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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Roy Cordy MD</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>914 3rd Avenue S Unit</AddressLine1Txt>
            <CityNm>Fargo</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58103</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ER physician services</ServicesDesc>
        <CompensationAmt>345095</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Ram Paneru MD</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2318 W Fallcreek Ct</AddressLine1Txt>
            <CityNm>Grand Forks</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58201</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ER physician services</ServicesDesc>
        <CompensationAmt>326395</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Medical Solutions</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5646 Merriam Dr</AddressLine1Txt>
            <CityNm>Merriam</CityNm>
            <StateAbbreviationCd>KS</StateAbbreviationCd>
            <ZIPCd>66203</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Travel nurse</ServicesDesc>
        <CompensationAmt>201339</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>7</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>34221</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>1095</AllOtherContributionsAmt>
      <TotalContributionsAmt>35316</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient service revenue</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>9379546</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>9379546</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Pharmacy revenue</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>416188</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>416188</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Outside laundry revenue</Desc>
        <BusinessCd>812300</BusinessCd>
        <TotalRevenueColumnAmt>160594</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>160594</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>EHR incentive</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>152837</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>152837</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Supporting revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>54327</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>54327</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>10163492</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>38515</TotalRevenueColumnAmt>
        <ExclusionAmt>38515</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>6606</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>6695</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>-89</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>-89</TotalRevenueColumnAmt>
        <ExclusionAmt>-89</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>10237234</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>10163492</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>38426</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>733</TotalAmt>
        <ProgramServicesAmt>733</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>3686694</TotalAmt>
        <ProgramServicesAmt>3208877</ProgramServicesAmt>
        <ManagementAndGeneralAmt>477817</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>87378</TotalAmt>
        <ProgramServicesAmt>71584</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15794</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>449906</TotalAmt>
        <ProgramServicesAmt>391596</ProgramServicesAmt>
        <ManagementAndGeneralAmt>58310</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>265344</TotalAmt>
        <ProgramServicesAmt>231146</ProgramServicesAmt>
        <ManagementAndGeneralAmt>34198</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>481596</TotalAmt>
        <ManagementAndGeneralAmt>481596</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>3212</TotalAmt>
        <ManagementAndGeneralAmt>3212</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>43750</TotalAmt>
        <ManagementAndGeneralAmt>43750</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>2832330</TotalAmt>
        <ProgramServicesAmt>2625915</ProgramServicesAmt>
        <ManagementAndGeneralAmt>206415</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>8188</TotalAmt>
        <ManagementAndGeneralAmt>8188</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>246565</TotalAmt>
        <ProgramServicesAmt>166703</ProgramServicesAmt>
        <ManagementAndGeneralAmt>79862</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>212476</TotalAmt>
        <ProgramServicesAmt>212476</ProgramServicesAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>34448</TotalAmt>
        <ProgramServicesAmt>21876</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12572</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>1009</TotalAmt>
        <ManagementAndGeneralAmt>1009</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>10581</TotalAmt>
        <ProgramServicesAmt>10581</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>466346</TotalAmt>
        <ProgramServicesAmt>466346</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>62350</TotalAmt>
        <ProgramServicesAmt>62350</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Medical supplies</Desc>
        <TotalAmt>913021</TotalAmt>
        <ProgramServicesAmt>913021</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Bad debt expense</Desc>
        <TotalAmt>355507</TotalAmt>
        <ProgramServicesAmt>355507</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Food</Desc>
        <TotalAmt>99959</TotalAmt>
        <ProgramServicesAmt>99959</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Dues &amp; subscriptions</Desc>
        <TotalAmt>43924</TotalAmt>
        <ProgramServicesAmt>34000</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9924</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>214</TotalAmt>
        <ProgramServicesAmt>86</ProgramServicesAmt>
        <ManagementAndGeneralAmt>128</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>10305531</TotalAmt>
        <ProgramServicesAmt>8872756</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1432775</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>546734</BOYAmt>
        <EOYAmt>390683</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1633565</BOYAmt>
        <EOYAmt>1044190</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>176818</BOYAmt>
        <EOYAmt>182637</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>13906</BOYAmt>
        <EOYAmt>16181</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>7648453</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>6567763</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>1312672</BOYAmt>
        <EOYAmt>1080690</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>1251373</BOYAmt>
        <EOYAmt>1556630</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>76704</BOYAmt>
        <EOYAmt>89776</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>529289</BOYAmt>
        <EOYAmt>785003</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>5541061</BOYAmt>
        <EOYAmt>5145790</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>912133</BOYAmt>
        <EOYAmt>814741</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>152837</BOYAmt>
      </DeferredRevenueGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>701925</BOYAmt>
        <EOYAmt>551537</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>1766895</BOYAmt>
        <EOYAmt>1366278</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>3716004</BOYAmt>
        <EOYAmt>3779512</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TemporarilyRstrNetAssetsGrp>
        <BOYAmt>58162</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </TemporarilyRstrNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>3774166</BOYAmt>
        <EOYAmt>3779512</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>5541061</BOYAmt>
        <EOYAmt>5145790</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-68297</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>79959</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>-6316</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolAndSepBasisFinclStmtInd>X</ConsolAndSepBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>0</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>75778</OtherCostOrOtherBasisAmt>
        <BookValueAmt>75778</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>4175084</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3776055</DepreciationAmt>
        <BookValueAmt>399029</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>3378513</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2772630</DepreciationAmt>
        <BookValueAmt>605883</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>19078</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>19078</DepreciationAmt>
        <BookValueAmt>0</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>1080690</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Estimated third-party payor settlements</Desc>
        <BookValueAmt>649000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Other receivables</Desc>
        <BookValueAmt>16003</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Estimated insurance recoveries on malpractice claims</Desc>
        <BookValueAmt>120000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>785003</TotalBookValueOtherAssetsAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>10019713</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>79959</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>-297345</OtherRevenueAmt>
      <RevenueNotReportedAmt>-217386</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>10237099</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>135</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>135</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>10237234</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>9950024</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>9950024</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>355507</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>355507</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>10305531</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Medical Center is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Medical Center has determined that it is not subject to unrelated business income and has not filed and Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Medical Center believes that it 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 Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Provision for bad debts recorded in expenses for Form 990 -355,507. Net assets released from restriction recorded in revenue for financial stmts 58,162.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Unrestricted contributions recorded in fund balance for financial statements 135.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Provisions for bad debts recorded in expenses for Form 990 355,507.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="RetDoc1041500001">
      <FinancialAssistancePolicyInd>1</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>1</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>1</FPGReferenceFreeCareInd>
      <Percent100Ind>X</Percent100Ind>
      <FPGReferenceDiscountedCareInd>1</FPGReferenceDiscountedCareInd>
      <Percent200DInd>X</Percent200DInd>
      <FreeCareMedicallyIndigentInd>1</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>1</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>0</ExpensesExceedBudgetInd>
      <AnnualCommunityBnftReportInd>1</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>1</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>83000</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>83000</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00830</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>83000</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>83000</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00830</TotalExpensePct>
      </TotalFinancialAssistanceTyp>
      <CommunityHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>44347</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>3465</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>40882</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00410</TotalExpensePct>
      </CommunityHealthServicesGrp>
      <SubsidizedHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>843441</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>772278</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>71163</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00720</TotalExpensePct>
      </SubsidizedHealthServicesGrp>
      <CashAndInKindContributionsGrp>
        <TotalCommunityBenefitExpnsAmt>17469</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>17469</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00180</TotalExpensePct>
      </CashAndInKindContributionsGrp>
      <TotalOtherBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>905257</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>775743</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>129514</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.01310</TotalExpensePct>
      </TotalOtherBenefitsGrp>
      <TotalCommunityBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>988257</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>775743</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>212514</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.02140</TotalExpensePct>
      </TotalCommunityBenefitsGrp>
      <EconomicDevelopmentGrp>
        <TotalCommunityBenefitExpnsAmt>685</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>685</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00010</TotalExpensePct>
      </EconomicDevelopmentGrp>
      <HealthImprovementAdvocacyGrp>
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        <NetCommunityBenefitExpnsAmt>12189</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00120</TotalExpensePct>
      </HealthImprovementAdvocacyGrp>
      <TotalCommuntityBuildingActyGrp>
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        <NetCommunityBenefitExpnsAmt>12874</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00130</TotalExpensePct>
      </TotalCommuntityBuildingActyGrp>
      <BadDebtExpenseReportedInd>0</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>355507</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>142203</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>3077014</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>3101702</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>-24688</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <OtherInd>X</OtherInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>1</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>1</FinancialAssistancePrvsnInd>
      <HospitalFacilitiesCnt>1</HospitalFacilitiesCnt>
      <HospitalFacilitiesGrp>
        <FacilityNum>1</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>Presentation Medical Center</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>213 2nd Avenue NE</AddressLine1Txt>
          <CityNm>Rolla</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>583670759</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>www.pmc-rolla.com</WebsiteAddressTxt>
        <StateLicenseNum>5045</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <CriticalAccessHospitalInd>X</CriticalAccessHospitalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <OtherDesc>1 provider based clinic</OtherDesc>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1Txt>Presentation Medical Center</BusinessNameLine1Txt>
        </HospitalFacilityName>
        <FacilityNum>1</FacilityNum>
        <FirstLicensedCYOrPYInd>0</FirstLicensedCYOrPYInd>
        <TaxExemptHospitalCYOrPYInd>0</TaxExemptHospitalCYOrPYInd>
        <CHNAConductedInd>1</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <InformationGapsInd>X</InformationGapsInd>
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        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 5: The PMC CEO and other staff participated in the community focus group and made copies of the survey available to staff and patients at the clinic and hospital. In order to not burden community members by repeating the assessment process recently completed by Rolette County Public Health, Presentation Medical Center chose to distribute an abbreviated survey. The questions selected, by PMC, were from a list of elective questions routinely used by the Center for Rural Health when conducting other CHNAs. The intent was to gather feedback from community residents more specific to the services provided by PMC hospital and clinic and not duplicate the recent CHNA survey. Eighty-one PMC service area residents completed the PMC survey. Additional information was also collected through a community meeting. The input from the residents represented broad interests of the communities in the service area, which primarily reside in Rolette County. Information gathered through the PMC survey and community meeting, the Rolette County Public Health CHNA process, and secondary data gathered from a wide range of sources, presents a valuable snapshot of health needs and concerns in the service area.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 11: The following needs were identified in the recently conducted community health needs assessment. Actions will be taken in the following fiscal year due to the timing of the completion of the Implementation Strategy.Tier I Needs:1. The ability to recruit and retain primary health care providers (MD, DO, PA, and NP):One of the main concerns from the community needs assessment was the limited number of primary health care providers in Rolette County. While this is a concern of most of the rural counties in North Dakota, Presentation Medical Center is keenly aware of the importance of continual recruitment and the value of retaining our medical staff. In September of 2016, our Medical staff consists of 2 Physicians and 3 Family Nurse Practitioners. We have also recently hired a new graduate Physician's Assistant, who is scheduled to join the staff on January, 2017. Recruiting for medical staff is a high priority at the facility, along with continuing the discovery to find solutions and options for the retention of staff. The most important aspect to hiring any new health care providers is to have them live and become part of the Rolla, ND community. In 2017, PMC will develop a formal health care provider retention plan to focus on the importance of retaining qualified providers.Timeframe: Ongoing action steps with oversight by PMC Executive Committee.Tier II Needs:1. High Rates of Diabetes:The high rate of diabetes is a medical issue that the 2016 Community Health Assessment revealed and the same issue was also identified as high priority in 2013. Presentation Medical Center has committed to providing a nurse educator in 2015 to host weekly diabetes education for the general public of the area. These education events have continued to run through 2016 and will continue to be facilitated at PMC. PMC will work closely with Rolette County Public Department on public education information that has a focus on diabetes prevention and obesity, as well as support group activities. In November 2016, a grant was written to facilitate and receive funding to implement a population health strategy that would screen 500 additional Rolette County residents for hypertension, refer individuals for further medical evaluation and provide health education regarding disease processes and modifiable risk factors. Presentation Medical Center will continue to offer an Outreach Specialty Podiatrist for foot care and will continue to provide additional information to our patients. This task will be ongoing with collaboration from Rolette County Public Health.2. Alcohol/Drug Use and Abuse:As alcohol/drug use and abuse were listed high on the PMC health concerns, as well as the 2015 Rolette County Public Health Needs Assessment, the survey dictates that attention must be focused at this continued health issue in our area. In 2016, RCPH started an education and awareness program that PMC will become an active participant and collaborator as it is presented to the community and at awareness events. In 2017, PMC plans to increase screening and education through our clinic providers and mental health providers. PMC, with assistance from RCPH, will also provide education materials at community events when appropriate and the yearly community health fair.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 13h: Presentation Medical Center also evaluates a patient's family size, income and demographics to determine eligibility for additional free or discounted care to low income individuals.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 22d: Presentation Medical Center has chosen to use the Look Back Method for calculating amounts charged to patients, The billing and coding process used for financial assistance eligible patients is the same process used for a Medicare costs. The discount will be applied once the patient has submitted a complete application for financial assistance. The patient will receive a letter and a Community Caring Card informing them the amount of their discount.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3c:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center also evaluates a patient's family size and demographics to determine eligibility for additional free or discounted care to low income individuals.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 6a:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center's community benefit report can be found on its website at pmc-rolla.com.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>Charity care expense was converted to cost on line 7a based on the cost-to-charge ratio derived from Worksheet 2. Inpatient and outpatient Hospital services provided to Medicaid program beneficiaries are primarily paid on a cost-related basis, therefore there is no community benefit related to Medicaid on line 7b. Community health improvement services, health professions education and in-kind contributions to community groups are reported based on actual expenses recorded in the organization's general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Ln 7 Col(f):</FormAndLineReferenceDesc>
        <ExplanationTxt>The amount of bad debt expense removed from total expenses to determine the percentage was $355,507.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part II, Community Building Activities:</FormAndLineReferenceDesc>
        <ExplanationTxt>Case Management Services are provided to patients, their family members and community members. Those individuals requiring substance abuse referrals and assistance require intensive services. Due to the significant number of social issues in Rolette County, case management services are provided to connect patients with the services that they need to regain/maintain their health status. Every effort is made to assist patients in obtaining the services that they require to maintain good health and a quality lifestyle. Transportation services are provided to patients who need rides home following hospitalization and for appointments for specialized care. These are patients who do not have family or friends who are willing or able to transport them for these appointments. By assisting with transportation, patients are able to receive specialty consultation services that allow them to enhance the quality of their life.Caregiver meals were provided to individuals. A caregiver gives so much of their time helping others they often don't have the time to get a meal. The meal is supplied so they can focus on caring for their loved one.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad debt expense is the write-off of a patient's account for services provided by the Hospital after all payments, discounts, and contractual allowances have been applied. Accounts that qualify or may qualify for financial assistance or charity care are not written off to bad debt. Payments received on accounts previously written off to bad debt reduces bad debt expense. Bad debt expense on line 2 is reported at charges as presented on the financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on an estimate of applications denied due to lack of information. This is estimated at 40%. Presentation Medical Center estimates the amount of bad debt expense attributable to patient's under the charity care policy because the Organization knows that some accounts are written off to bad debt that may have been charity care if the patient had completed the paper work.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The footnote to the Organization's financial statements can be found on page 8 of the attached audited financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicaid and Medicare Services.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center believes it has an obligation to make every effort possible to collect for services rendered from all patients who have the ability to pay their account. There are no collection efforts for patients who qualify for charity care or financial assistance, indigent patients, or patients that have set up payment arrangements. If a portion of an account is written off to charity care, any personal portion due follows the same collection procedures as other accounts. For patients who are indigent, Presentation Medical Center has a Charity Care provision with the appropriate application process. For self pay patients, Presentation Medical Center offers a prompt payment discount of 25% for payment in full within 30 days from the date of their first statement.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center strives to provide basic healthcare services to its communities. We have worked with the Rolette County Public Health, Rolette County Police Department, Rolla Community Ambulance, Rolette County Social Services and other community departments to provide basic care to the members of our community. Working with these organizations allows us to provide different services to our community and to make sure that one of these entities is able to provide care and or cover for one another.Our community health needs assessment is completed and posted to our website to meet the requirements of 501(r).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center is committed to providing care to persons who are uninsured, underinsured, ineligible for government programs, or otherwise unable to pay for medically necessary care. Our Community Caring Program was established in 2005. We have seen a continual increase every year in charity care as we try to get patients involved in the program before their accounts are sent to collections. A brochure is provided to every patient when they register outlining our payment expectations and explaining our Community Caring Program. Notification about charity care is available in emergency rooms, admitting and registration departments, the Business office, and other public areas within the Hospital. Information is also included in patient bills and patient information packets. At registration, patients are given the Payment Policy and Community Caring Program handout. This handout explains patient responsibilities, insurance billing guidelines, financing and payment options, and the Community Caring guidelines.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center (PMC) is a 25-bed not-for-profit, Critical Access Hospital (CAH) located in Rolla, Rolette County, ND. Rolla, ND is located in north central North Dakota, next to the Canadian border. Presentation Medical Center is located approximately 40 miles from Bottineau, 120 miles northeast of Minot, 170 miles northwest of Grand Forks, 205 miles northeast of Bismarck, and 240 miles northwest of Fargo. The nearest city with a population &gt; 50,000 is Bismarck, ND.PMC is highly dependent upon government Payors. In the Fiscal Year ending 09/30/2016, Medicaid was the payor for 35.3% of inpatients and 52.5% of outpatients, while Medicare was the payor for 54.4% of inpatients and 20.1% of total outpatients. By virtue of where we are located and the services that we provide, we are a benefit to our community.The service area of PMC includes Rolette and part of Towner Counties. Rolette County has a total population of 14,649 with 76.4% of the population being Native American. With this census, 1.94% of North Dakota's population lives in Rolette County. The per capita income for Rolette County is $15,825 compared with North Dakota's per capita income of $32,781 with 31.6% of the county living below the poverty guidelines. (Source: U.S. Census Bureau).The closest healthcare facility is 7 miles away located in Belcourt, ND, which is an Indian Healthcare Facility. All other hospitals are located 40 miles or more from Presentation Medical Center. Presentation Medical Center's tertiary facility is located over 120 miles away in Minot, ND. It is in the best interest of the community to be able to offer basic healthcare needs due to the distance that the patient must travel.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center works to address the basic healthcare needs in Rolette County and the surrounding communities. The Hospital is a major medical provider for the county providing inpatient, outpatient, and surgical services. In addition, Presentation Medical Center is a key provider of emergency care. The emergency room is open 24 hours and is available regardless of a person's ability to pay.Presentation Medical Center extends medical staff privileges to all qualified physicians who meet PMC's Medical Staff Bylaws. Surplus funds are used for equipment upgrades and facility improvements. A majority of the organization's governing body resides in Rolla, ND and none are employees nor contractors of the organization. The governing body does not have any family relationships with each other.In addition to our very existence, PMC believes that there are additional areas that highlight our benefit to the community. By being what and who we are, we strive to be a good community citizen and an asset to the communities that we serve. PMC routinely provides a variety of services that address needs within the community.PMC provided an annual Healthy Community Day that offers educational material and health screenings, including laboratory screenings that provide information about an individuals' general health condition. These services are offered to all community residents.Physical Therapy and Pharmacy students also had the opportunity to obtain clinical experience at PMC.Blood drives are sponsored two times per year. United Blood Services uses the Inservice Room as a collection site and the Lab and Admission staff members are responsible for recruiting and coordinating donors.Staff support and office space is provided to the Rural Mental Health Consortium. This allows mental health services to be available in the community on a weekly basis.Sport Injury evaluation and screenings are provided to area High School students and staff members from Physical Therapy provide support at local athletic events.PMC provides Pastoral Care services to all our patients and the community members. Pastoral Care serves as a liaison with the area Ministerial Associations.Supply donations are given out to patients. PMC will provide linen facilities to outside organizations in need.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 6:</FormAndLineReferenceDesc>
        <ExplanationTxt>We are an affiliate of the Sisters of Mary of the Presentation Health Corporation. Presentation Medical Center operates in accordance with the mission, vision, and values of the Sisters of Mary of the Presentation Health Corporation. Our annual budgeting process includes an assessment of how our budget demonstrates a commitment to the values of the system and the system works to ensure we are always mindful of our duty to care for the poor and those in need. Presentation Medical Center has a Strategic Plan developed from themes set forth by the health system for all affiliates.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Question 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center does not pay compensation to the President/CEO. This individual is compensated by Sisters of Mary of the Presentation Health Corporation, a related organization, for services to the Medical Center. Sisters of Mary of the Presentation Health Corporation uses one or more of the methods in Part I, question 3 to determine compensation.</ExplanationTxt>
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    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>Mark Kerr, Paula Wilkie and Sr. Margaret Rose Pfeifer have business relationships with each other. Gerry Krech and Paula Wilkie have a family relationship.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The sole member of the organization is the Sisters of Mary of the Presentation Health Corporation.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>The member is entitled to vote in the election of Directors and to cast one vote for each Director to be elected. The member is also entitled to one vote on every other matter to be voted on by the member. Votes cast on behalf of the member are cast by the Chief Executive Officer of Sisters of Mary of the Presentation Health Corporation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>The authority to act on the following matters are exclusively vested in the member of the organization: 1. any change in the philosophy, objectives and purposes of the organization; 2. amendment of the articles of incorporation and bylaws; 3. the election or removal of the Directors; 4. merger or consolidation with any other organization; 5. dissolution of the organization or the sale, lease or exchange of all or substantially all of its property or assets; 6. the sale, lease, transfer or encumbrance of any land, buildings or other assets owned by the organization or in which the organization has or will have equitable or legal title; 7. approval of the annual operating and capital budgets; 8. appointment of the Chief Executive Officer.</ExplanationTxt>
      </SupplementalInformationDetail>
      <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 11</FormAndLineReferenceDesc>
        <ExplanationTxt>The Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Each Director must submit in writing to the Chairperson of the Board and the CEO a list of all business or other organizations of which the individual is an officer, director, trustee, member, owner (either as a sole proprietor or partner), shareholder with a 5% or greater interest in all outstanding voting shares, employee or agent, with which the organization has, or might reasonably in the future enter into, a relationship or a transaction in which the Director would have conflicting interests. Each written statement is resubmitted with any necessary changes each year. The Chairperson of the Board reviews the statements of the Directors and the Vice Chairperson of the Board reviews the statement filed by the Chairperson. When a conflict arises the affected Director makes known the potential conflict, whether disclosed by written statement or not, and after answering any questions, will withdraw from the meeting for as long as the matter continues under discussion. Should the matter be brought to a vote, the affected Director will not vote on it. In the event the Director does not withdraw voluntarily, the Chairperson of the Board has authority to require the Director to remove himself from the room during both the discussion and vote on the matter. In the event the conflict of interest affects the Chairperson, the Vice Chairperson has authority to require the Chairperson remove himself in the same matter. If the matter is the item of business for which a special meeting of the Board was called, the affected Director will not be counted to establish a quorum, and he will not participate in the deliberations or vote on it.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization's CEO and CFO are both compensated by Sisters of Mary of the Presentation Health Corporation, a related organization. The compensation process is determined by the related organization. The Sisters of Mary of the Presentation Health Corporation Board of Trustees directly engages a nationally recognized independent compensation consulting firm to review the total compensation arrangements of the officers and key employees. The Sisters of Mary of the Presentation Health Corporation Board of Trustees approves all compensation based on comparable data and documents their decision in the meeting minutes.</ExplanationTxt>
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      <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 written request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Purchased services: Program service expenses 2,203,169. Management and general expenses 153,163. Fundraising expenses 0. Total expenses 2,356,332. Repairs and maintenance: Program service expenses 422,746. Management and general expenses 12,656. Fundraising expenses 0. Total expenses 435,402. Professional fees: Program service expenses 0. Management and general expenses 40,596. Fundraising expenses 0. Total expenses 40,596.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Equity transfer to Sisters of Mary of the Presentation Health Corporation -6,316.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2c:</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing board of Sisters of Mary of the Presentation Health Corporation assumes responsibility for oversight of the audit for Presentation Medical Center.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <AddressLine1Txt>1202 Page Drive SW</AddressLine1Txt>
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        <PrimaryActivitiesTxt>Facilitates management and operations of ten related facilities</PrimaryActivitiesTxt>
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          <AddressLine1Txt>316 Ohmer Street</AddressLine1Txt>
          <CityNm>Bottineau</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
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        <EIN>450413201</EIN>
        <PrimaryActivitiesTxt>Provide support to St. Andrew's Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 11a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Corporation</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Prairieland Home Care</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1102 Page Drive SW</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58103</ZIPCd>
        </USAddress>
        <EIN>450391192</EIN>
        <PrimaryActivitiesTxt>Home health and supportive services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 9</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Corporation</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Andrew's Hospital</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>316 Ohmer Street</AddressLine1Txt>
          <CityNm>Bottineau</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58318</ZIPCd>
        </USAddress>
        <EIN>450226426</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Corporation</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Aloisius Hospital</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>325 East Brewster Street</AddressLine1Txt>
          <CityNm>Harvey</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58341</ZIPCd>
        </USAddress>
        <EIN>450226729</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Corporation</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Margaret's Hospital</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>600 East First Street</AddressLine1Txt>
          <CityNm>Spring Valley</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61362</ZIPCd>
        </USAddress>
        <EIN>362167884</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Corporation</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Sisters of Mary of the Presentation Long Term Care</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1202 Page Drive SW</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58103</ZIPCd>
        </USAddress>
        <EIN>752999939</EIN>
        <PrimaryActivitiesTxt>Provide extended care and medically related services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 9</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Corporation</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Margaret's Hospital Foundation</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>600 East First Street</AddressLine1Txt>
          <CityNm>Spring Valley</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61362</ZIPCd>
        </USAddress>
        <EIN>364042262</EIN>
        <PrimaryActivitiesTxt>Provide support to St. Margaret's Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 11a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Corporation</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>St Andrew's Bottineau Clinic LLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>316 Ohmer Street</AddressLine1Txt>
          <CityNm>Bottineau</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58318</ZIPCd>
        </USAddress>
        <EIN>450451306</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Valley Regional Health Services</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>4391 Venture Drive</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>613541014</ZIPCd>
        </USAddress>
        <EIN>273891281</EIN>
        <PrimaryActivitiesTxt>Outpatient oncology services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>SMP Enterprises</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>PO Box 10007</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>581060007</ZIPCd>
        </USAddress>
        <EIN>363486506</EIN>
        <PrimaryActivitiesTxt>Collection Agency</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>1</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>