDENT. ONE HOSPITAL BOARD TRUSTEE EMPLOYED BY OVATION HEALTH CARE WITH HIS SPOUSE AND DAUGHTER ARE EMPLOYED BY THE HOSPITAL. THREE BOARD TRUSTEES ARE EMPLOYED BY THE HOSPITAL - NOT INDEPENDENT.</ExplanationTxt>
      </SupplementalInformationDetail>
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      <HousingAllowanceOrResidenceInd>X</HousingAllowanceOrResidenceInd>
      <WrittenPolicyRefTAndEExpnssInd>true</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>true</SubstantiationRequiredInd>
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <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>
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        <PersonNm>DR VINCENT OYLER</PersonNm>
        <TitleTxt>HCE</TitleTxt>
        <BaseCompensationFilingOrgAmt>324531</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>15000</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>102742</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>442273</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR CHRISTOPHER BRONSON</PersonNm>
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        <BaseCompensationFilingOrgAmt>234570</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>25000</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>92840</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>352410</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR BRETT MATHERS</PersonNm>
        <TitleTxt>HCE</TitleTxt>
        <BaseCompensationFilingOrgAmt>259553</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>10714</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>79759</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>350026</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR KRISTEN HUGHES</PersonNm>
        <TitleTxt>DIRECTOR/HCE</TitleTxt>
        <BaseCompensationFilingOrgAmt>255748</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>10000</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>69941</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>335689</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>SHAWN BARTEL</PersonNm>
        <TitleTxt>HCE</TitleTxt>
        <BaseCompensationFilingOrgAmt>262603</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>15000</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>45666</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>323269</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR TODD ANDERSON</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>252089</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>12000</BonusFilingOrganizationAmount>
        <TotalCompensationFilingOrgAmt>264089</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PART III</FormAndLineReferenceDesc>
        <ExplanationTxt>OVATION HEALTHCARE WHO IS CONTRACTED BY THE BOARD OF DIRECTORS TO MANAGE THE HOSPITAL PAYS THE PRES/CEO AND VP-FINANCE SINCE THEY ARE EMPLOYEES OF OVATION HEALTH CARE. HRMC PAID THE PLANE FARE FOR A SPOUSE OF A TRUSTEE TO ATTEND A BOARD TRAINING CONFERENCE.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="RetDoc8">
      <LoansBtwnOrgInterestedPrsnGrp>
        <PersonNm>DR KRISTEN HUGHES</PersonNm>
        <RelationshipWithOrgTxt>MD</RelationshipWithOrgTxt>
        <LoanPurposeTxt>HOUSING</LoanPurposeTxt>
        <LoanFromOrganizationInd>X</LoanFromOrganizationInd>
        <OriginalPrincipalAmt>50000</OriginalPrincipalAmt>
        <BalanceDueAmt>31833</BalanceDueAmt>
        <DefaultInd>false</DefaultInd>
        <BoardOrCommitteeApprovalInd>true</BoardOrCommitteeApprovalInd>
        <WrittenAgreementInd>true</WrittenAgreementInd>
      </LoansBtwnOrgInterestedPrsnGrp>
      <LoansBtwnOrgInterestedPrsnGrp>
        <PersonNm>DR CHRISTOPHER BRONSON</PersonNm>
        <RelationshipWithOrgTxt>MD</RelationshipWithOrgTxt>
        <LoanPurposeTxt>HOUSING</LoanPurposeTxt>
        <LoanFromOrganizationInd>X</LoanFromOrganizationInd>
        <OriginalPrincipalAmt>50000</OriginalPrincipalAmt>
        <BalanceDueAmt>26566</BalanceDueAmt>
        <DefaultInd>false</DefaultInd>
        <BoardOrCommitteeApprovalInd>true</BoardOrCommitteeApprovalInd>
        <WrittenAgreementInd>true</WrittenAgreementInd>
      </LoansBtwnOrgInterestedPrsnGrp>
      <TotalBalanceDueAmt>58399</TotalBalanceDueAmt>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>PICEK CONSTRUCTION</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>TREASURER</RelationshipDescriptionTxt>
        <TransactionAmt>30063</TransactionAmt>
        <TransactionDesc>CONST. OWNER REP</TransactionDesc>
        <SharingOfRevenuesInd>false</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc9">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE ATTACHED</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>HRMC CONTRACTED WITH OVATION HEALTHCARE TO PROVIDE MANAGEMENT SERVICES AS DIRECTED BY THE BOARD. OVATION HEALTHCARE THEN EMPLOYS PRESIDENT/CEO AND VP-FINANCE/CFO.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>ORGANIZATION'S PROCESS IS TO PROVIDE FORM 990 TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990 ALSO PRESENTED TO BOARD BY AUDITOR/CFO.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>ENFORCEMENT OF CONFLICTS OF INTEREST POLICY FOR BOARD OF DIRECTORS IS DONE THROUGH THE EXECUTIVE COMMITTEE WHO ACTIVELY MONITORS COMPLIANCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION COMMITTEE IN CONJUNCTION WITH OVATION HEALTHCARE REVIEWED INDEPENDENT COMPENSATION CONSULTANT'S COMPENSATION SURVEY FOR BOTH CEO AND CFO. BOARD APPROVED EXECUTIVE COMPENSATION POLICY, REQUIRES AN INDEPENDENT COMPENSATION SURVEY EVERY 4 YEARS AND REVIEW OF CEO AND CFO COMPENSATION ANNUALLY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION COMMITTEE IN CONJUNCTION WITH OVATION HEALTHCARE REVIEWED INDEPENDENT COMPENSATION CONSULTANT'S COMPENSATION SURVEY FOR BOTH CEO AND CFO. BOARD APPROVED EXECUTIVE COMPENSATION POLICY, REQUIRES AND INDEPENDENT COMPENSATION SURVEY EVERY 4 YEARS AND REVIEW OF CEO AND CFO COMPENSATION ANNUALLY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE FOR PUBLIC INSPECTION AT THE ADMINISTRATION OFFICE OF THE ORGANIZATION. FINANCIAL STATEMENTS MADE PUBLIC AND ANNUAL POSTING OF FORM 990 THROUGH GUIDESTAR AND ON HOSPITAL WEBSITE</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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        <DisregardedEntityName>
          <BusinessNameLine1Txt>HURON REG MEDICAL CTR FOUNDATION</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>110 4TH STREET SE</AddressLine1Txt>
          <CityNm>HURON</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57350</ZIPCd>
        </USAddress>
        <EIN>460437171</EIN>
        <PrimaryActivitiesTxt>FUNDRAISER</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501C</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
