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        <RelatedOrExemptFuncIncomeAmt>78329</RelatedOrExemptFuncIncomeAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>10905895</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>4261</TotalRevenueColumnAmt>
        <ExclusionAmt>4261</ExclusionAmt>
      </InvestmentIncomeGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <OtherAmt>2483</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-2483</TotalRevenueColumnAmt>
        <ExclusionAmt>-2483</ExclusionAmt>
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      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>10947203</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>10905895</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>1778</ExclusionAmt>
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      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>228557</TotalAmt>
        <ManagementAndGeneralAmt>228557</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>54455</TotalAmt>
        <ProgramServicesAmt>54455</ProgramServicesAmt>
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      <OtherSalariesAndWagesGrp>
        <TotalAmt>5525794</TotalAmt>
        <ProgramServicesAmt>5211069</ProgramServicesAmt>
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      <PensionPlanContributionsGrp>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>842858</ProgramServicesAmt>
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        <FundraisingAmt>8695</FundraisingAmt>
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        <TotalAmt>416058</TotalAmt>
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        <ManagementAndGeneralAmt>39035</ManagementAndGeneralAmt>
        <FundraisingAmt>2040</FundraisingAmt>
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      <FeesForServicesLegalGrp>
        <TotalAmt>64</TotalAmt>
        <ManagementAndGeneralAmt>64</ManagementAndGeneralAmt>
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      <FeesForServicesAccountingGrp>
        <TotalAmt>21188</TotalAmt>
        <ManagementAndGeneralAmt>21188</ManagementAndGeneralAmt>
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      <FeesForServicesOtherGrp>
        <TotalAmt>491537</TotalAmt>
        <ProgramServicesAmt>490556</ProgramServicesAmt>
        <ManagementAndGeneralAmt>981</ManagementAndGeneralAmt>
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      <AdvertisingGrp>
        <TotalAmt>53066</TotalAmt>
        <ManagementAndGeneralAmt>53066</ManagementAndGeneralAmt>
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      <OfficeExpensesGrp>
        <TotalAmt>68611</TotalAmt>
        <ProgramServicesAmt>44771</ProgramServicesAmt>
        <ManagementAndGeneralAmt>23830</ManagementAndGeneralAmt>
        <FundraisingAmt>10</FundraisingAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>775090</TotalAmt>
        <ProgramServicesAmt>775090</ProgramServicesAmt>
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      <TravelGrp>
        <TotalAmt>15375</TotalAmt>
        <ProgramServicesAmt>11082</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4293</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>23405</TotalAmt>
        <ProgramServicesAmt>19595</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3810</ManagementAndGeneralAmt>
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      <InterestGrp>
        <TotalAmt>315812</TotalAmt>
        <ProgramServicesAmt>306271</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9541</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>830344</TotalAmt>
        <ProgramServicesAmt>805813</ProgramServicesAmt>
        <ManagementAndGeneralAmt>24531</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>137732</TotalAmt>
        <ProgramServicesAmt>131599</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6133</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Dietary Supplies and Fo</Desc>
        <TotalAmt>453815</TotalAmt>
        <ProgramServicesAmt>453815</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>256403</TotalAmt>
        <ProgramServicesAmt>256403</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Other Supplies Expense</Desc>
        <TotalAmt>98314</TotalAmt>
        <ProgramServicesAmt>98314</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Bad Debt Expense</Desc>
        <TotalAmt>15227</TotalAmt>
        <ProgramServicesAmt>15227</ProgramServicesAmt>
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      <AllOtherExpensesGrp>
        <TotalAmt>68774</TotalAmt>
        <ProgramServicesAmt>33624</ProgramServicesAmt>
        <ManagementAndGeneralAmt>35102</ManagementAndGeneralAmt>
        <FundraisingAmt>48</FundraisingAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>10847456</TotalAmt>
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      <InventoriesForSaleOrUseGrp>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>32367</EOYAmt>
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        <EOYAmt>237</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>6568627</EOYAmt>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>8006764</EOYAmt>
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      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
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        <EOYAmt>4770095</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>4670348</BOYAmt>
        <EOYAmt>4770095</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>12848648</BOYAmt>
        <EOYAmt>12776859</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>99747</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>0</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>70465</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>49786</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>39698</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>60606</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>39530</CurrentTaxYearAmt>
        <TotalAmt>260085</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>9257214</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9259755</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9837048</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10279914</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10905895</CurrentTaxYearAmt>
        <TotalAmt>49539826</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>9327679</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9309541</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9876746</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10340520</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10945425</CurrentTaxYearAmt>
        <TotalAmt>49799911</TotalAmt>
      </Total509Grp>
      <AmountsRcvdDsqlfyPersonGrp>
        <CurrentTaxYearMinus3YearsAmt>58186</CurrentTaxYearMinus3YearsAmt>
        <TotalAmt>58186</TotalAmt>
      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
        <CurrentTaxYearMinus4YearsAmt>104260</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>183176</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>202567</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>173417</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>59447</CurrentTaxYearAmt>
        <TotalAmt>722867</TotalAmt>
      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
        <CurrentTaxYearMinus4YearsAmt>104260</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>241362</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>202567</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>173417</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>59447</CurrentTaxYearAmt>
        <TotalAmt>781053</TotalAmt>
      </SubstAndDsqlfyPrsnsTotGrp>
      <PublicSupportTotal509Amt>49018858</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>1442</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>819</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>872</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>956</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4261</CurrentTaxYearAmt>
        <TotalAmt>8350</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>1442</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>819</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>872</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>956</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>4261</CurrentTaxYearAmt>
        <TotalAmt>8350</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>9329121</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>9310360</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>9877618</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>10341476</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>10949686</CurrentTaxYearAmt>
        <TotalAmt>49808261</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.98420</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.98450</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.00020</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.00030</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleC documentId="RetDoc1039700001">
      <VolunteersInd>0</VolunteersInd>
      <PaidStaffOrManagementInd>0</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>0</MediaAdvertisementsInd>
      <MailingsMembersInd>0</MailingsMembersInd>
      <PublicationsOrBroadcastInd>0</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>1</GrantsOtherOrganizationsInd>
      <GrantsOtherOrganizationsAmt>564</GrantsOtherOrganizationsAmt>
      <DirectContactLegislatorsInd>0</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>0</RalliesDemonstrationsInd>
      <OtherActivitiesInd>0</OtherActivitiesInd>
      <TotalLobbyingExpendituresAmt>564</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>0</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part II-B, Line 1:</FormAndLineReferenceDesc>
        <ExplanationTxt>Lobbying activity in 2018 totaled $564 which was included in annual dues to healthcare associations.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <AgentTrusteeEtcInd>1</AgentTrusteeEtcInd>
      <BeginningBalanceAmt>654</BeginningBalanceAmt>
      <AdditionsDuringYearAmt>295</AdditionsDuringYearAmt>
      <DistributionsDuringYearAmt>469</DistributionsDuringYearAmt>
      <EndingBalanceAmt>480</EndingBalanceAmt>
      <InclEscrowCustodialAcctLiabInd>0</InclEscrowCustodialAcctLiabInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>67003</OtherCostOrOtherBasisAmt>
        <BookValueAmt>67003</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>18481205</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>8824466</DepreciationAmt>
        <BookValueAmt>9656739</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>3945584</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2352402</DepreciationAmt>
        <BookValueAmt>1593182</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>357327</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>287743</DepreciationAmt>
        <BookValueAmt>69584</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>11386508</TotalBookValueLandBuildingsAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>10939065</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueNotReportedAmt>0</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>10939065</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>8138</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>8138</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>10947203</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>10839318</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>2483</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>2483</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>10836835</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>10621</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>10621</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>10847456</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV, Line 1b:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization holds funds for nursing home residents for safe keeping and makes the funds available to the residents upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization is organized as a South Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. The Organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad debt expense netted with revenue on audited financial statements</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad debt expense netted with revenue on audited financial statements 10,621. Loss on disposal of fixed assets -2,483.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Loss on disposal of fixed assets 2,483.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad debt expense netted with revenue on audited financial statements 10,621.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>Barb Crawford</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Family member of Kathy Harris, current director.</RelationshipDescriptionTxt>
        <TransactionAmt>54455</TransactionAmt>
        <TransactionDesc>Compensation and benefits</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>Member churches - ELCA churches in the Aberdeen, SD area (membership by invitation only).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Member churches make recommendation of individuals up for election. Board members are elected at the annual member meeting in April of each year.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>There are no committees with the authority to act on behalf of the Board.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Accounting/Reimbursement Coordinator reviews the main portions verifying information and gives to the Administrator for approval. The 990 is presented to the Board of Directors at the first meeting after which the draft is received.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The members of the Board of Directors are each asked to fill out/sign a Conflict of Interest Statement on a yearly basis. The Conflict of Interest Statements are reviewed by the Administrator and disclosed at the Board Meetings on an annual basis or case by case if such situation presents itself throughout the year. Board members must disclose any and all conflicts that they knowingly have and these are filed with the Board of Director minutes. Restrictions included but not limited to may be the inability to vote on Board related actions.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>Executive Committee of the board meets yearly and discusses and determines the Administrator's yearly compensation amount. The Executive Committee looks at what was paid in prior year and adds given merit increase. The Administrator looks at what the Accounting/Reimbursement Coordinator made the prior year and gives merit increase.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Governing documents are provided upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>