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        <TotalRevenueColumn>1456662</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>1456662</RelatedOrExemptFunctionIncome>
      </InvestmentIncome>
      <GrossRents>
        <Personal>437977</Personal>
      </GrossRents>
      <LessRentalExpenses>
        <Personal>268364</Personal>
      </LessRentalExpenses>
      <RentalIncomeOrLoss>
        <Personal>169613</Personal>
      </RentalIncomeOrLoss>
      <NetRentalIncomeOrLoss>
        <TotalRevenueColumn>169613</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>169613</UnrelatedBusinessRevenue>
      </NetRentalIncomeOrLoss>
      <OtherRevenueMisc>
        <Description>OTHER OPERATING REVENUE</Description>
        <TotalRevenueColumn>588109</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>588109</RelatedOrExemptFunctionIncome>
      </OtherRevenueMisc>
      <TotalOtherRevenue>588109</TotalOtherRevenue>
      <TotalRevenue>
        <TotalRevenueColumn>35553591</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>35262975</RelatedOrExemptFunctionIncome>
        <UnrelatedBusinessRevenue>169613</UnrelatedBusinessRevenue>
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      <OtherSalariesAndWages>
        <Total>13741181</Total>
        <ProgramServices>13741181</ProgramServices>
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      <OtherEmployeeBenefits>
        <Total>3017146</Total>
        <ProgramServices>3017146</ProgramServices>
      </OtherEmployeeBenefits>
      <Interest>
        <Total>379202</Total>
        <ProgramServices>379202</ProgramServices>
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      <DepreciationDepletion>
        <Total>1999582</Total>
        <ProgramServices>1999582</ProgramServices>
      </DepreciationDepletion>
      <OtherExpenses>
        <Description>SUPPLIES</Description>
        <Total>4804670</Total>
        <ProgramServices>4804670</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>BAD DEBTS</Description>
        <Total>2993367</Total>
        <ProgramServices>2993367</ProgramServices>
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      <OtherExpenses>
        <Description>PURCHASED SERVICES &amp; FEES</Description>
        <Total>2277087</Total>
        <ProgramServices>2277087</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>REPAIRS &amp; MAINTENANCE</Description>
        <Total>1035601</Total>
        <ProgramServices>1035601</ProgramServices>
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      <AllOtherExpenses>
        <Total>2544330</Total>
        <ProgramServices>2544330</ProgramServices>
      </AllOtherExpenses>
      <TotalFunctionalExpenses>
        <Total>32792166</Total>
        <ProgramServices>32792166</ProgramServices>
        <ManagementAndGeneral>0</ManagementAndGeneral>
        <Fundraising>0</Fundraising>
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      <SavingsAndTempCashInvestments>
        <BOY>2053995</BOY>
        <EOY>1688608</EOY>
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      <AccountsReceivable>
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      <ReceivablesFromOfficersEtc>
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      </ReceivablesFromOfficersEtc>
      <InventoriesForSaleOrUse>
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        <EOY>904061</EOY>
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        <BOY>853411</BOY>
        <EOY>640350</EOY>
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      <LandBuildingsEquipmentBasis>54023066</LandBuildingsEquipmentBasis>
      <LandBldgEquipmentAccumDeprec>37367165</LandBldgEquipmentAccumDeprec>
      <LandBuildingsEquipmentBasisNet>
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        <EOY>16655901</EOY>
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        <BOY>50048524</BOY>
        <EOY>51019719</EOY>
      </InvestmentsOtherSecurities>
      <OtherAssetsTotal>
        <BOY>2146301</BOY>
        <EOY>2746246</EOY>
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      <TotalAssets>
        <BOY>73980504</BOY>
        <EOY>76377241</EOY>
      </TotalAssets>
      <AccountsPayableAccruedExpenses>
        <BOY>2848972</BOY>
        <EOY>3180801</EOY>
      </AccountsPayableAccruedExpenses>
      <TaxExemptBondLiabilities>
        <BOY>6414123</BOY>
        <EOY>5877448</EOY>
      </TaxExemptBondLiabilities>
      <OtherLiabilities>
        <BOY>159842</BOY>
      </OtherLiabilities>
      <TotalLiabilities>
        <BOY>9422937</BOY>
        <EOY>9058249</EOY>
      </TotalLiabilities>
      <FollowSFAS117>X</FollowSFAS117>
      <UnrestrictedNetAssets>
        <BOY>64557567</BOY>
        <EOY>67318992</EOY>
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      <TotalNetAssetsFundBalances>
        <BOY>64557567</BOY>
        <EOY>67318992</EOY>
      </TotalNetAssetsFundBalances>
      <TotalLiabNetAssetsFundBalances>
        <BOY>73980504</BOY>
        <EOY>76377241</EOY>
      </TotalLiabNetAssetsFundBalances>
      <ReconcilationRevenueExpenses>2761425</ReconcilationRevenueExpenses>
      <MethodOfAccountingAccrual>X</MethodOfAccountingAccrual>
      <AccountantCompileOrReview>false</AccountantCompileOrReview>
      <FSAudited>true</FSAudited>
      <AuditCommittee>true</AuditCommittee>
      <FinancialStatementConsolidated>X</FinancialStatementConsolidated>
      <FederalGrantAuditRequired>false</FederalGrantAuditRequired>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc5">
      <Hospital170b1Aiii>X</Hospital170b1Aiii>
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    <IRS990ScheduleB documentId="RetDoc1">
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        <ContributorNumber>RESTRICTED</ContributorNumber>
        <ContributorNameBusiness>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
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        <ContributorAddressUS>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
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        <AggregateContributions>RESTRICTED</AggregateContributions>
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    <IRS990ScheduleD documentId="RetDoc6">
      <DisclosedOrgsLegalControl>false</DisclosedOrgsLegalControl>
      <DisclosedForCharitablePurposes>false</DisclosedForCharitablePurposes>
      <WrittenPolicyMonitoring>false</WrittenPolicyMonitoring>
      <Sect170hRequirementsSatisfied>false</Sect170hRequirementsSatisfied>
      <SolicitedAssetsForSale>false</SolicitedAssetsForSale>
      <AgentTrusteeEtc>false</AgentTrusteeEtc>
      <IncludedOnFS>false</IncludedOnFS>
      <EndowmentsHeldByUnrelatedOrgs>false</EndowmentsHeldByUnrelatedOrgs>
      <EndowmentsHeldByRelatedOrgs>false</EndowmentsHeldByRelatedOrgs>
      <AreRelatedOrgsListedScheduleR>false</AreRelatedOrgsListedScheduleR>
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        <OtherCostOrOtherBasis>54023066</OtherCostOrOtherBasis>
        <Depreciation>37367165</Depreciation>
        <BookValue>16655901</BookValue>
      </Buildings>
      <TotalOfBookValueLandBuildings>16655901</TotalOfBookValueLandBuildings>
      <OtherSecurities>
        <Description>INVESTMENTS</Description>
        <BookValue>51019719</BookValue>
        <MethodOfValuation>C</MethodOfValuation>
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      <TotalOfBookValueSecurities>51019719</TotalOfBookValueSecurities>
      <TotalRevenue>35553591</TotalRevenue>
      <TotalExpenses>32792166</TotalExpenses>
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      <ExcessOrDeficitPerFS>2761425</ExcessOrDeficitPerFS>
      <TotRevenueEtcAuditedFinclStmt>35553591</TotRevenueEtcAuditedFinclStmt>
      <RevenueSubtotal>35553591</RevenueSubtotal>
      <TotalRevenuePerForm990>35553591</TotalRevenuePerForm990>
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      <ExpensesSubtotal>32792166</ExpensesSubtotal>
      <TotalExpensesPerForm990>32792166</TotalExpensesPerForm990>
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    <IRS990ScheduleH documentId="RetDoc8">
      <CharityCarePolicy>true</CharityCarePolicy>
      <WrittenPolicy>true</WrittenPolicy>
      <PolicyTailoredToIndHospitals>X</PolicyTailoredToIndHospitals>
      <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>
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        <NetCommunityBenefitExpense>50818</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00150</PercentOfTotalExpense>
      </CharityCareAtCost>
      <UnreimbursedMedicaid>
        <TotalCommunityBenefitExpense>3060448</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>2817018</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>243430</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00740</PercentOfTotalExpense>
      </UnreimbursedMedicaid>
      <UnreimbursedCosts>
        <TotalCommunityBenefitExpense>114062</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>86231</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>27831</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00080</PercentOfTotalExpense>
      </UnreimbursedCosts>
      <TotalCharityCare>
        <TotalCommunityBenefitExpense>3225328</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>2903249</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>322079</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00980</PercentOfTotalExpense>
      </TotalCharityCare>
      <CommunityHealthServices>
        <TotalCommunityBenefitExpense>294875</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>27684</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>267191</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00810</PercentOfTotalExpense>
      </CommunityHealthServices>
      <HealthProfessionsEducation>
        <TotalCommunityBenefitExpense>59750</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>59750</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00180</PercentOfTotalExpense>
      </HealthProfessionsEducation>
      <SubsidizedHealthServices>
        <TotalCommunityBenefitExpense>3436425</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>2604837</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>831588</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.02540</PercentOfTotalExpense>
      </SubsidizedHealthServices>
      <CashAndInKindContributions>
        <TotalCommunityBenefitExpense>23827</TotalCommunityBenefitExpense>
        <NetCommunityBenefitExpense>23827</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.00070</PercentOfTotalExpense>
      </CashAndInKindContributions>
      <TotalOtherBenefits>
        <TotalCommunityBenefitExpense>3814877</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>2632521</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>1182356</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.03610</PercentOfTotalExpense>
      </TotalOtherBenefits>
      <TotalCommunityBenefits>
        <TotalCommunityBenefitExpense>7040205</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>5535770</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>1504435</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.04590</PercentOfTotalExpense>
      </TotalCommunityBenefits>
      <LeadershipDevelopment>
        <TotalCommunityBuildingExpense>63507</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>63507</NetCommunityBuildingExpense>
        <PercentOfTotalExpense>0.00190</PercentOfTotalExpense>
      </LeadershipDevelopment>
      <Total>
        <TotalCommunityBuildingExpense>63507</TotalCommunityBuildingExpense>
        <NetCommunityBuildingExpense>63507</NetCommunityBuildingExpense>
        <PercentOfTotalExpense>0.00190</PercentOfTotalExpense>
      </Total>
      <BadDebtExpenseReported>true</BadDebtExpenseReported>
      <BadDebtExpenseAmount>2993367</BadDebtExpenseAmount>
      <AmountAttributableTo>598673</AmountAttributableTo>
      <AmountReimbursedByMedicare>9942884</AmountReimbursedByMedicare>
      <CostOfCareReimbursedByMedicare>9917905</CostOfCareReimbursedByMedicare>
      <MedicareSurplusOrShortfall>24979</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>
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      <Form990ScheduleHPartVSectionB>
        <HospitalFacilityName>
          <BusinessNameLine1>HURON REGIONAL MEDICAL CENTER</BusinessNameLine1>
        </HospitalFacilityName>
        <HospitalFacilityNumber>1</HospitalFacilityNumber>
        <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>
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      <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 17385 PLUS PEDIATRIC CLINIC 323560 FOR A TOTAL OF 340945 BAD DEBT EXPENSE NOT REPORTED ON LINE 7G WAS 178893</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</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 2012 AND 2011 WERE 5736643 AND 4876393 ALLOWANCE FOR DOUBTFUL ACCOUNTS AS OF JUNE 30 2012 AND 2011 WERE 3122539 AND 1942709 ACCOUNTS RECEIVABLE NET AS OF JUNE 30 2012 AND 2011 WERE 2614104 AND 2933684 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>
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      <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 ROBIN BROZ</NamePerson>
        <BaseCompensationFilingOrg>171326</BaseCompensationFilingOrg>
        <BonusFilingOrg>10000</BonusFilingOrg>
        <OtherCompensationFilingOrg>54144</OtherCompensationFilingOrg>
        <TotalCompensationFilingOrg>235470</TotalCompensationFilingOrg>
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      <Form990ScheduleJPartII>
        <NamePerson>DR CARL HUFF</NamePerson>
        <BaseCompensationFilingOrg>212671</BaseCompensationFilingOrg>
        <BonusFilingOrg>4583</BonusFilingOrg>
        <OtherCompensationFilingOrg>2778</OtherCompensationFilingOrg>
        <TotalCompensationFilingOrg>220032</TotalCompensationFilingOrg>
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      <Form990ScheduleJPartII>
        <NamePerson>MICHEL MELMER</NamePerson>
        <BaseCompensationFilingOrg>183923</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>3719</DeferredCompFilingOrg>
        <TotalCompensationFilingOrg>187642</TotalCompensationFilingOrg>
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      <Form990ScheduleJPartII>
        <NamePerson>SCOTT HOLZEMER</NamePerson>
        <BaseCompensationFilingOrg>166120</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>3412</DeferredCompFilingOrg>
        <TotalCompensationFilingOrg>169532</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>SAMUEL JANES</NamePerson>
        <BaseCompensationFilingOrg>158612</BaseCompensationFilingOrg>
        <DeferredCompFilingOrg>3236</DeferredCompFilingOrg>
        <TotalCompensationFilingOrg>161848</TotalCompensationFilingOrg>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartIII>
        <Identifier>FRINGE OR EXPENSE EXPLANATION</Identifier>
        <ReturnReference>SCHEDULE J, PAGE 1, PART I, LINE 1A</ReturnReference>
        <Explanation>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="RetDoc10">
      <Form990ScheduleKPartI>
        <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>
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      <Form990ScheduleKPartII>
        <AmountRetired>1863750</AmountRetired>
        <TotalProceeds>6115928</TotalProceeds>
        <AmountInReserveFund>339461</AmountInReserveFund>
        <IssuanceCostsFromProceeds>158313</IssuanceCostsFromProceeds>
        <OtherSpentProceeds>5433965</OtherSpentProceeds>
        <YearOfSubstCompletion>1995</YearOfSubstCompletion>
        <CurrentRefunding>true</CurrentRefunding>
        <AdvanceRefunding>false</AdvanceRefunding>
        <FinalAllocationMade>true</FinalAllocationMade>
        <AdequateBooksAndRecdsMaintaind>true</AdequateBooksAndRecdsMaintaind>
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        <AnyLeaseArrangements>false</AnyLeaseArrangements>
        <MngmentCntrctBondFinancdPrprty>false</MngmentCntrctBondFinancdPrprty>
        <EngageBondCounselContracts>false</EngageBondCounselContracts>
        <AnyResearchAgreements>false</AnyResearchAgreements>
        <EngageBondCounselResearch>false</EngageBondCounselResearch>
        <PostIssuanceComplianceProcdrs>true</PostIssuanceComplianceProcdrs>
      </Form990ScheduleKPartIII>
      <Form990ScheduleKPartIV>
        <Form8038TFiled>true</Form8038TFiled>
        <VariableRateIssue>false</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>false</HedgeIdentifiedInBooksAndRecds>
        <GrossProceedsInvestedInGIC>false</GrossProceedsInvestedInGIC>
        <GrossProceedsInvested>false</GrossProceedsInvested>
        <ExceptionToRebate>false</ExceptionToRebate>
      </Form990ScheduleKPartIV>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="RetDoc11">
      <LoanTable>
        <NamePerson>DR ROBIN BROZ</NamePerson>
        <PurposeOfLoan>HOUSING ASSISTANCE</PurposeOfLoan>
        <LoanFromOrganization>X</LoanFromOrganization>
        <OriginalPrincipalAmount>100497</OriginalPrincipalAmount>
        <BalanceDue>67835</BalanceDue>
        <Default>false</Default>
        <ApprovedByBoard>true</ApprovedByBoard>
        <WrittenAgreement>true</WrittenAgreement>
      </LoanTable>
      <LoanTable>
        <NamePerson>DR CARL HUFF</NamePerson>
        <PurposeOfLoan>HOUSING ASSISTANCE</PurposeOfLoan>
        <LoanFromOrganization>X</LoanFromOrganization>
        <OriginalPrincipalAmount>50000</OriginalPrincipalAmount>
        <BalanceDue>40417</BalanceDue>
        <Default>false</Default>
        <ApprovedByBoard>true</ApprovedByBoard>
        <WrittenAgreement>true</WrittenAgreement>
      </LoanTable>
      <TotalBalanceDue>108252</TotalBalanceDue>
      <Form990ScheduleLPartIV>
        <NameOfInterestedPerson>
          <NamePerson>DR KARL BLESSINGER</NamePerson>
        </NameOfInterestedPerson>
        <Relationship>DIRECTOR</Relationship>
        <AmountOfTransaction>128600</AmountOfTransaction>
        <DescriptionOfTransaction>LAB/PATHOLOGY</DescriptionOfTransaction>
        <SharingOfRevenues>false</SharingOfRevenues>
      </Form990ScheduleLPartIV>
      <Form990ScheduleLPartIV>
        <NameOfInterestedPerson>
          <NamePerson>BILL ANDERSON</NamePerson>
        </NameOfInterestedPerson>
        <Relationship>DIRECTOR</Relationship>
        <AmountOfTransaction>130789</AmountOfTransaction>
        <DescriptionOfTransaction>CARPETING &amp; FURNISHI</DescriptionOfTransaction>
        <SharingOfRevenues>false</SharingOfRevenues>
      </Form990ScheduleLPartIV>
      <Form990ScheduleLPartIV>
        <NameOfInterestedPerson>
          <NamePerson>PHIL WIEDENMAN</NamePerson>
        </NameOfInterestedPerson>
        <Relationship>DIRECTOR</Relationship>
        <AmountOfTransaction>247389</AmountOfTransaction>
        <DescriptionOfTransaction>CONSTRUCTION SERVICE</DescriptionOfTransaction>
        <SharingOfRevenues>false</SharingOfRevenues>
      </Form990ScheduleLPartIV>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc12">
      <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>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 OFFICE OF THE ORGANIZATION. FINANCIAL STATEMENTS ALSO MADE PUBLIC THROUGH QUARTERLY AND ANNUAL POSTING ON ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AND ANNUAL POSTING OF FORM 990 THROUGH GUIDESTAR</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc13">
      <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>501(C)</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>
      <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>