﻿<?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="2023v6.0">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2025-07-14T16:40:00-05:00</ReturnTs>
    <TaxPeriodEndDt>2024-09-30</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>460403496</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>CASEY PETERSON LTD</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>909 ST JOSEPH ST STE 101</AddressLine1Txt>
        <CityNm>RAPID CITY</CityNm>
        <StateAbbreviationCd>SD</StateAbbreviationCd>
        <ZIPCd>57701</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-10-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>460401085</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>LEMMON AREA MEDICAL ASSOCIATION</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>LEMM</BusinessNameControlTxt>
      <PhoneNum>6053743871</PhoneNum>
      <USAddress>
        <AddressLine1Txt>405 6TH AVENUE WEST</AddressLine1Txt>
        <CityNm>LEMMON</CityNm>
        <StateAbbreviationCd>SD</StateAbbreviationCd>
        <ZIPCd>57638</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>JORDAN FISH</PersonNm>
      <PersonTitleTxt>ADMINISTRATOR</PersonTitleTxt>
      <PhoneNum>6053743871</PhoneNum>
      <SignatureDt>2025-07-11</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>1</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>KAYLA GIESEY CPA</PreparerPersonNm>
      <PTIN>P01874520</PTIN>
      <PhoneNum>6053481930</PhoneNum>
      <PreparationDt>2025-07-14</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2025-03-06 01:10:19Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="6">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <DoingBusinessAsName>
        <BusinessNameLine1Txt>FIVE COUNTIES NURSING HOME</BusinessNameLine1Txt>
      </DoingBusinessAsName>
      <PrincipalOfficerNm>JORDAN FISH</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>405 6TH AVENUE WEST</AddressLine1Txt>
        <CityNm>LEMMON</CityNm>
        <StateAbbreviationCd>SD</StateAbbreviationCd>
        <ZIPCd>57638</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>3612059</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>N/A</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1952</FormationYr>
      <LegalDomicileStateCd>SD</LegalDomicileStateCd>
      <ActivityOrMissionDesc>TO PROVIDE HEALTH CARE TO THE RESIDENTS OF LEMMON, SOUTH DAKOTA</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>7</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>7</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>72</TotalEmployeeCnt>
      <TotalVolunteersCnt>15</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>46165</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>34455</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>3718076</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>3449133</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>36949</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>87515</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>42300</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>40956</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>3843490</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>3612059</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>1883583</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>1500231</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>1918910</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>2282354</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>3802493</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>3782585</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>40997</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-170526</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>3938781</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>3796511</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>343261</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>337944</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>3595520</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>3458567</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>FIVE COUNTIES NURSING HOME IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF LIFE FOR THE PEOPLE WE SERVE.</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>2822028</ExpenseAmt>
      <RevenueAmt>3490089</RevenueAmt>
      <Desc>LEMMON AREA MEDICAL ASSOCIATION (THE ASSOCIATION) IS A NONPROFIT ASSOCIATION WHOSE PURPOSE IS TO OPERATE FIVE COUNTIES NURSING HOME AND TO RAISE THE FUNDS NECESSARY FOR ITS OPERATION. FIVE COUNTIES NURSING HOME CONSISTS OF A 42-BED NURSING HOME. FOR THE YEAR ENDED SEPTEMBER 30, 2024, THE ASSOCIATION PROVIDED 12,159 NURSING HOME DAYS OF CARE.</Desc>
      <TotalProgramServiceExpensesAmt>2822028</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc1039100001">1</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1234500001">1</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>0</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>0</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>0</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc1040000001">0</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc1040000001">0</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc1040000001">0</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc1040000001">1</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>1</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc1040000001">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc1040000001">1</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc1040000001">0</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc1040000001">0</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc1040000001">0</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc1040000001">0</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>0</SchoolOperatingInd>
      <ForeignOfficeInd>0</ForeignOfficeInd>
      <ForeignActivitiesInd>0</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>0</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>0</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>0</FundraisingActivitiesInd>
      <GamingActivitiesInd>0</GamingActivitiesInd>
      <OperateHospitalInd>0</OperateHospitalInd>
      <GrantsToOrganizationsInd>0</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd>0</ScheduleJRequiredInd>
      <TaxExemptBondsInd>0</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>0</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>0</PYExcessBenefitTransInd>
      <LoanOutstandingInd>0</LoanOutstandingInd>
      <GrantToRelatedPersonInd>0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>0</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>0</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>0</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>0</DeductibleArtContributionInd>
      <TerminateOperationsInd>0</TerminateOperationsInd>
      <PartialLiquidationInd>0</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentId="RetDoc1043400001">0</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="RetDoc1043400001">1</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>1</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentId="RetDoc1043400001">0</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentId="RetDoc1043400001">0</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="RetDoc1043400001">0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>5</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>72</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>1</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>0</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>0</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>0</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>0</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>0</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>0</PayPremiumsPrsnlBnftCntrctInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>0</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>0</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>7</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>7</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>0</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>0</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>0</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>0</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>0</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>1</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>1</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>1</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>1</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>0</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>0</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>1</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>0</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>THE ORGANIZATION</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>6053743871</PhoneNum>
        <USAddress>
          <AddressLine1Txt>405 6TH AVENUE WEST</AddressLine1Txt>
          <CityNm>LEMMON</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57638</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK EVANS</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TIM HEIL</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LYNDSEY WHEELER</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KORI DAUWEN</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TRAVIS MAIER</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SUSAN GUNN</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KAYLA ANDERSON</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JORDAN FISH</PersonNm>
        <TitleTxt>ADMINISTRATOR (BEG DEC 2023)</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>5769</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>5769</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>0</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>0</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>0</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>AUREUS NURSING LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 850854</AddressLine1Txt>
            <CityNm>MINNEAPOLIS</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>55485</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT STAFFING</ServicesDesc>
        <CompensationAmt>452455</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MEDICAL SOLUTIONS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1010 N 102ND STREET SUITE 300</AddressLine1Txt>
            <CityNm>OMAHA</CityNm>
            <StateAbbreviationCd>NE</StateAbbreviationCd>
            <ZIPCd>68114</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT STAFFING</ServicesDesc>
        <CompensationAmt>180491</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>105 SERVICES LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>14205 72ND AVE NE</AddressLine1Txt>
            <CityNm>SURREY</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58785</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>BUILDING REPAIRS</ServicesDesc>
        <CompensationAmt>168571</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>DTN STAFFING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1200 COLLINS AVE</AddressLine1Txt>
            <CityNm>MANDAN</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58554</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT STAFFING</ServicesDesc>
        <CompensationAmt>134137</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>HA THOMPSON &amp; SONS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 1195</AddressLine1Txt>
            <CityNm>BISMARCK</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58502</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>BUILDING REPAIRS</ServicesDesc>
        <CompensationAmt>117142</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>6</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>20000</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>14455</AllOtherContributionsAmt>
      <TotalContributionsAmt>34455</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICE REVENU</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>3421798</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3421798</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>19756</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>19756</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>DIETARY REVENUE</Desc>
        <BusinessCd>722514</BusinessCd>
        <TotalRevenueColumnAmt>7579</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>7579</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>3449133</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>87515</TotalRevenueColumnAmt>
        <ExclusionAmt>87515</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>40956</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>0</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>40956</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>40956</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>40956</RelatedOrExemptFuncIncomeAmt>
      </NetRentalIncomeOrLossGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>3612059</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3490089</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>87515</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>48507</TotalAmt>
        <ManagementAndGeneralAmt>48507</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>1199171</TotalAmt>
        <ProgramServicesAmt>788076</ProgramServicesAmt>
        <ManagementAndGeneralAmt>411095</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>157138</TotalAmt>
        <ProgramServicesAmt>102305</ProgramServicesAmt>
        <ManagementAndGeneralAmt>54833</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>95415</TotalAmt>
        <ProgramServicesAmt>60475</ProgramServicesAmt>
        <ManagementAndGeneralAmt>34940</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>48349</TotalAmt>
        <ManagementAndGeneralAmt>48349</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>18983</TotalAmt>
        <ManagementAndGeneralAmt>18983</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1485348</TotalAmt>
        <ProgramServicesAmt>1333729</ProgramServicesAmt>
        <ManagementAndGeneralAmt>151619</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <OfficeExpensesGrp>
        <TotalAmt>32908</TotalAmt>
        <ManagementAndGeneralAmt>32908</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>36141</TotalAmt>
        <ProgramServicesAmt>700</ProgramServicesAmt>
        <ManagementAndGeneralAmt>35441</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>123556</TotalAmt>
        <ProgramServicesAmt>92667</ProgramServicesAmt>
        <ManagementAndGeneralAmt>30889</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>12099</TotalAmt>
        <ProgramServicesAmt>12099</ProgramServicesAmt>
      </TravelGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>93860</TotalAmt>
        <ProgramServicesAmt>70395</ProgramServicesAmt>
        <ManagementAndGeneralAmt>23465</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>71551</TotalAmt>
        <ProgramServicesAmt>40754</ProgramServicesAmt>
        <ManagementAndGeneralAmt>30797</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>228680</TotalAmt>
        <ProgramServicesAmt>190542</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38138</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DIETARY SERVICES</Desc>
        <TotalAmt>115581</TotalAmt>
        <ProgramServicesAmt>115581</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS AND MAINTENANCE</Desc>
        <TotalAmt>15298</TotalAmt>
        <ProgramServicesAmt>14705</ProgramServicesAmt>
        <ManagementAndGeneralAmt>593</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>3782585</TotalAmt>
        <ProgramServicesAmt>2822028</ProgramServicesAmt>
        <ManagementAndGeneralAmt>960557</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>61912</BOYAmt>
        <EOYAmt>138668</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>1874612</BOYAmt>
        <EOYAmt>1798095</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>606935</BOYAmt>
        <EOYAmt>389755</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>33801</BOYAmt>
        <EOYAmt>33801</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>11747</BOYAmt>
        <EOYAmt>49226</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>4736695</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>3661610</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>1053243</BOYAmt>
        <EOYAmt>1075085</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>49314</BOYAmt>
        <EOYAmt>49314</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>247217</BOYAmt>
        <EOYAmt>262567</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <TotalAssetsGrp>
        <BOYAmt>3938781</BOYAmt>
        <EOYAmt>3796511</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>217275</BOYAmt>
        <EOYAmt>278886</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>2716</BOYAmt>
        <EOYAmt>6228</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>123270</BOYAmt>
        <EOYAmt>52830</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>343261</BOYAmt>
        <EOYAmt>337944</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>3309035</BOYAmt>
        <EOYAmt>3143494</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>286485</BOYAmt>
        <EOYAmt>315073</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>3595520</BOYAmt>
        <EOYAmt>3458567</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>3938781</BOYAmt>
        <EOYAmt>3796511</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-170526</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>33573</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>1</AccountantCompileOrReviewInd>
      <AcctCompileOrReviewBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </AcctCompileOrReviewBasisGrp>
      <FSAuditedInd>0</FSAuditedInd>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>45415</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>1072075</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>204602</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>46165</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>34455</CurrentTaxYearAmt>
        <TotalAmt>1402712</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>3426078</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>3404138</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>3899033</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3760376</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3490089</CurrentTaxYearAmt>
        <TotalAmt>17979714</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>3471493</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4476213</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4103635</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3806541</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3524544</CurrentTaxYearAmt>
        <TotalAmt>19382426</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <TotalAmt>0</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <CurrentTaxYearMinus4YearsAmt>555186</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>495884</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>636319</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>667782</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>675125</CurrentTaxYearAmt>
        <TotalAmt>3030296</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <CurrentTaxYearMinus4YearsAmt>555186</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>495884</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>636319</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>667782</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>675125</CurrentTaxYearAmt>
        <TotalAmt>3030296</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>16352130</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>27089</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>49121</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>46771</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>36949</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>87515</CurrentTaxYearAmt>
        <TotalAmt>247445</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>27089</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>49121</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>46771</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>36949</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>87515</CurrentTaxYearAmt>
        <TotalAmt>247445</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>3498582</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>4525334</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>4150406</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3843490</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3612059</CurrentTaxYearAmt>
        <TotalAmt>19629871</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.83300</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.84210</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.01260</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.01080</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <AgentTrusteeEtcInd>0</AgentTrusteeEtcInd>
      <InclEscrowCustodialAcctLiabInd>1</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>190674</BeginningYearBalanceAmt>
        <ContributionsAmt>200</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>28773</InvestmentEarningsOrLossesAmt>
        <AdministrativeExpensesAmt>1804</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>217843</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>168789</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>23109</InvestmentEarningsOrLossesAmt>
        <AdministrativeExpensesAmt>1224</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>190674</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>236855</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>-29582</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>36500</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>1984</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>168789</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>215260</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>30367</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>6669</GrantsOrScholarshipsAmt>
        <AdministrativeExpensesAmt>2103</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>236855</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>196303</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>20777</InvestmentEarningsOrLossesAmt>
        <AdministrativeExpensesAmt>1819</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>215260</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <PrmnntEndowmentBalanceEOYPct>0.73370</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.26630</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>1</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>0</EndowmentsHeldRelatedOrgInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>4837</OtherCostOrOtherBasisAmt>
        <BookValueAmt>4837</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>2438490</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2080883</DepreciationAmt>
        <BookValueAmt>357607</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>2149416</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1480447</DepreciationAmt>
        <BookValueAmt>668969</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>143952</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>100280</DepreciationAmt>
        <BookValueAmt>43672</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>1075085</TotalBookValueLandBuildingsAmt>
      <CloselyHeldEquityInterestsGrp>
        <BookValueAmt>44724</BookValueAmt>
        <MethodValuationCd>C</MethodValuationCd>
      </CloselyHeldEquityInterestsGrp>
      <OtherSecuritiesGrp>
        <Desc>INVESTMENTS HELD AT SD COMMUNITY FOUNDATION</Desc>
        <BookValueAmt>217843</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>262567</TotalBookValueSecuritiesAmt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART IV, LINE 2B:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE LIABILITY ACCOUNT REFLECTS THE AMOUNTS HELD BY THE ASSOCIATION FOR NURSING HOME RESIDENTS TO USE FOR PERSONAL EXPENSES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART V, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE INCOME FROM THE ENDOWMENT FUND CAN BE USED FOR PURCHASES OF PROPERTY AND EQUIPMENT. THE CORPUS OF $159,823 IS TO BE MAINTAINED IN PERPETUITY. THE ENDOWMENT FUNDS ARE HELD AND ADMINISTERED BY SOUTH DAKOTA COMMUNITY FOUNDATION.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ASSOCIATION DOES NOT HAVE COMMITTEES WITH BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ADMINISTRATOR REVIEWS THE 990 IN DETAIL. AFTER THE ADMINISTRATOR'S REVIEW, THE 990 IS PROVIDED TO EACH BOARD MEMBER. THE ADMINISTRATOR PRESENTS THE 990 TO THE BOARD OF DIRECTORS AT THE MEETING HELD PRIOR TO ITS FILING. THE 990 IS NOT FILED UNTIL EACH BOARD MEMBERS HAS BEEN GIVEN A COPY OF IT AND GIVEN AMPLE TIME TO REVIEW IT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD MEMBERS, DEPARTMENT HEADS, AND THE ADMINISTRATOR ARE COVERED BY THE POLICY. ANY POTENTIAL CONFLICTS ARE DIRECTED TO THE SECRETARY. THE BOARD OF DIRECTORS DETERMINES WHETHER A CONFLICT EXISTS. IF THE PERSON WITH THE CONFLICT IS A BOARD MEMBER, THAT PERSON IS REQUIRED TO LEAVE THE MEETING DURING THE DISCUSSION. IF A CONFLICT EXISTS, THE BOARD MEMBER INVOLVED IS REQUIRED TO ABSTAIN FROM VOTING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION USES SALARY INFORMATION PROVIDED BY SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATIONS (SDAHO) TO DETERMINE THE APPROPRIATE LEVEL OF COMPENSATION FOR THE ADMINISTRATOR. THE ADMINISTRATOR'S COMPENSATION DOES NOT EXCEED THE AMOUNT DETERMINED BY SDAHO SURVEYS. MINUTES ARE KEPT REGARDING THE DISCUSSION, DELIBERATION, AND DETERMINATION OF THE ADMINISTRATOR'S SALARY. THE PROCESS FOR DETERMINING COMPENSATION WAS LAST UNDERTAKEN IN 2018.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CONFLICT OF INTEREST POLICY, BYLAWS, AND ARTICLES OF INCORPORATION ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE GENERAL PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,333,729. MANAGEMENT AND GENERAL EXPENSES 151,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,485,348.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>LEMMON PRAIRIE PINES APARTMENTS INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>401 SIXTH AVENUE WEST</AddressLine1Txt>
          <CityNm>LEMMON</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>576380479</ZIPCd>
        </USAddress>
        <EIN>460442677</EIN>
        <PrimaryActivitiesTxt>LOW INCOME HOUSING</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>LEMMON AREA MEDICAL ASSOCIATION</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>