﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile" returnVersion="2011v1.5">
  <ReturnHeader binaryAttachmentCount="0">
    <Timestamp>2013-04-10T13:44:23-05:00</Timestamp>
    <TaxPeriodEndDate>2012-05-31</TaxPeriodEndDate>
    <PreparerFirm>
      <EIN>410746749</EIN>
      <PreparerFirmBusinessName>
        <BusinessNameLine1>CLIFTONLARSONALLEN LLP</BusinessNameLine1>
      </PreparerFirmBusinessName>
      <PreparerFirmUSAddress>
        <AddressLine1>220 SOUTH SIXTH STREET SUITE 300</AddressLine1>
        <City>MINNEAPOLIS</City>
        <State>MN</State>
        <ZIPCode>55402</ZIPCode>
      </PreparerFirmUSAddress>
    </PreparerFirm>
    <ReturnType>990</ReturnType>
    <TaxPeriodBeginDate>2011-06-01</TaxPeriodBeginDate>
    <Filer>
      <EIN>460391067</EIN>
      <Name>
        <BusinessNameLine1>PRAIRIE LAKES HEALTH CARE SYSTEM INC</BusinessNameLine1>
      </Name>
      <NameControl>PRAI</NameControl>
      <Phone>6058827000</Phone>
      <USAddress>
        <AddressLine1>PO BOX 1210</AddressLine1>
        <City>WATERTOWN</City>
        <State>SD</State>
        <ZIPCode>57201</ZIPCode>
      </USAddress>
    </Filer>
    <Officer>
      <Name>JILL FULLER</Name>
      <Title>CFO</Title>
      <Phone>6058827000</Phone>
      <DateSigned>2013-04-05</DateSigned>
      <AuthorizeThirdParty>1</AuthorizeThirdParty>
    </Officer>
    <Preparer>
      <Name>ROBERT E SCHILE</Name>
      <PTIN>P00369682</PTIN>
      <Phone>6123764500</Phone>
    </Preparer>
    <TaxYear>2011</TaxYear>
    <BuildTS>2016-02-25 16:41:14Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCount="11">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <NameOfPrincipalOfficerPerson>JILL FULLER</NameOfPrincipalOfficerPerson>
      <AddressPrincipalOfficerUS>
        <AddressLine1>PO BOX 1210</AddressLine1>
        <City>WATERTOWN</City>
        <State>SD</State>
        <ZIPCode>57201</ZIPCode>
      </AddressPrincipalOfficerUS>
      <GrossReceipts>114588652</GrossReceipts>
      <GroupReturnForAffiliates>0</GroupReturnForAffiliates>
      <Organization501c3>X</Organization501c3>
      <WebSite>WWW.PRAIRIELAKES.COM</WebSite>
      <TypeOfOrganizationCorporation>X</TypeOfOrganizationCorporation>
      <YearFormation>1986</YearFormation>
      <StateLegalDomicile>SD</StateLegalDomicile>
      <ActivityOrMissionDescription>HEALTH CARE SERVICES</ActivityOrMissionDescription>
      <NbrVotingMembersGoverningBody>14</NbrVotingMembersGoverningBody>
      <NbrIndependentVotingMembers>14</NbrIndependentVotingMembers>
      <TotalNbrEmployees>544</TotalNbrEmployees>
      <TotalNbrVolunteers>88</TotalNbrVolunteers>
      <TotalGrossUBI>1153629</TotalGrossUBI>
      <NetUnrelatedBusinessTxblIncome>0</NetUnrelatedBusinessTxblIncome>
      <ContributionsGrantsPriorYear>129359</ContributionsGrantsPriorYear>
      <ContributionsGrantsCurrentYear>226880</ContributionsGrantsCurrentYear>
      <ProgramServiceRevenuePriorYear>77489811</ProgramServiceRevenuePriorYear>
      <ProgramServiceRevenueCY>78930177</ProgramServiceRevenueCY>
      <InvestmentIncomePriorYear>3309449</InvestmentIncomePriorYear>
      <InvestmentIncomeCurrentYear>4029479</InvestmentIncomeCurrentYear>
      <OtherRevenuePriorYear>1077973</OtherRevenuePriorYear>
      <OtherRevenueCurrentYear>2094818</OtherRevenueCurrentYear>
      <TotalRevenuePriorYear>82006592</TotalRevenuePriorYear>
      <TotalRevenueCurrentYear>85281354</TotalRevenueCurrentYear>
      <GrantsAndSimilarAmntsPriorYear>143596</GrantsAndSimilarAmntsPriorYear>
      <GrantsAndSimilarAmntsCY>155832</GrantsAndSimilarAmntsCY>
      <BenefitsPaidToMembersPriorYear>0</BenefitsPaidToMembersPriorYear>
      <BenefitsPaidToMembersCY>0</BenefitsPaidToMembersCY>
      <SalariesEtcPriorYear>33571146</SalariesEtcPriorYear>
      <SalariesEtcCurrentYear>33433689</SalariesEtcCurrentYear>
      <TotalProfFundrsngExpPriorYear>0</TotalProfFundrsngExpPriorYear>
      <TotalProfFundrsngExpCY>0</TotalProfFundrsngExpCY>
      <TotalFundrsngExpCurrentYear>0</TotalFundrsngExpCurrentYear>
      <OtherExpensePriorYear>38983847</OtherExpensePriorYear>
      <OtherExpensesCurrentYear>36004779</OtherExpensesCurrentYear>
      <TotalExpensesPriorYear>72698589</TotalExpensesPriorYear>
      <TotalExpensesCurrentYear>69594300</TotalExpensesCurrentYear>
      <RevenuesLessExpensesPriorYear>9308003</RevenuesLessExpensesPriorYear>
      <RevenuesLessExpensesCY>15687054</RevenuesLessExpensesCY>
      <TotalAssetsBOY>169631399</TotalAssetsBOY>
      <TotalAssetsEOY>181017131</TotalAssetsEOY>
      <TotalLiabilitiesBOY>34640935</TotalLiabilitiesBOY>
      <TotalLiabilitiesEOY>32586154</TotalLiabilitiesEOY>
      <NetAssetsOrFundBalancesBOY>134990464</NetAssetsOrFundBalancesBOY>
      <NetAssetsOrFundBalancesEOY>148430977</NetAssetsOrFundBalancesEOY>
      <InfoInScheduleOPartIII>X</InfoInScheduleOPartIII>
      <MissionDescription>PRAIRIE LAKES HEALTH CARE SYSTEM THROUGH THE EFFORTS OF ITS DEDICATED EMPLOYEES AND PHYSICIANS, PROVIDES HIGH QUALITY, AFFORDABLE AND COMPASSIONATE HEALTHCARE SERVICES FOR THE PEOPLE IN THE REGION.</MissionDescription>
      <SignificantNewProgramServices>0</SignificantNewProgramServices>
      <SignificantChange>0</SignificantChange>
      <Expense>61295820</Expense>
      <Grants>155832</Grants>
      <Revenue>78930177</Revenue>
      <Description>PRAIRIE LAKES HEALTHCARE SYSTEM IS A LEADER IN REGIONAL HEALTHCARE FOR NORTHEASTERN SOUTH DAKOTA. CARING FOR A NINE-COUNTY SERVICE AREA OF 88,000 PEOPLE, THE HEALTH PROFESSIONALS OF PRAIRIE LAKES HEALTHCARE SYSTEM ARE DEDICATED TO EXCELLENCE. THAT COMMITMENT HAS MADE PRAIRIE LAKES ONE OF THE MOST INNOVATIVE RURAL MEDICAL CENTERS IN THE NATION. PRAIRIE LAKES HEALTHCARE SYSTEM HAS BEEN A DYNAMIC MODEL FOR RURAL HEALTH; HAS SERVED AS A "SHOW SITE" FOR PATIENT CARE TECHNOLOGY AND DIAGNOSTIC EQUIPMENT; AND WE ARE UNCHALLENGED IN OUR UNCOMPROMISING CARE FOR PATIENTS AND THEIR FAMILIES. PRAIRIE LAKES HEALTHCARE SYSTEM PRIDES ITSELF ON BEING A TECHNOLOGICALLY-ADVANCED PROVIDER OF HEALTHCARE SERVICES TO THE PEOPLE IN THIS REGION. OUR MISSION TO OFFER QUALITY AND COMPASSIONATE SERVICES GUIDES OUR MEDICAL STAFF, EMPLOYEES, ADMINISTRATION, AND BOARD OF DIRECTORS. BECAUSE OF OUR PROACTIVE EFFORTS, PRAIRIE LAKES HAS BEEN FIRST IN THE STATE TO OFFER OUR PATIENTS LEADING-EDGE TECHNOLOGY AND SERVICES.PRAIRIE LAKES INVITED TO PARTICIPATE IN NATIONAL PROJECT. PRAIRIE LAKES HEALTHCARE SYSTEM IS ONE OF 13 HOSPITALS NATIONWIDE THAT PARTICIPATED IN A NATIONAL DEMONSTRATION PROJECT TO IMPROVE INPATIENT PROCESSES OF CARE IN AMERICAN HOSPITALS. THE ROBERT WOOD JOHNSON FOUNDATION AND THE INSTITUTE FOR HEALTHCARE IMPROVEMENT LEAD THE PROJECT. PRAIRIE LAKES RECEIVED THE EXCLUSIVE INVITATION AFTER BEING RECOGNIZED FOR INNOVATION AND QUALITY OF CARE DURING A PREVIOUS INSTITUTE FOR HEALTHCARE PROJECT. PRAIRIE LAKES FIRST IN STATE TO OFFER 8-CHANNEL MRI TECHNOLOGY. PRAIRIE LAKES HEALTHCARE SYSTEM WAS THE FIRST HOSPITAL IN THE STATE TO DEPLOY GE EXCITE 8-CHANNEL MRI TECHNOLOGY WITH THE PURCHASE OF A 8-CHANNEL MAGNETIC RESONANCE IMAGING (MRI) SCANNER. THE UNIT IS LOCATED IN THE RADIOLOGY DEPARTMENT AT PRAIRIE LAKES HOSPITAL AND REPLACED THE MOBILE UNIT LOCATED OUTSIDE THE HOSPITAL BUILDING. FIRST MINIMALLY INVASIVE KNEE SURGERY IN TRI-STATE AREA PERFORMED AT PRAIRIE LAKES. AN INNOVATIVE KNEE REPLACEMENT SURGERY AVAILABLE IN WATERTOWN GIVES PATIENTS A LESS INVASIVE ALTERNATIVE. THE TECHNIQUE, CALLED MINI-INCISION TOTAL KNEE ARTHROPLASTY, UTILIZES A 4- TO 5-INCH INCISION TO ACCESS THE DAMAGED PORTION OF THE KNEE, WHICH IS THEN REPLACED WITH AN ARTIFICIAL DEVICE. A SMALLER INCISION GENERALLY MEANS PATIENTS MAY EXPERIENCE LESS PAIN, LESS DISRUPTION OF TISSUE IN THE KNEE, AND MAY BE ABLE TO EXERCISE THE KNEE SOONER AND MORE EFFECTIVELY. THE SURGERY WAS THE FIRST OF ITS KIND IN NORTH AND SOUTH DAKOTA AND MINNESOTA.PRAIRIE LAKES FIRST IN STATE TO INSTALL 16-SLICE CT TECHNOLOGY. PRAIRIE LAKES HEALTHCARE SYSTEM WAS THE FIRST HOSPITAL IN SOUTH DAKOTA TO INSTALL AN ADVANCED COMPUTED TOMOGRAPHY (CT) SCANNER THAT PROVIDES DETAILED IMAGES OF THE BODY. THIS ADVANCED TECHNOLOGY NOT ONLY MEANS MORE DIAGNOSTIC INFORMATION FOR DOCTORS IN ROUTINE SITUATIONS, BUT ITS SPEED CAN ALSO SAVE PRECIOUS EXAM TIME IN THE EMERGENCY ROOM.PRAIRIE LAKES FIRST IN STATE TO OFFER IMRT. PRAIRIE LAKES CANCER CENTER WAS THE FIRST CANCER CENTER IN SOUTH DAKOTA TO OFFER ITS PATIENTS A SOPHISTICATED RADIATION THERAPY CALLED IMRT - INTENSITY MODULATED RADIATION THERAPY. THE GOAL AT THE CANCER CENTER IS TO CONTINUE TO STAY ABREAST OF THE LATEST ONCOLOGY TREATMENTS AND TECHNOLOGY AND BRING ADVANCED THERAPIES - LIKE IMRT - HERE TO WATERTOWN.</Description>
      <TotalProgramServiceExpense>61295820</TotalProgramServiceExpense>
      <DescribedIn501C3 referenceDocumentId="RetDoc1039100001">1</DescribedIn501C3>
      <ScheduleBRequired referenceDocumentId="RetDoc1234500001">1</ScheduleBRequired>
      <PoliticalActivities>0</PoliticalActivities>
      <LobbyingActivities>0</LobbyingActivities>
      <SubjectToProxyTax>0</SubjectToProxyTax>
      <DonorAdvisedFunds referenceDocumentId="RetDoc1040000001">0</DonorAdvisedFunds>
      <ConservationEasements referenceDocumentId="RetDoc1040000001">0</ConservationEasements>
      <CollectionsOfArt referenceDocumentId="RetDoc1040000001">0</CollectionsOfArt>
      <CreditCounseling referenceDocumentId="RetDoc1040000001">0</CreditCounseling>
      <TermOrPermanentEndowments referenceDocumentId="RetDoc1040000001">0</TermOrPermanentEndowments>
      <ReportLandBldgEquip referenceDocumentId="RetDoc1040000001">1</ReportLandBldgEquip>
      <ReportInvestOthSecurities referenceDocumentId="RetDoc1040000001">0</ReportInvestOthSecurities>
      <ReportProgRelInvest referenceDocumentId="RetDoc1040000001">0</ReportProgRelInvest>
      <ReportOtherAssets referenceDocumentId="RetDoc1040000001">0</ReportOtherAssets>
      <ReportOtherLiabilities referenceDocumentId="RetDoc1040000001">1</ReportOtherLiabilities>
      <ReportFin48Footnote referenceDocumentId="RetDoc1040000001">1</ReportFin48Footnote>
      <IndependentAuditFinancialStmt referenceDocumentId="RetDoc1040000001">0</IndependentAuditFinancialStmt>
      <ConsolidatedAuditFinancialStmt referenceDocumentId="RetDoc1040000001">1</ConsolidatedAuditFinancialStmt>
      <School>0</School>
      <ForeignOffice>0</ForeignOffice>
      <ForeignActivities>0</ForeignActivities>
      <MoreThan5000KToOrganizations>0</MoreThan5000KToOrganizations>
      <MoreThan5000KToIndividuals>0</MoreThan5000KToIndividuals>
      <ProfessionalFundraising>0</ProfessionalFundraising>
      <FundraisingActivities>0</FundraisingActivities>
      <Gaming>0</Gaming>
      <Hospital referenceDocumentId="RetDoc1041500001">1</Hospital>
      <FinancialStmtAttached referenceDocumentId="RetDoc2436500001">1</FinancialStmtAttached>
      <GrantsToOrganizations referenceDocumentId="RetDoc1041900001">1</GrantsToOrganizations>
      <GrantsToIndividuals referenceDocumentId="RetDoc1041900001">0</GrantsToIndividuals>
      <ScheduleJRequired referenceDocumentId="RetDoc1042400001">1</ScheduleJRequired>
      <TaxExemptBonds referenceDocumentId="RetDoc1053100001">1</TaxExemptBonds>
      <InvestTaxExemptBonds>1</InvestTaxExemptBonds>
      <EscrowAccount>0</EscrowAccount>
      <OnBehalfOfIssuer>0</OnBehalfOfIssuer>
      <ExcessBenefitTransaction referenceDocumentId="RetDoc1042800001">0</ExcessBenefitTransaction>
      <PriorExcessBenefitTransaction referenceDocumentId="RetDoc1042800001">0</PriorExcessBenefitTransaction>
      <LoanToOfficerOrDQP referenceDocumentId="RetDoc1042800001">1</LoanToOfficerOrDQP>
      <GrantToRelatedPerson referenceDocumentId="RetDoc1042800001">0</GrantToRelatedPerson>
      <BsnssRltnshpWithOrganization referenceDocumentId="RetDoc1042800001">0</BsnssRltnshpWithOrganization>
      <BsnssRltnshpThruFamilyMember referenceDocumentId="RetDoc1042800001">0</BsnssRltnshpThruFamilyMember>
      <OfficerEntityWithBsnssRltnshp referenceDocumentId="RetDoc1042800001">0</OfficerEntityWithBsnssRltnshp>
      <DeductibleNonCashContributions>0</DeductibleNonCashContributions>
      <DeductibleContributionsOfArt>0</DeductibleContributionsOfArt>
      <Terminated>0</Terminated>
      <PartialLiquidation>0</PartialLiquidation>
      <DisregardedEntity referenceDocumentId="RetDoc1043400001">0</DisregardedEntity>
      <RelatedEntity referenceDocumentId="RetDoc1043400001">1</RelatedEntity>
      <RelatedOrgControlledEntity>0</RelatedOrgControlledEntity>
      <TransactionRelatedEntity referenceDocumentId="RetDoc1043400001">0</TransactionRelatedEntity>
      <TransfersToExemptNonChrtblOrg referenceDocumentId="RetDoc1043400001">0</TransfersToExemptNonChrtblOrg>
      <ActivitiesConductedPartnership referenceDocumentId="RetDoc1043400001">0</ActivitiesConductedPartnership>
      <ScheduleORequired>1</ScheduleORequired>
      <NumberFormsTransmittedWith1096>82</NumberFormsTransmittedWith1096>
      <NumberW2GIncluded>0</NumberW2GIncluded>
      <NumberOfEmployees>544</NumberOfEmployees>
      <EmploymentTaxReturnsFiled>1</EmploymentTaxReturnsFiled>
      <UnrelatedBusinessIncome>1</UnrelatedBusinessIncome>
      <Form990-TFiled>1</Form990-TFiled>
      <ForeignFinancialAccount>0</ForeignFinancialAccount>
      <ProhibitedTaxShelterTrans>0</ProhibitedTaxShelterTrans>
      <TaxablePartyNotification>0</TaxablePartyNotification>
      <NonDeductibleContributions>0</NonDeductibleContributions>
      <QuidProQuoContributions>0</QuidProQuoContributions>
      <Form8282PropertyDisposedOf>0</Form8282PropertyDisposedOf>
      <FundsToPayPremiums>0</FundsToPayPremiums>
      <PremiumsPaid>0</PremiumsPaid>
      <IndoorTanningServices>0</IndoorTanningServices>
      <InfoInScheduleOPartVI>X</InfoInScheduleOPartVI>
      <NbrVotingGoverningBodyMembers>14</NbrVotingGoverningBodyMembers>
      <NumberIndependentVotingMembers>14</NumberIndependentVotingMembers>
      <FamilyOrBusinessRelationship>0</FamilyOrBusinessRelationship>
      <DelegationOfManagementDuties>0</DelegationOfManagementDuties>
      <ChangesToOrganizingDocs>0</ChangesToOrganizingDocs>
      <MaterialDiversionOrMisuse>0</MaterialDiversionOrMisuse>
      <MembersOrStockholders>0</MembersOrStockholders>
      <ElectionOfBoardMembers>0</ElectionOfBoardMembers>
      <DecisionsSubjectToApproval>0</DecisionsSubjectToApproval>
      <MinutesOfGoverningBody>1</MinutesOfGoverningBody>
      <MinutesOfCommittees>1</MinutesOfCommittees>
      <OfficerMailingAddress>0</OfficerMailingAddress>
      <LocalChapters>0</LocalChapters>
      <Form990ProvidedToGoverningBody>0</Form990ProvidedToGoverningBody>
      <ConflictOfInterestPolicy>1</ConflictOfInterestPolicy>
      <AnnualDisclosureCoveredPersons>1</AnnualDisclosureCoveredPersons>
      <RegularMonitoringEnforcement>1</RegularMonitoringEnforcement>
      <WhistleblowerPolicy>1</WhistleblowerPolicy>
      <DocumentRetentionPolicy>1</DocumentRetentionPolicy>
      <CompensationProcessCEO>1</CompensationProcessCEO>
      <CompensationProcessOther>1</CompensationProcessOther>
      <InvestmentInJointVenture>0</InvestmentInJointVenture>
      <UponRequest>X</UponRequest>
      <TheBooksAreInCareOf>
        <NameBusiness>
          <BusinessNameLine1>ADAM PAUL</BusinessNameLine1>
        </NameBusiness>
        <TelephoneNumber>6058827000</TelephoneNumber>
        <AddressUS>
          <AddressLine1>401 9TH AVENUE NW</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
      </TheBooksAreInCareOf>
      <InfoInScheduleOPartVII>X</InfoInScheduleOPartVII>
      <Form990PartVIISectionA>
        <NamePerson>JOHN CALVIN</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>ROGER CARTER MD</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>DUSTIN FLATTEN</NamePerson>
        <Title>BOARD TREASURER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <Officer>X</Officer>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>VINCE FOLEY</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>CATHERINE GERRISH MD</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>BERNIE HANSON MD</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>GEOFF HEIG</NamePerson>
        <Title>BOARD SECRETARY</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <Officer>X</Officer>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>MONTE HOPPER</NamePerson>
        <Title>BOARD CHAIR</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <Officer>X</Officer>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>JIM REDLINGER</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>GERALD RIEBER MD</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>MARK ROBY</NamePerson>
        <Title>BOARD VICE CHAIR</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <Officer>X</Officer>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>DOUG SHARP</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>LUANN STRAIT</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>LISSA TURBAK</NamePerson>
        <Title>BOARD MEMBER</Title>
        <AverageHoursPerWeek>1.00</AverageHoursPerWeek>
        <IndividualTrusteeOrDirector>X</IndividualTrusteeOrDirector>
        <ReportableCompFromOrganization>0</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>0</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>JILL FULLER</NamePerson>
        <Title>CEO</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <Officer>X</Officer>
        <ReportableCompFromOrganization>419372</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>25868</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>ADAM PAUL</NamePerson>
        <Title>CFO</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <Officer>X</Officer>
        <ReportableCompFromOrganization>72970</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>1078</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>MICHAEL ANDERSON</NamePerson>
        <Title>CHIEF INVESTMENT OFFICER</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <KeyEmployee>X</KeyEmployee>
        <ReportableCompFromOrganization>429508</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>24518</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>TRACI RABINE</NamePerson>
        <Title>VP CLINIC OPERATIONS</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <KeyEmployee>X</KeyEmployee>
        <ReportableCompFromOrganization>151605</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>21960</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>MICHELE TURBAK</NamePerson>
        <Title>CHIEF NURSING OFFICER</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <KeyEmployee>X</KeyEmployee>
        <ReportableCompFromOrganization>157540</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>21980</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>EVELIO GARCIA MD</NamePerson>
        <Title>PHYSICIAN</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <HighestCompensatedEmployee>X</HighestCompensatedEmployee>
        <ReportableCompFromOrganization>1170008</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>24861</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>SALEM MAALIKI MD</NamePerson>
        <Title>PHYSICIAN</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <HighestCompensatedEmployee>X</HighestCompensatedEmployee>
        <ReportableCompFromOrganization>979185</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>25058</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>SAIRAV SHAH MD</NamePerson>
        <Title>PHYSICIAN</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <HighestCompensatedEmployee>X</HighestCompensatedEmployee>
        <ReportableCompFromOrganization>786960</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>17506</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>BIPINKUMAR AMIN MD</NamePerson>
        <Title>PHYSICIAN</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <HighestCompensatedEmployee>X</HighestCompensatedEmployee>
        <ReportableCompFromOrganization>620500</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>21610</OtherCompensation>
      </Form990PartVIISectionA>
      <Form990PartVIISectionA>
        <NamePerson>JEFFERY BRINDLE MD</NamePerson>
        <Title>PHYSICIAN</Title>
        <AverageHoursPerWeek>40.00</AverageHoursPerWeek>
        <HighestCompensatedEmployee>X</HighestCompensatedEmployee>
        <ReportableCompFromOrganization>488849</ReportableCompFromOrganization>
        <ReportableCompFromRelatedOrgs>0</ReportableCompFromRelatedOrgs>
        <OtherCompensation>26709</OtherCompensation>
      </Form990PartVIISectionA>
      <TotalReportableCompFromOrg>5276497</TotalReportableCompFromOrg>
      <TotalReportableCompFrmRltdOrgs>0</TotalReportableCompFrmRltdOrgs>
      <TotalOtherCompensation>211148</TotalOtherCompensation>
      <NumberIndividualsGT100K>25</NumberIndividualsGT100K>
      <FormersListed>0</FormersListed>
      <TotalCompGT150K>1</TotalCompGT150K>
      <CompensationFromOtherSources>0</CompensationFromOtherSources>
      <ContractorCompensation>
        <NameOfContractor>
          <NameBusiness>
            <BusinessNameLine1>DR EW FILLER MD PC</BusinessNameLine1>
          </NameBusiness>
        </NameOfContractor>
        <AddressOfContractor>
          <AddressUS>
            <AddressLine1>21804 468TH AVE</AddressLine1>
            <City>VOLGA</City>
            <State>SD</State>
            <ZIPCode>57006</ZIPCode>
          </AddressUS>
        </AddressOfContractor>
        <DescriptionOfServices>ER MD COVERAGE</DescriptionOfServices>
        <Compensation>365379</Compensation>
      </ContractorCompensation>
      <ContractorCompensation>
        <NameOfContractor>
          <NameBusiness>
            <BusinessNameLine1>WEATHERBY LOCUMS</BusinessNameLine1>
          </NameBusiness>
        </NameOfContractor>
        <AddressOfContractor>
          <AddressUS>
            <AddressLine1>PO BOX 972633</AddressLine1>
            <City>DALLAS</City>
            <State>TX</State>
            <ZIPCode>75397</ZIPCode>
          </AddressUS>
        </AddressOfContractor>
        <DescriptionOfServices>ER MD ONCOLOGY COVERAGE</DescriptionOfServices>
        <Compensation>328106</Compensation>
      </ContractorCompensation>
      <ContractorCompensation>
        <NameOfContractor>
          <NameBusiness>
            <BusinessNameLine1>PDS INC</BusinessNameLine1>
          </NameBusiness>
        </NameOfContractor>
        <AddressOfContractor>
          <AddressUS>
            <AddressLine1>4152 30TH AVE S STE 103</AddressLine1>
            <City>FARGO</City>
            <State>ND</State>
            <ZIPCode>58104</ZIPCode>
          </AddressUS>
        </AddressOfContractor>
        <DescriptionOfServices>SLEEP STUDIES</DescriptionOfServices>
        <Compensation>317725</Compensation>
      </ContractorCompensation>
      <ContractorCompensation>
        <NameOfContractor>
          <NameBusiness>
            <BusinessNameLine1>MARK VOSSLER MD</BusinessNameLine1>
          </NameBusiness>
        </NameOfContractor>
        <AddressOfContractor>
          <AddressUS>
            <AddressLine1>47241 180TH ST</AddressLine1>
            <City>CLEAR LAKE</City>
            <State>SD</State>
            <ZIPCode>57226</ZIPCode>
          </AddressUS>
        </AddressOfContractor>
        <DescriptionOfServices>ER MD COVERAGE</DescriptionOfServices>
        <Compensation>195199</Compensation>
      </ContractorCompensation>
      <ContractorCompensation>
        <NameOfContractor>
          <NameBusiness>
            <BusinessNameLine1>PRAIRIE EMERGENCY PHYSICIANS LLC</BusinessNameLine1>
          </NameBusiness>
        </NameOfContractor>
        <AddressOfContractor>
          <AddressUS>
            <AddressLine1>PO BOX 793</AddressLine1>
            <City>TRAVERSE CITY</City>
            <State>MI</State>
            <ZIPCode>49685</ZIPCode>
          </AddressUS>
        </AddressOfContractor>
        <DescriptionOfServices>ER MD COVERAGE</DescriptionOfServices>
        <Compensation>187609</Compensation>
      </ContractorCompensation>
      <NumberOfContractorsGT100K>12</NumberOfContractorsGT100K>
      <RelatedOrganizations>126000</RelatedOrganizations>
      <AllOtherContributions>100880</AllOtherContributions>
      <TotalContributions>226880</TotalContributions>
      <ProgramServiceRevenue>
        <Description>NET PATIENT SERVICE RE</Description>
        <BusinessCode>621400</BusinessCode>
        <TotalRevenueColumn>78035608</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>78035608</RelatedOrExemptFunctionIncome>
      </ProgramServiceRevenue>
      <ProgramServiceRevenue>
        <Description>RETAIL PHARMACY</Description>
        <BusinessCode>900000</BusinessCode>
        <TotalRevenueColumn>639498</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>639498</UnrelatedBusinessRevenue>
      </ProgramServiceRevenue>
      <ProgramServiceRevenue>
        <Description>LAB SERVICE</Description>
        <BusinessCode>621500</BusinessCode>
        <TotalRevenueColumn>255071</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>255071</UnrelatedBusinessRevenue>
      </ProgramServiceRevenue>
      <TotalProgramServiceRevenue>78930177</TotalProgramServiceRevenue>
      <InvestmentIncome>
        <TotalRevenueColumn>284533</TotalRevenueColumn>
        <ExclusionAmount>284533</ExclusionAmount>
      </InvestmentIncome>
      <GrossRents>
        <Real>765534</Real>
      </GrossRents>
      <LessRentalExpenses>
        <Real>0</Real>
      </LessRentalExpenses>
      <RentalIncomeOrLoss>
        <Real>765534</Real>
      </RentalIncomeOrLoss>
      <NetRentalIncomeOrLoss>
        <TotalRevenueColumn>765534</TotalRevenueColumn>
        <ExclusionAmount>765534</ExclusionAmount>
      </NetRentalIncomeOrLoss>
      <GrossAmountSalesAssets>
        <Securities>20833290</Securities>
        <Other>12218954</Other>
      </GrossAmountSalesAssets>
      <LessCostOthBasisSalesExpenses>
        <Securities>17093908</Securities>
        <Other>12213390</Other>
      </LessCostOthBasisSalesExpenses>
      <GainOrLoss>
        <Securities>3739382</Securities>
        <Other>5564</Other>
      </GainOrLoss>
      <NetGainOrLossInvestments>
        <TotalRevenueColumn>3744946</TotalRevenueColumn>
        <ExclusionAmount>3744946</ExclusionAmount>
      </NetGainOrLossInvestments>
      <OtherRevenueMisc>
        <Description>OTHER INCOME</Description>
        <BusinessCode>900099</BusinessCode>
        <TotalRevenueColumn>1070224</TotalRevenueColumn>
        <ExclusionAmount>1070224</ExclusionAmount>
      </OtherRevenueMisc>
      <OtherRevenueMisc>
        <Description>CAFETERIA REVENUE</Description>
        <BusinessCode>722210</BusinessCode>
        <TotalRevenueColumn>253161</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>253161</UnrelatedBusinessRevenue>
      </OtherRevenueMisc>
      <OtherRevenueMisc>
        <Description>VENDING MACHINES</Description>
        <BusinessCode>722210</BusinessCode>
        <TotalRevenueColumn>4968</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>4968</UnrelatedBusinessRevenue>
      </OtherRevenueMisc>
      <MiscellaneousRevenue>
        <TotalRevenueColumn>931</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>931</UnrelatedBusinessRevenue>
      </MiscellaneousRevenue>
      <TotalOtherRevenue>1329284</TotalOtherRevenue>
      <TotalRevenue>
        <TotalRevenueColumn>85281354</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>78035608</RelatedOrExemptFunctionIncome>
        <UnrelatedBusinessRevenue>1153629</UnrelatedBusinessRevenue>
        <ExclusionAmount>5865237</ExclusionAmount>
      </TotalRevenue>
      <GrantsToDomesticOrgs>
        <Total>155832</Total>
        <ProgramServices>155832</ProgramServices>
      </GrantsToDomesticOrgs>
      <CompCurrentOfficersDirectors>
        <Total>1514800</Total>
        <ManagementAndGeneral>1514800</ManagementAndGeneral>
      </CompCurrentOfficersDirectors>
      <OtherSalariesAndWages>
        <Total>26703117</Total>
        <ProgramServices>23908776</ProgramServices>
        <ManagementAndGeneral>2794341</ManagementAndGeneral>
      </OtherSalariesAndWages>
      <PensionPlanContributions>
        <Total>633923</Total>
        <ProgramServices>557926</ProgramServices>
        <ManagementAndGeneral>75997</ManagementAndGeneral>
      </PensionPlanContributions>
      <OtherEmployeeBenefits>
        <Total>2599424</Total>
        <ProgramServices>2279763</ProgramServices>
        <ManagementAndGeneral>319661</ManagementAndGeneral>
      </OtherEmployeeBenefits>
      <PayrollTaxes>
        <Total>1982425</Total>
        <ProgramServices>1707991</ProgramServices>
        <ManagementAndGeneral>274434</ManagementAndGeneral>
      </PayrollTaxes>
      <FeesForServicesLegal>
        <Total>25193</Total>
        <ManagementAndGeneral>25193</ManagementAndGeneral>
      </FeesForServicesLegal>
      <FeesForServicesAccounting>
        <Total>49515</Total>
        <ManagementAndGeneral>49515</ManagementAndGeneral>
      </FeesForServicesAccounting>
      <FeesForServicesOther>
        <Total>5920241</Total>
        <ProgramServices>4782696</ProgramServices>
        <ManagementAndGeneral>1137545</ManagementAndGeneral>
      </FeesForServicesOther>
      <Advertising>
        <Total>261103</Total>
        <ProgramServices>29703</ProgramServices>
        <ManagementAndGeneral>231400</ManagementAndGeneral>
      </Advertising>
      <OfficeExpenses>
        <Total>6076257</Total>
        <ProgramServices>5830432</ProgramServices>
        <ManagementAndGeneral>245825</ManagementAndGeneral>
      </OfficeExpenses>
      <InformationTechnology>
        <Total>416834</Total>
        <ProgramServices>410101</ProgramServices>
        <ManagementAndGeneral>6733</ManagementAndGeneral>
      </InformationTechnology>
      <Occupancy>
        <Total>954941</Total>
        <ProgramServices>16150</ProgramServices>
        <ManagementAndGeneral>938791</ManagementAndGeneral>
      </Occupancy>
      <Travel>
        <Total>432052</Total>
        <ProgramServices>346111</ProgramServices>
        <ManagementAndGeneral>85941</ManagementAndGeneral>
      </Travel>
      <ConferencesMeetings>
        <Total>137297</Total>
        <ProgramServices>58369</ProgramServices>
        <ManagementAndGeneral>78928</ManagementAndGeneral>
      </ConferencesMeetings>
      <Interest>
        <Total>809016</Total>
        <ProgramServices>809016</ProgramServices>
      </Interest>
      <DepreciationDepletion>
        <Total>4717362</Total>
        <ProgramServices>4478650</ProgramServices>
        <ManagementAndGeneral>238712</ManagementAndGeneral>
      </DepreciationDepletion>
      <Insurance>
        <Total>250071</Total>
        <ProgramServices>250071</ProgramServices>
      </Insurance>
      <OtherExpenses>
        <Description>DRUGS</Description>
        <Total>7265869</Total>
        <ProgramServices>7265869</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>PROVISION FOR BAD DEBT</Description>
        <Total>3484501</Total>
        <ProgramServices>3484501</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>MEDICAL SUPPLIES</Description>
        <Total>2996386</Total>
        <ProgramServices>2995928</ProgramServices>
        <ManagementAndGeneral>458</ManagementAndGeneral>
      </OtherExpenses>
      <OtherExpenses>
        <Description>EQUIPMENT RENTAL &amp; MAIN</Description>
        <Total>1496489</Total>
        <ProgramServices>1485762</ProgramServices>
        <ManagementAndGeneral>10727</ManagementAndGeneral>
      </OtherExpenses>
      <AllOtherExpenses>
        <Total>711652</Total>
        <ProgramServices>442173</ProgramServices>
        <ManagementAndGeneral>269479</ManagementAndGeneral>
      </AllOtherExpenses>
      <TotalFunctionalExpenses>
        <Total>69594300</Total>
        <ProgramServices>61295820</ProgramServices>
        <ManagementAndGeneral>8298480</ManagementAndGeneral>
        <Fundraising>0</Fundraising>
      </TotalFunctionalExpenses>
      <CashNonInterestBearing>
        <BOY>1558</BOY>
        <EOY>1558</EOY>
      </CashNonInterestBearing>
      <SavingsAndTempCashInvestments>
        <BOY>6321488</BOY>
        <EOY>7700535</EOY>
      </SavingsAndTempCashInvestments>
      <AccountsReceivable>
        <BOY>6994797</BOY>
        <EOY>7466057</EOY>
      </AccountsReceivable>
      <ReceivablesFromOfficersEtc>
        <BOY>88633</BOY>
        <EOY>21033</EOY>
      </ReceivablesFromOfficersEtc>
      <OtherNotesLoansReceivableNet>
        <BOY>651081</BOY>
        <EOY>1767814</EOY>
      </OtherNotesLoansReceivableNet>
      <InventoriesForSaleOrUse>
        <BOY>1645996</BOY>
        <EOY>1633591</EOY>
      </InventoriesForSaleOrUse>
      <PrepaidExpensesDeferredCharges>
        <BOY>408091</BOY>
        <EOY>434407</EOY>
      </PrepaidExpensesDeferredCharges>
      <LandBuildingsEquipmentBasis>105719852</LandBuildingsEquipmentBasis>
      <LandBldgEquipmentAccumDeprec>51680743</LandBldgEquipmentAccumDeprec>
      <LandBuildingsEquipmentBasisNet>
        <BOY>54811788</BOY>
        <EOY>54039109</EOY>
      </LandBuildingsEquipmentBasisNet>
      <InvestmentsPubTradedSecurities>
        <BOY>93648690</BOY>
        <EOY>101188116</EOY>
      </InvestmentsPubTradedSecurities>
      <InvestmentsOtherSecurities>
        <BOY>3085144</BOY>
        <EOY>4688636</EOY>
      </InvestmentsOtherSecurities>
      <IntangibleAssets>
        <BOY>619820</BOY>
        <EOY>565861</EOY>
      </IntangibleAssets>
      <OtherAssetsTotal>
        <BOY>1354313</BOY>
        <EOY>1510414</EOY>
      </OtherAssetsTotal>
      <TotalAssets>
        <BOY>169631399</BOY>
        <EOY>181017131</EOY>
      </TotalAssets>
      <AccountsPayableAccruedExpenses>
        <BOY>12430100</BOY>
        <EOY>12148605</EOY>
      </AccountsPayableAccruedExpenses>
      <TaxExemptBondLiabilities>
        <BOY>20409894</BOY>
        <EOY>18469057</EOY>
      </TaxExemptBondLiabilities>
      <OtherLiabilities>
        <BOY>1800941</BOY>
        <EOY>1968492</EOY>
      </OtherLiabilities>
      <TotalLiabilities>
        <BOY>34640935</BOY>
        <EOY>32586154</EOY>
      </TotalLiabilities>
      <FollowSFAS117>X</FollowSFAS117>
      <UnrestrictedNetAssets>
        <BOY>132155320</BOY>
        <EOY>145492341</EOY>
      </UnrestrictedNetAssets>
      <TemporarilyRestrictedNetAssets>
        <BOY>2835144</BOY>
        <EOY>2938636</EOY>
      </TemporarilyRestrictedNetAssets>
      <TotalNetAssetsFundBalances>
        <BOY>134990464</BOY>
        <EOY>148430977</EOY>
      </TotalNetAssetsFundBalances>
      <TotalLiabNetAssetsFundBalances>
        <BOY>169631399</BOY>
        <EOY>181017131</EOY>
      </TotalLiabNetAssetsFundBalances>
      <InfoInScheduleOPartXI>X</InfoInScheduleOPartXI>
      <ReconcilationRevenueExpenses>15687054</ReconcilationRevenueExpenses>
      <ReconcilationOtherChanges>-2246541</ReconcilationOtherChanges>
      <MethodOfAccountingAccrual>X</MethodOfAccountingAccrual>
      <AccountantCompileOrReview>0</AccountantCompileOrReview>
      <FSAudited>1</FSAudited>
      <AuditCommittee>1</AuditCommittee>
      <FinancialStatementConsolidated>X</FinancialStatementConsolidated>
      <FederalGrantAuditRequired>0</FederalGrantAuditRequired>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <Hospital170b1Aiii>X</Hospital170b1Aiii>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInfo>
        <ContributorNumber>RESTRICTED</ContributorNumber>
        <ContributorNameBusiness>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorNameBusiness>
        <ContributorAddressUS>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorAddressUS>
        <AggregateContributions>RESTRICTED</AggregateContributions>
      </ContributorInfo>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <Land>
        <OtherCostOrOtherBasis>2341520</OtherCostOrOtherBasis>
        <BookValue>2341520</BookValue>
      </Land>
      <Buildings>
        <OtherCostOrOtherBasis>47210466</OtherCostOrOtherBasis>
        <Depreciation>16443990</Depreciation>
        <BookValue>30766476</BookValue>
      </Buildings>
      <LeaseholdImprovements>
        <OtherCostOrOtherBasis>2602478</OtherCostOrOtherBasis>
        <Depreciation>1407213</Depreciation>
        <BookValue>1195265</BookValue>
      </LeaseholdImprovements>
      <Equipment>
        <OtherCostOrOtherBasis>53565388</OtherCostOrOtherBasis>
        <Depreciation>33829540</Depreciation>
        <BookValue>19735848</BookValue>
      </Equipment>
      <TotalOfBookValueLandBuildings>54039109</TotalOfBookValueLandBuildings>
      <OtherLiabilities>
        <Description>457(B) PAYABLE</Description>
        <Amount>1364757</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>LONG-TERM PTO</Description>
        <Amount>511835</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>ASBESTOS PAYABLE</Description>
        <Amount>91900</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>1968492</TotalOfAmounts>
      <Form990ScheduleDPartXIV>
        <Identifier>DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:</Identifier>
        <ReturnReference>PART X:</ReturnReference>
        <Explanation>THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT PRAIRIE LAKES AND HOME CONNECTIONS ARE TAX-EXEMPT, NOT-FOR-PROFIT CORPORATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE HEALTH SYSTEM FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE HEALTH SYSTEM'S FINANCIAL STATEMENTS. THE HEALTH SYSTEMS INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE INFORMATION TAX RETURNS FOR THE YEARS ENDED 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES.</Explanation>
      </Form990ScheduleDPartXIV>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="RetDoc1041500001">
      <CharityCarePolicy>1</CharityCarePolicy>
      <WrittenPolicy>1</WrittenPolicy>
      <PolicyAppliedToAllHospitals>X</PolicyAppliedToAllHospitals>
      <FPGReferenceFreeCare>1</FPGReferenceFreeCare>
      <Pcent200>X</Pcent200>
      <FPGReferenceDiscountedCare>1</FPGReferenceDiscountedCare>
      <Pcent200D>X</Pcent200D>
      <FreeDiscCareMedicallyIndigent>1</FreeDiscCareMedicallyIndigent>
      <AmountsBudgetedForCharityCare>1</AmountsBudgetedForCharityCare>
      <ExpensesExceededBudget>1</ExpensesExceededBudget>
      <UnableToProvideCare>0</UnableToProvideCare>
      <AnnualCommunityBenefitReport>1</AnnualCommunityBenefitReport>
      <ReportPublicallyAvailable>0</ReportPublicallyAvailable>
      <CharityCareAtCost>
        <TotalCommunityBenefitExpense>1529609</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>1529609</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.02200</PercentOfTotalExpense>
      </CharityCareAtCost>
      <UnreimbursedMedicaid>
        <TotalCommunityBenefitExpense>3131754</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>1388557</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>1743197</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.02500</PercentOfTotalExpense>
      </UnreimbursedMedicaid>
      <TotalCharityCare>
        <TotalCommunityBenefitExpense>4661363</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>1388557</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>3272806</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.04700</PercentOfTotalExpense>
      </TotalCharityCare>
      <SubsidizedHealthServices>
        <TotalCommunityBenefitExpense>11685938</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>8142112</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>3543826</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.05090</PercentOfTotalExpense>
      </SubsidizedHealthServices>
      <CashAndInKindContributions>
        <TotalCommunityBenefitExpense>188000</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>188000</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00270</PercentOfTotalExpense>
      </CashAndInKindContributions>
      <TotalOtherBenefits>
        <TotalCommunityBenefitExpense>11873938</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>8142112</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>3731826</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.05360</PercentOfTotalExpense>
      </TotalOtherBenefits>
      <TotalCommunityBenefits>
        <TotalCommunityBenefitExpense>16535301</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>9530669</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>7004632</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.10060</PercentOfTotalExpense>
      </TotalCommunityBenefits>
      <CommunitySupport>
        <TotalCommunityBuildingExpense>20000</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>20000</NetCommunityBuildingExpense>
        <PercentOfTotalExpense>0.00030</PercentOfTotalExpense>
      </CommunitySupport>
      <Total>
        <TotalCommunityBuildingExpense>20000</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>20000</NetCommunityBuildingExpense>
        <PercentOfTotalExpense>0.00030</PercentOfTotalExpense>
      </Total>
      <BadDebtExpenseReported>1</BadDebtExpenseReported>
      <BadDebtExpenseAmount>3484501</BadDebtExpenseAmount>
      <AmountReimbursedByMedicare>27106826</AmountReimbursedByMedicare>
      <CostOfCareReimbursedByMedicare>23363613</CostOfCareReimbursedByMedicare>
      <MedicareSurplusOrShortfall>3743213</MedicareSurplusOrShortfall>
      <CostingMethodologyUsed>
        <CostToChargeRatio>X</CostToChargeRatio>
      </CostingMethodologyUsed>
      <WrittenDebtCollectionPolicy>1</WrittenDebtCollectionPolicy>
      <ProvisionForCharityCare>1</ProvisionForCharityCare>
      <NumberOfHospitalFacilities>1</NumberOfHospitalFacilities>
      <Form990ScheduleHPartVSectionA>
        <FacilityNumber>1</FacilityNumber>
        <Name>
          <BusinessNameLine1>PRAIRIE LAKES HOSPITAL</BusinessNameLine1>
        </Name>
        <Address>
          <AddressLine1>401 9TH AVE NW</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </Address>
        <LicensedHospital>X</LicensedHospital>
        <GeneralMedicalAndSurgical>X</GeneralMedicalAndSurgical>
        <Er24Hours>X</Er24Hours>
      </Form990ScheduleHPartVSectionA>
      <Form990ScheduleHPartVSectionB>
        <HospitalFacilityName>
          <BusinessNameLine1>PRAIRIE LAKES HEALTH CARE SYSTEM</BusinessNameLine1>
        </HospitalFacilityName>
        <HospitalFacilityNumber>1</HospitalFacilityNumber>
        <EligibilityCriteriaExplained>1</EligibilityCriteriaExplained>
        <UsesFPGFree>1</UsesFPGFree>
        <FPGFreePercent>200.000000000000</FPGFreePercent>
        <UsesFPGDiscounted>1</UsesFPGDiscounted>
        <FPGDiscountPercent>200.000000000000</FPGDiscountPercent>
        <ExplainsBasis>1</ExplainsBasis>
        <IncomeLevel>X</IncomeLevel>
        <AssetLevel>X</AssetLevel>
        <MedicalIndigency>X</MedicalIndigency>
        <InsuranceStatus>X</InsuranceStatus>
        <MedicaidMedicare>X</MedicaidMedicare>
        <ExplainsApplicationMethod>1</ExplainsApplicationMethod>
        <IncludesPublicityMeasures>1</IncludesPublicityMeasures>
        <AvailableOnRequest>X</AvailableOnRequest>
        <ActionsOnNonpayment>1</ActionsOnNonpayment>
        <CollectionActivities>0</CollectionActivities>
        <NondiscrimEmergencyCarePolicy>1</NondiscrimEmergencyCarePolicy>
        <UsedOtherMethod>X</UsedOtherMethod>
        <AmountsGenerallyBilled>0</AmountsGenerallyBilled>
        <GrossCharges>0</GrossCharges>
      </Form990ScheduleHPartVSectionB>
      <Form990ScheduleHPartVSectionC>
        <NumberOfOtherFacilities>3</NumberOfOtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>SISSETON SATELLITE DIALYSIS</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>5 EAST CHESTNUT</AddressLine1>
            <City>SISSETON</City>
            <State>SD</State>
            <ZIPCode>57262</ZIPCode>
          </Address>
          <FacilityType>DIALYSIS UNIT</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>BROOKINGS SATELLITE DIALYSIS</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>300 22ND AVENUE</AddressLine1>
            <City>BROOKINGS</City>
            <State>SD</State>
            <ZIPCode>57006</ZIPCode>
          </Address>
          <FacilityType>DIALYSIS UNIT</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>ORTONVILLE SATELLITE DIALYSIS</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>450 EASTVOLD AVENUE</AddressLine1>
            <City>ORTONVILLE</City>
            <State>MN</State>
            <ZIPCode>56278</ZIPCode>
          </Address>
          <FacilityType>DIALYSIS UNIT</FacilityType>
        </OtherFacilities>
      </Form990ScheduleHPartVSectionC>
      <Form990ScheduleHPartVI>
        <Explanation>PART I, LINE 7: THE COSTS ARE CALCULATED USING A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. $3,484,501 IN BAD DEBT EXPENSE WAS ELIMINATED WHEN CALCULATING PART I, LINE 7.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART II: THE ORGANIZATION SUPPORTS COMMUNITY BUILDING ACTIVITIES THROUGH DONATIONS TO COMMUNITY PROJECTS SUCH AS THE WATERTOWN COMMUNITY FOUNDATION WHICH WORKS TO BRING NEW BUSINESSES TO WATERTOWN, JOY RANCH WHICH PROVIDES CAMP EXPERIENCE TO DISABLED CHILDREN, AND A CAPITAL BUILDING PROJECT FOR LAKE AREA TECHNICAL INSTITUTE.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART III, LINE 4: BAD DEBT IS DETERMINED BY THE PERCENTAGE OF PRIVATE PAY ACCOUNTS THAT ARE HISTORICALLY WRITTEN OFF TO BAD DEBT. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE PERTAINING TO BAD DEBT EXPENSE.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART III, LINE 8: THERE WAS NO SHORTAGE CALCULATED.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART III, LINE 9B: FINANCIAL ASSISTANCE/CHARITY CARE FORM IS SENT TO THE PATIENT FOR COMPLETION. UPON RECEIPT BY THE FACILITY, THE FORM AND GUIDELINES ARE REVIEWED AND THE PATIENT IS NOTIFIED OF THE QUALIFICATION FOR FINANCIAL ASSISTANCE/CHARITY CARE. THE PATIENT'S ACCOUNT(S) ARE THEN WRITTEN OFF.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>PRAIRIE LAKES HEALTH CARE SYSTEM</Identifier>
        <Explanation>PART V, SECTION B, LINE 9: DEPENDING ON THE ACCOUNT BALANCE, AMOUNT RANGES FROM 50% TO 200%.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>PRAIRIE LAKES HEALTH CARE SYSTEM</Identifier>
        <Explanation>PART V, SECTION B, LINE 10: DEPENDING ON THE ACCOUNT BALANCE, AMOUNT RANGES FROM 50% TO 200%.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>PRAIRIE LAKES HEALTH CARE SYSTEM</Identifier>
        <Explanation>PART V, SECTION B, LINE 19D: THE HOSPITAL USED THE CRITERIA SET FORTH IN ITS FINANCIAL ASSISTANCE POLICY TO DETERMINE THE LEVEL OF DISCOUNT FOR PATIENTS QUALIFYING FOR ASSISTANCE. THE HOSPITAL IS CURRENTLY REVISING ITS PROCEDURE FOR CALCULATING DISCOUNTS CONSISTENT WITH THE REQUIREMENT OF THE AFFORDABLE CARE ACT.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART VI, LINE 2: THE FACILITY CONDUCTS NEEDS ASSESSMENT SURVEYS IN THE COMMUNITY AND SURROUNDING AREA TO DETERMINE WHAT HEALTH CARE SERVICES NEED TO BE ADDRESSED.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART VI, LINE 3: PRIVATE PAY INPATIENTS SPEAK WITH A SOCIAL WORKER TO DETERMINE IF THEY HAVE A NEED FOR FINANCIAL ASSISTANCE. THE SOCIAL WORKER WILL GIVE THEM A NUMBER OF AVAILABLE OPTIONS FOR ASSISTANCE. AFTER A PATIENT HAS RECEIVED STATEMENTS WITH THE PORTION THAT THEY ARE RESPONSIBLE FOR THEY ARE CONTACTED TO SEE IF THEY ARE IN NEED OF FINANCIAL ASSISTANCE. AT THAT TIME THEY ARE INFORMED OF ALL OPTIONS AVAILABLE TO THEM.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART VI, LINE 4: PRAIRIE LAKES HEALTH CARE SYSTEM'S PRIMARY SERVICE AREA COVERS 3 COUNTIES IN SOUTH DAKOTA WITH A POPULATION OF APPROXIMATELY 36,000. IT'S SECONDARY SERVICE AREA COVERS 4 COUNTIES IN SOUTH DAKOTA AND 3 COUNTIES IN MINNESOTA WITH A POPULATION OF 54,000.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Explanation>PART VI, LINE 5: THE ORGANIZATION OFFERS FREE HEALTH SEMINARS TO COMMUNITY MEMBERS COVERING A VARIETY OF HEALTH TOPICS IN AN EFFORT TO EDUCATE PEOPLE ABOUT LEADING HEALTHY LIVES. COMMUNITY FORUMS ARE HELD TO UPDATE ATTENDEES ABOUT NEW EVENTS AND TECHNOLOGY AT THE FACILITY. THE ORGANIZATION WORKS WITH THE TECHNICAL INSTITUTE AND TWO STATE UNIVERSITIES TO HELP TRAIN MEDICAL STUDENTS. THE ORGANIZATION IS DEDICATED TO IMPLEMENTING AND MAINTAINING THE MOST CURRENT TECHNOLOGY IN PROVIDING CARE.</Explanation>
      </Form990ScheduleHPartVI>
    </IRS990ScheduleH>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <RecordsMaintained>1</RecordsMaintained>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>WATERTOWN UNITED WAY</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>PO BOX 283</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EINOfRecipient>460359557</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>30000</AmountOfCashGrant>
        <PurposeOfGrant>GENERAL DONATION</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>NATIONAL KIDNEY FOUNDATION</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>1970 OAKCREST AVE STE 208</AddressLine1>
          <City>ST PAUL</City>
          <State>MN</State>
          <ZIPCode>55113</ZIPCode>
        </AddressUS>
        <EINOfRecipient>131673104</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>11275</AmountOfCashGrant>
        <PurposeOfGrant>BASH FUNDRAISING EVENT</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>SANFORD CLINIC</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>901 4TH ST NW</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EINOfRecipient>460447693</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>10000</AmountOfCashGrant>
        <PurposeOfGrant>GENERAL DONATION</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>WATERTOWN SCHOOL DISTRICT</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>PO BOX 730</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EINOfRecipient>466001273</EINOfRecipient>
        <AmountOfCashGrant>5000</AmountOfCashGrant>
        <PurposeOfGrant>GENERAL DONATION</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>SD EMTA</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>401 9TH AVE NW</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EINOfRecipient>460350240</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>5000</AmountOfCashGrant>
        <PurposeOfGrant>GENERAL DONATION</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>WATERTOWN COMMUNITY FOUNDATION</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>211 KEMP AVE E</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EINOfRecipient>460350319</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>20000</AmountOfCashGrant>
        <PurposeOfGrant>GENERAL DONATION</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>WATERTOWN AREA TRANSIT</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>205 1ST AVE NE</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EINOfRecipient>411908759</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>5500</AmountOfCashGrant>
        <PurposeOfGrant>GENERAL DONATION</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>HUMAN SERVICE AGENCY</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>PO BOX 1030</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EINOfRecipient>460275247</EINOfRecipient>
        <IRCSection>501(C)(3)</IRCSection>
        <AmountOfCashGrant>6000</AmountOfCashGrant>
        <PurposeOfGrant>GENERAL DONATION</PurposeOfGrant>
      </RecipientTable>
      <TotalNbrOf501C3AndGovtGrants>7</TotalNbrOf501C3AndGovtGrants>
      <TotalNbrOfOtherOrganizations>1</TotalNbrOfOtherOrganizations>
      <Form990ScheduleIPartIV>
        <Identifier>PROCEDURE FOR MONITORING GRANTS IN THE U.S.:</Identifier>
        <ReturnReference>PART I, LINE 2:</ReturnReference>
        <Explanation>SCHEDULE I, PART I, LINE 2: THE GRANTS ARE APPROVED BY ADMINISTRATION AND GIVEN AS UNRESTRICTED DONATIONS. THYE ARE NOT MONITORED ONCE GIVEN.</Explanation>
      </Form990ScheduleIPartIV>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <WrittenEmploymentContract>X</WrittenEmploymentContract>
      <CompensationSurvey>X</CompensationSurvey>
      <BoardOrCommitteeApproval>X</BoardOrCommitteeApproval>
      <SeverancePayment>0</SeverancePayment>
      <SupplementalNonqualRetirePlan>0</SupplementalNonqualRetirePlan>
      <EquityBasedCompArrangement>0</EquityBasedCompArrangement>
      <CompBasedOnRevenueOfFilingOrg>0</CompBasedOnRevenueOfFilingOrg>
      <CompBasedOnRevenueRelatedOrgs>0</CompBasedOnRevenueRelatedOrgs>
      <CompBasedNetEarningsFilingOrg>0</CompBasedNetEarningsFilingOrg>
      <CompBasedNetEarningsRelateOrgs>0</CompBasedNetEarningsRelateOrgs>
      <AnyNonFixedPayments>0</AnyNonFixedPayments>
      <InitialContractException>0</InitialContractException>
      <Form990ScheduleJPartII>
        <NamePerson>JILL FULLER</NamePerson>
        <BaseCompensationFilingOrg>306962</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>88800</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>23610</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>7350</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>18518</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>445240</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>MICHAEL ANDERSON</NamePerson>
        <BaseCompensationFilingOrg>223077</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>200000</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>6431</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>7350</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>17168</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>454026</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>TRACI RABINE</NamePerson>
        <BaseCompensationFilingOrg>121462</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>20000</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>10143</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>3853</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>18107</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>173565</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>MICHELE TURBAK</NamePerson>
        <BaseCompensationFilingOrg>132330</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>20000</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>5210</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>4067</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>17913</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>179520</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>EVELIO GARCIA MD</NamePerson>
        <BaseCompensationFilingOrg>1100008</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>50000</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>20000</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>7350</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>17511</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>1194869</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>SALEM MAALIKI MD</NamePerson>
        <BaseCompensationFilingOrg>958358</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>20827</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>7350</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>17708</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>1004243</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>SAIRAV SHAH MD</NamePerson>
        <BaseCompensationFilingOrg>736960</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>50000</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>17506</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>804466</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>BIPINKUMAR AMIN MD</NamePerson>
        <BaseCompensationFilingOrg>550000</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>70500</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>4442</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>17168</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>642110</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>JEFFERY BRINDLE MD</NamePerson>
        <BaseCompensationFilingOrg>470456</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>18393</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>7350</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>19359</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>515558</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc1053100001">
      <Form990ScheduleKPartI>
        <IssuerName>
          <BusinessNameLine1>SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY</BusinessNameLine1>
        </IssuerName>
        <IssuerEIN>460315509</IssuerEIN>
        <CUSIPNumber>83755VRN6</CUSIPNumber>
        <DateIssued>2010-12-08</DateIssued>
        <IssuePrice>21672812</IssuePrice>
        <DescriptionOfPurpose>CURRENT REFUNDING OF SERIES 1998 BONDS &amp; ADVANCE REFUNDING OF SERIES 2002</DescriptionOfPurpose>
        <Defeased>0</Defeased>
        <OnBehalfOfIssuer>0</OnBehalfOfIssuer>
        <PoolFinancing>0</PoolFinancing>
      </Form990ScheduleKPartI>
      <Form990ScheduleKPartII>
        <AmountRetired>7526290</AmountRetired>
        <TotalProceeds>25166290</TotalProceeds>
        <AmountInReserveFund>3303</AmountInReserveFund>
        <RefundingEscrow>24731480</RefundingEscrow>
        <IssuanceCostsFromProceeds>431508</IssuanceCostsFromProceeds>
        <YearOfSubstCompletion>2010</YearOfSubstCompletion>
        <CurrentRefunding>1</CurrentRefunding>
        <AdvanceRefunding>1</AdvanceRefunding>
        <FinalAllocationMade>1</FinalAllocationMade>
        <AdequateBooksAndRecdsMaintaind>1</AdequateBooksAndRecdsMaintaind>
      </Form990ScheduleKPartII>
      <Form990ScheduleKPartIII>
        <OwningBondFinancedProperty>0</OwningBondFinancedProperty>
        <AnyLeaseArrangements>0</AnyLeaseArrangements>
        <MngmentCntrctBondFinancdPrprty>0</MngmentCntrctBondFinancdPrprty>
        <AnyResearchAgreements>0</AnyResearchAgreements>
        <PostIssuanceComplianceProcdrs>1</PostIssuanceComplianceProcdrs>
      </Form990ScheduleKPartIII>
      <Form990ScheduleKPartIV>
        <Form8038TFiled>0</Form8038TFiled>
        <VariableRateIssue>0</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>0</HedgeIdentifiedInBooksAndRecds>
        <GrossProceedsInvestedInGIC>0</GrossProceedsInvestedInGIC>
        <GrossProceedsInvested>0</GrossProceedsInvested>
        <ExceptionToRebate>0</ExceptionToRebate>
      </Form990ScheduleKPartIV>
      <Form990ScheduleKPartVI>
        <Identifier>SCHEDULE K, PART II, LINE 3</Identifier>
        <Explanation>THE DIFFERENCE IN THE ISSUANCE PRICE INCLUDED IN PART I, LINE A, COLUMN E OF $21,672,812 IS DIFFERENT THAN THE TOTAL PROCEEDS OF ISSUANCE INCLUDED IN PART II, LINE 3 OF $25,166,290 BECAUSE OF THE TRUSTEE FUNDS UTILIZED DURING THE REFINANCING.</Explanation>
      </Form990ScheduleKPartVI>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <LoanTable>
        <NamePerson>EVELIO GARCIA MD</NamePerson>
        <PurposeOfLoan>SIGNING BONUS</PurposeOfLoan>
        <LoanFromOrganization>X</LoanFromOrganization>
        <OriginalPrincipalAmount>140000</OriginalPrincipalAmount>
        <BalanceDue>21033</BalanceDue>
        <Default>0</Default>
        <ApprovedByBoard>1</ApprovedByBoard>
        <WrittenAgreement>1</WrittenAgreement>
      </LoanTable>
      <TotalBalanceDue>21033</TotalBalanceDue>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION A, LINE 1</ReturnReference>
        <Explanation>THE EXECUTIVE COMMITTEE SHALL BE COMPRISED OF THE OFFICERS OF THE CORPORATION. EXCEPT AS MAY BE LIMITED BY THE BOARD, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. THE EXECUTIVE COMMITTEE SHALL ACT IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD AND SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL ALSO SERVE AS THE CORPORATION'S COMPENSATION COMMITTEE, UNLESS IT OR THE BOARD DELEGATES THOSE RESPONSIBILITIES TO ANOTHER COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL NOT USURP THE FUNCTIONS OF THE OTHER STANDING COMMITTEES, ALTHOUGH IT WILL COORDINATE PROJECTS, TASKS AND COMMUNICATIONS AMONG SUCH COMMITTEES. A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ANY BUSINESS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 11</ReturnReference>
        <Explanation>THE FINANCE COMMITTEE WILL REVIEW THE FORM 990 BEFORE IT IS FILED WITH THE IRS. THE FINANCE COMMITTE WILL DETERMINE IF IT IS NECESSARY FOR THE BOARD TO REVIEW THE FORM 990.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 12C</ReturnReference>
        <Explanation>A CONFLICT OF INTEREST STATEMENT IS SIGNED BY ALL BOARD MEMBERS ON AN ANNUAL BASIS. THAT STATEMENT DISCLOSES ANY AREAS THAT MAY HAVE A POTENTIAL FOR CONFLICT OF INTEREST WITH THEMSELVES OR FAMILY MEMBERS. AT BOARD MEETINGS, THE MEMBERS WILL EXCUSE THEMSELVES FROM ANY DISCUSSION OR VOTING ON AN ISSUE WHERE A CONFLICT MAY EXIST.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 15</ReturnReference>
        <Explanation>COMPENSATION COMPARABILITY STUDIES ARE REVIEWED EACH YEAR FOR ALL POSITIONS. THE COMPENSATION STUDIES ARE CONDUCTED INTERNALLY BY THE HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES DEPARTMENT HAS ACCESS TO VARIOUS COMPENSATION SURVEYS WHICH THEY REVIEW IN ORDER TO DETERMINE IF THE HOSPITAL'S COMPENSATION IS REASONABLE COMPARED TO OTHER FACILITIES. THE LAST COMPENSATION STUDY WAS PERFORMED IN 2012. THE BOARD APPROVES SALARY OF THE CEO THROUGH ITS EXECUTIVE COMMITTEE SERVING AS THE COMPENSATION COMMITTEE. THE BOARD DELEGATES VICE PRESIDENT EXECUTIVE COMPENSATION APPROVAL TO CEO BASED ON THE ORGANIZATION'S COMPENSATION PHILOSOPHY IN CONJUNCTION WITH MARKET BENCHMARKS. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE SALARIES OF OTHER KEY EMPLOYEES.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION C, LINE 19</ReturnReference>
        <Explanation>FINANCIAL STATEMENTS ARE AVAILABLE THROUGH FILINGS WITH BONDING AUTHORITY. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>BOARD OVERLAP</Identifier>
        <ReturnReference>PART VII, SECTION A</ReturnReference>
        <Explanation>LUANN STRAIT, BOARD MEMBER, SERVES AS A BOARD MEMBER FOR THE REPORTING ORGANIZATION AND THE RELATED ORGANIZATION, PRAIRIE LAKES HEALTHCARE FOUNDATION, AS INDICATED IN SCHEDULE R, PART II. ON AVERAGE, SHE SPENDS APPROXIMATELY 1 HOUR PER WEEK IN TOTAL FOR SERVICES PERFORMED ON BEHALF OF THIS ORGANIZATION. JILL FULLER, CHIEF EXECUTIVE OFFICER, SERVES AS AN EXECUTIVE OFFICIAL FOR THE RELATED ORGANIZATION, PRAIRIE LAKES HEALTHCARE FOUNDATION, AS INDICATED IN SCHEDULE R, PART II. ON AVERAGE, SHE SPENDS APPROXIMATELY 1 HOUR PER WEEK IN TOTAL FOR SERVICES PERFORMED ON BEHALF OF THIS ORGANIZATION.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>CHANGES IN NET ASSETS OR FUND BALANCES:</Identifier>
        <ReturnReference>FORM 990, PART XI, LINE 5:</ReturnReference>
        <Explanation>NET UNREALIZED LOSSES ON INVESTMENTS: -2,350,033. CHANGE IN BENEFICIAL INTEREST IN PRAIRIE LAKES FOUNDATION 103,492. TOTAL TO FORM 990, PART XI, LINE 5: -2,246,541.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>PRAIRIE LAKES HOME CONNECTIONS INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>401 9TH AVE NW</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EIN>460394984</EIN>
        <PrimaryActivities>HOMEMAKER &amp; NURSING SERVICES</PrimaryActivities>
        <LegalDomicileState>SD</LegalDomicileState>
        <ExemptCodeSection>501(C)(3)</ExemptCodeSection>
        <PublicCharityStatus>9</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>PRAIRIE LAKES FOUNDATION INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>401 9TH AVE NW</AddressLine1>
          <City>WATERTOWN</City>
          <State>SD</State>
          <ZIPCode>57201</ZIPCode>
        </AddressUS>
        <EIN>460350240</EIN>
        <PrimaryActivities>PROMOTES HEALTH EDUCATION AND GENERAL HEALTH AND WELL-BEING OF THE PUBLIC</PrimaryActivities>
        <LegalDomicileState>SD</LegalDomicileState>
        <ExemptCodeSection>501(C)(3)</ExemptCodeSection>
        <PublicCharityStatus>7</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
      </Form990ScheduleRPartII>
      <ReceiptOfIntAnnRentsRoyalties>0</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>0</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>1</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>0</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>0</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>0</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>0</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>0</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>0</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>0</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>0</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>0</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>0</SharingOfFacilities>
      <SharingOfPaidEmployees>0</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>0</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>0</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>0</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>0</OtherTransferFromOtherOrg>
    </IRS990ScheduleR>
  </ReturnData>
</Return>