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      <NetRentalIncomeOrLoss>
        <TotalRevenueColumn>166065</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>166065</UnrelatedBusinessRevenue>
      </NetRentalIncomeOrLoss>
      <OtherRevenueMisc>
        <Description>OTHER OPERATING REVENUE</Description>
        <TotalRevenueColumn>483940</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>483940</RelatedOrExemptFunctionIncome>
      </OtherRevenueMisc>
      <TotalOtherRevenue>483940</TotalOtherRevenue>
      <TotalRevenue>
        <TotalRevenueColumn>32018956</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>31804093</RelatedOrExemptFunctionIncome>
        <UnrelatedBusinessRevenue>166065</UnrelatedBusinessRevenue>
      </TotalRevenue>
      <OtherSalariesAndWages>
        <Total>13573805</Total>
        <ProgramServices>13573805</ProgramServices>
      </OtherSalariesAndWages>
      <OtherEmployeeBenefits>
        <Total>3119430</Total>
        <ProgramServices>3119430</ProgramServices>
      </OtherEmployeeBenefits>
      <Interest>
        <Total>339799</Total>
        <ProgramServices>339799</ProgramServices>
      </Interest>
      <DepreciationDepletion>
        <Total>1837188</Total>
        <ProgramServices>1837188</ProgramServices>
      </DepreciationDepletion>
      <OtherExpenses>
        <Description>SUPPLIES</Description>
        <Total>3954165</Total>
        <ProgramServices>3954165</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>PURCHASED SERVICES &amp; FEES</Description>
        <Total>2322852</Total>
        <ProgramServices>2322852</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>OTHER EXPENSES</Description>
        <Total>1379590</Total>
        <ProgramServices>1379590</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>REPAIRS &amp; MAINTENANCE</Description>
        <Total>1184637</Total>
        <ProgramServices>1184637</ProgramServices>
      </OtherExpenses>
      <AllOtherExpenses>
        <Total>1758268</Total>
        <ProgramServices>1758268</ProgramServices>
      </AllOtherExpenses>
      <TotalFunctionalExpenses>
        <Total>29469734</Total>
        <ProgramServices>29469734</ProgramServices>
        <ManagementAndGeneral>0</ManagementAndGeneral>
        <Fundraising>0</Fundraising>
      </TotalFunctionalExpenses>
      <SavingsAndTempCashInvestments>
        <BOY>1688608</BOY>
        <EOY>1109779</EOY>
      </SavingsAndTempCashInvestments>
      <AccountsReceivable>
        <BOY>2614104</BOY>
        <EOY>2140176</EOY>
      </AccountsReceivable>
      <ReceivablesFromOfficersEtc>
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        <EOY>30417</EOY>
      </ReceivablesFromOfficersEtc>
      <InventoriesForSaleOrUse>
        <BOY>904061</BOY>
        <EOY>871293</EOY>
      </InventoriesForSaleOrUse>
      <PrepaidExpensesDeferredCharges>
        <BOY>640350</BOY>
        <EOY>762775</EOY>
      </PrepaidExpensesDeferredCharges>
      <LandBuildingsEquipmentBasis>58426954</LandBuildingsEquipmentBasis>
      <LandBldgEquipmentAccumDeprec>39152126</LandBldgEquipmentAccumDeprec>
      <LandBuildingsEquipmentBasisNet>
        <BOY>16655901</BOY>
        <EOY>19274828</EOY>
      </LandBuildingsEquipmentBasisNet>
      <InvestmentsOtherSecurities>
        <BOY>51019719</BOY>
        <EOY>52231595</EOY>
      </InvestmentsOtherSecurities>
      <OtherAssetsTotal>
        <BOY>2746246</BOY>
        <EOY>2142749</EOY>
      </OtherAssetsTotal>
      <TotalAssets>
        <BOY>76377241</BOY>
        <EOY>78563612</EOY>
      </TotalAssets>
      <AccountsPayableAccruedExpenses>
        <BOY>3180801</BOY>
        <EOY>3375778</EOY>
      </AccountsPayableAccruedExpenses>
      <TaxExemptBondLiabilities>
        <BOY>5877448</BOY>
        <EOY>5300479</EOY>
      </TaxExemptBondLiabilities>
      <OtherLiabilities>
        <EOY>19141</EOY>
      </OtherLiabilities>
      <TotalLiabilities>
        <BOY>9058249</BOY>
        <EOY>8695398</EOY>
      </TotalLiabilities>
      <FollowSFAS117>X</FollowSFAS117>
      <UnrestrictedNetAssets>
        <BOY>67318992</BOY>
        <EOY>69868214</EOY>
      </UnrestrictedNetAssets>
      <TotalNetAssetsFundBalances>
        <BOY>67318992</BOY>
        <EOY>69868214</EOY>
      </TotalNetAssetsFundBalances>
      <TotalLiabNetAssetsFundBalances>
        <BOY>76377241</BOY>
        <EOY>78563612</EOY>
      </TotalLiabNetAssetsFundBalances>
      <ReconcilationRevenueExpenses>2549222</ReconcilationRevenueExpenses>
      <MethodOfAccountingAccrual>X</MethodOfAccountingAccrual>
      <AccountantCompileOrReview>false</AccountantCompileOrReview>
      <FSAudited>true</FSAudited>
      <FSAuditedBasis>
        <FinancialStatementSeparate>X</FinancialStatementSeparate>
      </FSAuditedBasis>
      <AuditCommittee>true</AuditCommittee>
      <FederalGrantAuditRequired>false</FederalGrantAuditRequired>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc6">
      <Hospital170b1Aiii>X</Hospital170b1Aiii>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1">
      <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="RetDoc7">
      <Buildings>
        <OtherCostOrOtherBasis>58426954</OtherCostOrOtherBasis>
        <Depreciation>39152126</Depreciation>
        <BookValue>19274828</BookValue>
      </Buildings>
      <TotalOfBookValueLandBuildings>19274828</TotalOfBookValueLandBuildings>
      <OtherSecurities>
        <Description>INVESTMENTS</Description>
        <BookValue>52231595</BookValue>
        <MethodOfValuation>C</MethodOfValuation>
      </OtherSecurities>
      <TotalOfBookValueSecurities>52231595</TotalOfBookValueSecurities>
      <OtherLiabilities>
        <Description>EST. THIRD PARTY PAYOR SETTLEMENTS</Description>
        <Amount>19141</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>19141</TotalOfAmounts>
      <TotRevenueEtcAuditedFinclStmt>32018956</TotRevenueEtcAuditedFinclStmt>
      <RevenueSubtotal>32018956</RevenueSubtotal>
      <TotalRevenuePerForm990>32018956</TotalRevenuePerForm990>
      <TotExpensesEtcAuditedFinclStmt>29469734</TotExpensesEtcAuditedFinclStmt>
      <ExpensesSubtotal>29469734</ExpensesSubtotal>
      <TotalExpensesPerForm990>29469734</TotalExpensesPerForm990>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="RetDoc9">
      <CharityCarePolicy>true</CharityCarePolicy>
      <WrittenPolicy>true</WrittenPolicy>
      <FPGReferenceFreeCare>true</FPGReferenceFreeCare>
      <OtherPercentage>
        <Other>X</Other>
        <FreeOtherPercentage>1.25000</FreeOtherPercentage>
      </OtherPercentage>
      <FPGReferenceDiscountedCare>true</FPGReferenceDiscountedCare>
      <Pcent200D>X</Pcent200D>
      <FreeDiscCareMedicallyIndigent>true</FreeDiscCareMedicallyIndigent>
      <AmountsBudgetedForCharityCare>true</AmountsBudgetedForCharityCare>
      <ExpensesExceededBudget>false</ExpensesExceededBudget>
      <AnnualCommunityBenefitReport>false</AnnualCommunityBenefitReport>
      <CharityCareAtCost>
        <TotalCommunityBenefitExpense>40812</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>40812</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00140</PercentOfTotalExpense>
      </CharityCareAtCost>
      <UnreimbursedMedicaid>
        <TotalCommunityBenefitExpense>3038505</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>2888372</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>150133</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00510</PercentOfTotalExpense>
      </UnreimbursedMedicaid>
      <UnreimbursedCosts>
        <TotalCommunityBenefitExpense>232642</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>207800</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>24842</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00080</PercentOfTotalExpense>
      </UnreimbursedCosts>
      <TotalCharityCare>
        <TotalCommunityBenefitExpense>3311959</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>3096172</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>215787</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00730</PercentOfTotalExpense>
      </TotalCharityCare>
      <CommunityHealthServices>
        <TotalCommunityBenefitExpense>341553</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>32314</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>309239</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.01050</PercentOfTotalExpense>
      </CommunityHealthServices>
      <HealthProfessionsEducation>
        <TotalCommunityBenefitExpense>56250</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>56250</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00190</PercentOfTotalExpense>
      </HealthProfessionsEducation>
      <SubsidizedHealthServices>
        <TotalCommunityBenefitExpense>4626813</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>2651036</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>1975777</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.06700</PercentOfTotalExpense>
      </SubsidizedHealthServices>
      <CashAndInKindContributions>
        <TotalCommunityBenefitExpense>16864</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>16864</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00060</PercentOfTotalExpense>
      </CashAndInKindContributions>
      <TotalOtherBenefits>
        <TotalCommunityBenefitExpense>5041480</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>2683350</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2358130</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.08000</PercentOfTotalExpense>
      </TotalOtherBenefits>
      <TotalCommunityBenefits>
        <TotalCommunityBenefitExpense>8353439</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>5779522</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2573917</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.08730</PercentOfTotalExpense>
      </TotalCommunityBenefits>
      <LeadershipDevelopment>
        <TotalCommunityBuildingExpense>30389</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>30389</NetCommunityBuildingExpense>
        <PercentOfTotalExpense>0.00100</PercentOfTotalExpense>
      </LeadershipDevelopment>
      <Total>
        <TotalCommunityBuildingExpense>30389</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>30389</NetCommunityBuildingExpense>
        <PercentOfTotalExpense>0.00100</PercentOfTotalExpense>
      </Total>
      <BadDebtExpenseReported>true</BadDebtExpenseReported>
      <BadDebtExpenseAmount>2936814</BadDebtExpenseAmount>
      <AmountAttributableTo>598673</AmountAttributableTo>
      <AmountReimbursedByMedicare>9816524</AmountReimbursedByMedicare>
      <CostOfCareReimbursedByMedicare>9851840</CostOfCareReimbursedByMedicare>
      <MedicareSurplusOrShortfall>-35316</MedicareSurplusOrShortfall>
      <CostingMethodologyUsed>
        <CostToChargeRatio>X</CostToChargeRatio>
      </CostingMethodologyUsed>
      <WrittenDebtCollectionPolicy>true</WrittenDebtCollectionPolicy>
      <ProvisionForCharityCare>true</ProvisionForCharityCare>
      <NumberOfHospitalFacilities>1</NumberOfHospitalFacilities>
      <Form990ScheduleHPartVSectionA>
        <FacilityNumber>1</FacilityNumber>
        <Name>
          <BusinessNameLine1>HURON REGIONAL MEDICAL CENTER</BusinessNameLine1>
        </Name>
        <Address>
          <AddressLine1>172 4TH STREET SE</AddressLine1>
          <City>HURON</City>
          <State>SD</State>
          <ZIPCode>57350</ZIPCode>
        </Address>
        <LicensedHospital>X</LicensedHospital>
        <GeneralMedicalAndSurgical>X</GeneralMedicalAndSurgical>
        <CriticalAccessHospital>X</CriticalAccessHospital>
        <Er24Hours>X</Er24Hours>
      </Form990ScheduleHPartVSectionA>
      <Form990ScheduleHPartVSectionB>
        <HospitalFacilityName>
          <BusinessNameLine1>HURON REGIONAL MEDICAL CENTER</BusinessNameLine1>
        </HospitalFacilityName>
        <HospitalFacilityNumber>1</HospitalFacilityNumber>
        <CHNAConducted>true</CHNAConducted>
        <CommunityDefinition>X</CommunityDefinition>
        <CommunityDemographics>X</CommunityDemographics>
        <ExistingResources>X</ExistingResources>
        <HowDataObtained>X</HowDataObtained>
        <CommunityHealthNeeds>X</CommunityHealthNeeds>
        <OtherHealthIssues>X</OtherHealthIssues>
        <IdentifyingProcess>X</IdentifyingProcess>
        <ConsultingProcess>X</ConsultingProcess>
        <InformationGaps>X</InformationGaps>
        <Other>X</Other>
        <NeedsAssessmentConducted>13</NeedsAssessmentConducted>
        <TakeIntoAccount>true</TakeIntoAccount>
        <OtherFacilities>false</OtherFacilities>
        <CHNAWidelyAvailable>true</CHNAWidelyAvailable>
        <OwnWebsite>X</OwnWebsite>
        <OnRequest>X</OnRequest>
        <AdoptImplementStrategy>X</AdoptImplementStrategy>
        <ExecuteImplementStrategy>X</ExecuteImplementStrategy>
        <PrioritizeHealthNeeds>X</PrioritizeHealthNeeds>
        <PrioritizeServices>X</PrioritizeServices>
        <AllNeedsAddressed>false</AllNeedsAddressed>
        <OrganizationIncurExciseTax>false</OrganizationIncurExciseTax>
        <EligibilityCriteriaExplained>true</EligibilityCriteriaExplained>
        <UsesFPGFree>true</UsesFPGFree>
        <FPGFreePercent>125.0</FPGFreePercent>
        <UsesFPGDiscounted>true</UsesFPGDiscounted>
        <FPGDiscountPercent>200.0</FPGDiscountPercent>
        <ExplainsBasis>false</ExplainsBasis>
        <ExplainsApplicationMethod>true</ExplainsApplicationMethod>
        <IncludesPublicityMeasures>true</IncludesPublicityMeasures>
        <PostedOnWebsite>X</PostedOnWebsite>
        <AttachedToInvoices>X</AttachedToInvoices>
        <ProvidedOnAdmission>X</ProvidedOnAdmission>
        <AvailableOnRequest>X</AvailableOnRequest>
        <ActionsOnNonpayment>true</ActionsOnNonpayment>
        <PermitReportToCreditAgency>X</PermitReportToCreditAgency>
        <PermitLawsuit>X</PermitLawsuit>
        <PermitLienOnResidence>X</PermitLienOnResidence>
        <CollectionActivities>true</CollectionActivities>
        <ReportToCreditAgency>X</ReportToCreditAgency>
        <Lawsuit>X</Lawsuit>
        <LienOnResidence>X</LienOnResidence>
        <NotifyUponAdmission>X</NotifyUponAdmission>
        <NotifyBeforeDischarge>X</NotifyBeforeDischarge>
        <NotifiedAllPatients>X</NotifiedAllPatients>
        <DocumentedDetermination>X</DocumentedDetermination>
        <NondiscrimEmergencyCarePolicy>true</NondiscrimEmergencyCarePolicy>
        <AverageNegotiatedRates>X</AverageNegotiatedRates>
        <MedicareRate>X</MedicareRate>
        <AmountsGenerallyBilled>false</AmountsGenerallyBilled>
        <GrossCharges>false</GrossCharges>
      </Form990ScheduleHPartVSectionB>
      <Form990ScheduleHPartVI>
        <Identifier>SUBSIDIZED HEALTH SERVICES EXPLANATION</Identifier>
        <ReturnReference>PART I LINE 7G</ReturnReference>
        <Explanation>COSTS ATTRIBUTABLE TO PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES ORTHOPEDIC CLINIC 396532 PEDIATRIC CLINIC 275858 SURGICAL CLINIC 473248 AND ENT CLINIC 345035 FOR A TOTAL OF 1490673 BAD DEBT EXPENSE NOT REPORTED ON LINE 7G WAS 251457</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COSTING METHODOLOGY EXPLANATION</Identifier>
        <ReturnReference>PART I LINE 7</ReturnReference>
        <Explanation>WORKSHEET 2 WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN THE TABLES ALONG WITH COST REPORT AMOUNTS WHEN APPLICABLE</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COMMUNITY BUILDING ACTIVITIES</Identifier>
        <ReturnReference>PART II</ReturnReference>
        <Explanation>SEE ATTACHED 5</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>BAD DEBT EXPENSE EXPLANATION</Identifier>
        <ReturnReference>PART III LINE 4</ReturnReference>
        <Explanation>ACCOUNTS RECEIVABLE FROM PATIENTS CONSIST OF THE FOLLOWING ACCOUNTS RECEIVABLE AS OF JUNE 30 2013 AND 2012 WERE4632799 AND 5736643 ALLOWANCE FOR DOUBTFUL ACCOUNTS AS OF JUNE 30 2013 AND 2012 WERE2492623 AND 3122539 ACCOUNTS RECEIVABLE NET AS OF JUNE 30 2013 AND 2012 WERE 2140176 AND 2614104 THE ABOVE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON AN ESTIMATE USING PAST COLLECTION EXPERIENCE FINANCIAL CLASS AND AGE OF THE PATIENT ACCOUNT ESTIMATED BAD DEBTS EXPENSE REFLECTS THIS PROVISION FOR ACTUAL OR EXPECTED DOUBTFUL ACCOUNTS DISCOUNTS AND PAYMENTS ON ACCOUNTS REDUCES ACCOUNTS RECEIVABLE BALANCES THEREFORE REDUCING BAD DEBT EXPENSE A STUDY OF CHARITY APPLICATIONS AND EXPERIENCE OF FINANCIAL ASSISTANCE STAFF WAS USED TO REASONABLY ESTIMATE THE PERCENTAGE OF BAD DEBT FOR PATIENTS WHO WOULD HAVE QUALIFIED FOR CHARITY IF THEY APPLIED</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>NEEDS ASSESSMENT</Identifier>
        <ReturnReference>PART VI</ReturnReference>
        <Explanation>SEE ATTACHED 2</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE</Identifier>
        <ReturnReference>PART VI</ReturnReference>
        <Explanation>SEE ATTACHED 3</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>COMMUNITY INFORMATION</Identifier>
        <ReturnReference>PART VI</ReturnReference>
        <Explanation>SEE ATTACHED 4</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE</Identifier>
        <ReturnReference>PART VI</ReturnReference>
        <Explanation>SEE ATTACHED 6</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>ADDITIONAL INFORMATION</Identifier>
        <ReturnReference>PART VI</ReturnReference>
        <Explanation>SEE ATTACHED 1</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>HURON REGIONAL MEDICAL CENTER LINE NUMBER 1 PART V LINE 3</Identifier>
        <ReturnReference>PART V LINE 3</ReturnReference>
        <Explanation>WHEN THE ANALYSIS WAS COMPLETE WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL GROUP OF EXPERTS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL STATEMENTS OF NEED AND NEW NEEDS DID EMERGE FROM THIS EXCHANGE SEE THE CHART ON PAGE 60 28 OF THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE LISTING OF INDIVIDUALS PARTICIPATING AS LOCAL EXPERT ADVISORS</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>HURON REGIONAL MEDICAL CENTER LINE NUMBER 1 PART V LINE 7</Identifier>
        <ReturnReference>PART V LINE 7</ReturnReference>
        <Explanation>SIGNIFICANT NEEDS WHERE HOSPITAL DID NOT DEVELOP IMPLEMENTATION PLAN DENTAL NEED IS ADDRESSED BY OTHER FACILITY OR ORGANIZATION</Explanation>
      </Form990ScheduleHPartVI>
    </IRS990ScheduleH>
    <IRS990ScheduleJ documentId="RetDoc10">
      <HousingAllowanceOrResidence>X</HousingAllowanceOrResidence>
      <WrittenPolicyReTAndEExpenses>true</WrittenPolicyReTAndEExpenses>
      <SubstantiationRequired>true</SubstantiationRequired>
      <CompensationCommittee>X</CompensationCommittee>
      <IndependentConsultant>X</IndependentConsultant>
      <Form990OfOtherOrganizations>X</Form990OfOtherOrganizations>
      <CompensationSurvey>X</CompensationSurvey>
      <BoardOrCommitteeApproval>X</BoardOrCommitteeApproval>
      <SeverancePayment>false</SeverancePayment>
      <SupplementalNonqualRetirePlan>false</SupplementalNonqualRetirePlan>
      <EquityBasedCompArrangement>false</EquityBasedCompArrangement>
      <CompBasedOnRevenueOfFilingOrg>false</CompBasedOnRevenueOfFilingOrg>
      <CompBasedOnRevenueRelatedOrgs>false</CompBasedOnRevenueRelatedOrgs>
      <CompBasedNetEarningsFilingOrg>false</CompBasedNetEarningsFilingOrg>
      <CompBasedNetEarningsRelateOrgs>false</CompBasedNetEarningsRelateOrgs>
      <AnyNonFixedPayments>false</AnyNonFixedPayments>
      <InitialContractException>false</InitialContractException>
      <Form990ScheduleJPartII>
        <NamePerson>DR CARL HUFF</NamePerson>
        <Title>MD</Title>
        <BaseCompensationFilingOrg>498299</BaseCompensationFilingOrg>
        <BonusFilingOrg>10000</BonusFilingOrg>
        <OtherCompensationFilingOrg>10000</OtherCompensationFilingOrg>
        <TotalCompensationFilingOrg>518299</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>DR ALAN BRENNER</NamePerson>
        <Title>MD</Title>
        <BaseCompensationFilingOrg>400014</BaseCompensationFilingOrg>
        <BonusFilingOrg>10000</BonusFilingOrg>
        <TotalCompensationFilingOrg>410014</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>MICHEL MELMER</NamePerson>
        <Title>CRNA</Title>
        <BaseCompensationFilingOrg>190391</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>3800</DeferredCompFilingOrg>
        <TotalCompensationFilingOrg>194191</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>SCOTT HOLZEMER</NamePerson>
        <Title>CRNA</Title>
        <BaseCompensationFilingOrg>171866</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>3475</DeferredCompFilingOrg>
        <TotalCompensationFilingOrg>175341</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>SAMUEL JANES</NamePerson>
        <Title>CRNA</Title>
        <BaseCompensationFilingOrg>159768</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>3343</DeferredCompFilingOrg>
        <TotalCompensationFilingOrg>163111</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartIII>
        <Identifier>FRINGE OR EXPENSE EXPLANATION</Identifier>
        <ReturnReference>SCHEDULE J, PAGE 1, PART I, LINE 1A</ReturnReference>
        <Explanation>HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE HOUSING LOANS PROVIDED TO TWO OF THE HIGHLY COMPENSATED EMPLOYEES AS PART OF THEIR EMPLOYMENT/RECRUITMENT AGREEMENT.</Explanation>
      </Form990ScheduleJPartIII>
      <Form990ScheduleJPartIII>
        <Identifier>OTHER ADDITIONAL INFORMATION</Identifier>
        <ReturnReference>SCHEDULE J, PART III</ReturnReference>
        <Explanation>QUORUM HEALTH RESOURCES (QHR) WHO IS THE CONTRACTED BY THE BOARD OF DIRECTORS TO MANAGE THE HOSPITAL PAYS THE PRES/CFO AND VP-FINANCE SINCE THEY ARE EMPLOYEES OF QHR.</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc11">
      <Form990ScheduleKPartI>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>SD HEALTH&amp;EDUC FACILITIES AUTHORITY</BusinessNameLine1>
        </IssuerName>
        <IssuerEIN>460315509</IssuerEIN>
        <CUSIPNumber>83755VJS4</CUSIPNumber>
        <DateIssued>2006-01-06</DateIssued>
        <IssuePrice>5272366</IssuePrice>
        <DescriptionOfPurpose>REFINANCE BONDS</DescriptionOfPurpose>
        <Defeased>false</Defeased>
        <OnBehalfOfIssuer>false</OnBehalfOfIssuer>
        <PoolFinancing>false</PoolFinancing>
      </Form990ScheduleKPartI>
      <Form990ScheduleKPartII>
        <BondReferenceCd>A</BondReferenceCd>
        <AmountRetired>1880000</AmountRetired>
        <TotalProceeds>6115928</TotalProceeds>
        <AmountInReserveFund>340527</AmountInReserveFund>
        <IssuanceCostsFromProceeds>158313</IssuanceCostsFromProceeds>
        <OtherSpentProceeds>5433965</OtherSpentProceeds>
        <YearOfSubstCompletion>1995</YearOfSubstCompletion>
        <CurrentRefunding>true</CurrentRefunding>
        <AdvanceRefunding>false</AdvanceRefunding>
        <FinalAllocationMade>true</FinalAllocationMade>
        <AdequateBooksAndRecdsMaintaind>true</AdequateBooksAndRecdsMaintaind>
      </Form990ScheduleKPartII>
      <Form990ScheduleKPartIII>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedProperty>false</OwningBondFinancedProperty>
        <AnyLeaseArrangements>false</AnyLeaseArrangements>
        <MngmentCntrctBondFinancdPrprty>false</MngmentCntrctBondFinancdPrprty>
        <AnyResearchAgreements>false</AnyResearchAgreements>
        <BondIssMeetPrvtSecurityPayTest>false</BondIssMeetPrvtSecurityPayTest>
        <ChangeInUseBondFinancedProp>false</ChangeInUseBondFinancedProp>
        <RemedialActionTaken>false</RemedialActionTaken>
        <NonQualifiedBondRemedProcdrs>true</NonQualifiedBondRemedProcdrs>
      </Form990ScheduleKPartIII>
      <Form990ScheduleKPartIV>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiled>true</Form8038TFiled>
        <VariableRateIssue>false</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>false</HedgeIdentifiedInBooksAndRecds>
        <GrossProceedsInvestedInGIC>false</GrossProceedsInvestedInGIC>
        <GrossProceedsInvested>false</GrossProceedsInvested>
        <WrittenProcToMonitorReqs>false</WrittenProcToMonitorReqs>
      </Form990ScheduleKPartIV>
      <Form990ScheduleKPartV>
        <BondReferenceCd>A</BondReferenceCd>
        <ProcToUndertkCorrectiveAction>false</ProcToUndertkCorrectiveAction>
      </Form990ScheduleKPartV>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="RetDoc12">
      <LoanTable>
        <NamePerson>DR CARL HUFF</NamePerson>
        <RelationshipWithOrganization>HCE</RelationshipWithOrganization>
        <PurposeOfLoan>HOUSING ASSISTANCE</PurposeOfLoan>
        <LoanFromOrganization>X</LoanFromOrganization>
        <OriginalPrincipalAmount>50000</OriginalPrincipalAmount>
        <BalanceDue>30417</BalanceDue>
        <Default>false</Default>
        <ApprovedByBoard>true</ApprovedByBoard>
        <WrittenAgreement>true</WrittenAgreement>
      </LoanTable>
      <TotalBalanceDue>30417</TotalBalanceDue>
      <Form990ScheduleLPartIV>
        <NameOfInterestedPerson>
          <NamePerson>DR KARL BLESSINGER</NamePerson>
        </NameOfInterestedPerson>
        <Relationship>DIRECTOR</Relationship>
        <AmountOfTransaction>128600</AmountOfTransaction>
        <DescriptionOfTransaction>LAB/PATHOLOGY</DescriptionOfTransaction>
        <SharingOfRevenues>false</SharingOfRevenues>
      </Form990ScheduleLPartIV>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc13">
      <GeneralExplanation>
        <Identifier>RELATED PARTY INFORMATION AMONG OFFICERS</Identifier>
        <ReturnReference>FORM 990, PAGE 6, PART VI, LINE 2</ReturnReference>
        <Explanation>SEE ATTACHED INFORMATION</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>MANAGEMENT DELEGATED</Identifier>
        <ReturnReference>FORM 990, PAGE 6, PART VI, LINE 3</ReturnReference>
        <Explanation>HRMC CONTRACTED WITH QUORUM HEALTH RESOURCES (QHR) TO PROVIDE MANAGEMENT SERVICES AS DIRECTED BY THE BOARD. QHR THEN EMPLOYS PRESIDENT/CEO AND VP-FINANCE/CFO</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>ORGANIZATION'S PROCESS USED TO REVIEW FORM 990</Identifier>
        <ReturnReference>FORM 990, PAGE 6, PART VI, LINE 11B</ReturnReference>
        <Explanation>AUDITOR PRESENTS AND THE BOARD OF DIRECTORS REVIEWS THE FORM 990 AND APPROVES PRIOR TO SUBMISSION.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>ENFORCEMENT OF CONFLICTS POLICY</Identifier>
        <ReturnReference>FORM 990, PAGE 6, PART VI, LINE 12C</ReturnReference>
        <Explanation>ENFORCEMENT OF CONFLICTS OF INTEREST POLICY FOR BOARD OF DIRECTORS IS DONE THROUGH THE EXECUTIVE COMMITTEE WHO ACTIVELY MONITORS COMPLIANCE.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>COMPENSATION PROCESS FOR TOP OFFICIAL</Identifier>
        <ReturnReference>FORM 990, PAGE 6, PART VI, LINE 15A</ReturnReference>
        <Explanation>IN 2010 COMPENSATION COMMITTEE IN CONJUNCTION WITH QHR REVIEWED INDEPENDENT COMPENSATION CONSULTANT'S COMPENSATION SURVEY FOR BOTH CEO AND CFO. BOARD APPROVED EXECUTIVE COMPENSATION POLICY, REQUIRES AN INDEPENDENT COMPENSATION SURVEY EVERY 4 YEARS AND REVIEW OF CEO AND CFO COMPENSATION ANNUALLY.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>COMPENSATION PROCESS FOR OFFICERS</Identifier>
        <ReturnReference>FORM 990, PAGE 6, PART VI, LINE 15B</ReturnReference>
        <Explanation>IN 2010 COMPENSATION COMMITTEE IN CONJUNCTION WITH QHR REVIEWED INDEPENDENT COMPENSATION CONSULTANT'S COMPENSATION SURVERY FOR BOTH CEO AND CFO. BOARD APPROVED EXECUTIVE COMPENSATION POLICY, REQUIRES AN INDEPENDENT COMPENSATION SURVEY EVERY 4 YEARS AND REVIEW OF CEO AND CFO COMPENSATION ANNUALLY.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>GOVERNING DOCUMENTS DISCLOSURE EXPLANATION</Identifier>
        <ReturnReference>FORM 990, PAGE 6, PART VI, LINE 19</ReturnReference>
        <Explanation>FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE FOR PUBLIC INSPECTION AT THE ADMINISTRATION OFFICE OF THE ORGANIZATION. FINANCIAL STATEMENTS ALSO MADE PUBLIC THROUGH QUARTERLY AND ANNUAL POSTINGON ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AND ANNUAL POSTING OF FORM 990 THROUGH GUIDESTAR.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc14">
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>HURON REG MEDICAL CTR FOUNDATION</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>110 4TH STREET SE</AddressLine1>
          <City>HURON</City>
          <State>SD</State>
          <ZIPCode>57350</ZIPCode>
        </AddressUS>
        <EIN>460437171</EIN>
        <PrimaryActivities>FUNDRAISIN</PrimaryActivities>
        <LegalDomicileState>SD</LegalDomicileState>
        <ExemptCodeSection>501C</ExemptCodeSection>
        <PublicCharityStatus>3</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartII>
      <ReceiptOfIntAnnRentsRoyalties>false</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>false</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>false</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>false</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>false</LoansOrGuaranteesFromOtherOrg>
      <DividendsRelatedOrganization>false</DividendsRelatedOrganization>
      <SaleOfAssetsToOtherOrg>false</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>false</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>false</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>false</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>false</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>false</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>false</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>false</SharingOfFacilities>
      <SharingOfPaidEmployees>false</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>false</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>false</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>false</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>false</OtherTransferFromOtherOrg>
    </IRS990ScheduleR>
  </ReturnData>
</Return>