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        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>154931</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>41596</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHELLE SYBESMA</PersonNm>
        <TitleTxt>VP EDUCATION &amp; COMMUNICATION</TitleTxt>
        <AverageHoursPerWeekRt>39.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>140924</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>40086</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>728425</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>148726</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>3</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <CntrctRcvdGreaterThan100KCnt>0</CntrctRcvdGreaterThan100KCnt>
      <ProgramServiceRevenueGrp>
        <Desc>MEMBERSHIP DUES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>2193027</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2193027</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>INSTITUTES AND WORKSHO</Desc>
        <BusinessCd>532000</BusinessCd>
        <TotalRevenueColumnAmt>223221</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>223221</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>MANAGEMENT SERVICES</Desc>
        <BusinessCd>541610</BusinessCd>
        <TotalRevenueColumnAmt>189282</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>176562</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>12720</UnrelatedBusinessRevenueAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>7089</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>7089</RelatedOrExemptFuncIncomeAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>2612619</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>232090</TotalRevenueColumnAmt>
        <ExclusionAmt>232090</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>203459</SecuritiesAmt>
        <OtherAmt>1656</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>240179</SecuritiesAmt>
        <OtherAmt>0</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>-36720</SecuritiesAmt>
        <OtherAmt>1656</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-35064</TotalRevenueColumnAmt>
        <ExclusionAmt>-35064</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>2809645</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>2599899</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>12720</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>197026</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>6000</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>696141</TotalAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>616829</TotalAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>94045</TotalAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>115398</TotalAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>113330</TotalAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>1950</TotalAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>34747</TotalAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>400</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>17321</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>22492</TotalAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>16116</TotalAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>79480</TotalAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>146517</TotalAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>25971</TotalAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>163059</TotalAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>279946</TotalAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>2379</TotalAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>79347</TotalAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>18375</TotalAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>IN-HOUSE LOBBYING EXPEN</Desc>
        <TotalAmt>114780</TotalAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BANK CHARGES &amp; FEES</Desc>
        <TotalAmt>1565</TotalAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>2646188</TotalAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>1197417</BOYAmt>
        <EOYAmt>540805</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>417059</BOYAmt>
        <EOYAmt>308308</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>70716</BOYAmt>
        <EOYAmt>57342</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>849589</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>571967</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>323331</BOYAmt>
        <EOYAmt>277622</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>5294051</BOYAmt>
        <EOYAmt>5896766</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>295982</BOYAmt>
        <EOYAmt>309325</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>218550</BOYAmt>
        <EOYAmt>168233</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>7817106</BOYAmt>
        <EOYAmt>7558401</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>189931</BOYAmt>
        <EOYAmt>101248</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>1317852</BOYAmt>
        <EOYAmt>595383</EOYAmt>
      </DeferredRevenueGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>185081</BOYAmt>
        <EOYAmt>113121</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>33913</BOYAmt>
        <EOYAmt>55812</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>1726777</BOYAmt>
        <EOYAmt>865564</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>6044347</BOYAmt>
        <EOYAmt>6633512</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>45982</BOYAmt>
        <EOYAmt>59325</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>6090329</BOYAmt>
        <EOYAmt>6692837</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>7817106</BOYAmt>
        <EOYAmt>7558401</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>163457</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>425708</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>13343</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>1</AccountantCompileOrReviewInd>
      <AcctCompileOrReviewBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </AcctCompileOrReviewBasisGrp>
      <FSAuditedInd>0</FSAuditedInd>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleC documentId="RetDoc1039700001">
      <SubstantiallyAllDuesNondedInd>1</SubstantiallyAllDuesNondedInd>
      <OnlyInHouseLobbyingInd>0</OnlyInHouseLobbyingInd>
      <AgreeCarryoverPriorYearInd>0</AgreeCarryoverPriorYearInd>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <AgentTrusteeEtcInd>0</AgentTrusteeEtcInd>
      <InclEscrowCustodialAcctLiabInd>1</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>531480</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>381603</DepreciationAmt>
        <BookValueAmt>149877</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>239938</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>158704</DepreciationAmt>
        <BookValueAmt>81234</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>78171</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>31660</DepreciationAmt>
        <BookValueAmt>46511</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>277622</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>CAPITAL LEASE OBLIGATION</Desc>
        <Amt>55812</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>55812</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART IV, LINE 2B:</FormAndLineReferenceDesc>
        <ExplanationTxt>DURING THE YEARS ENDED DECEMBER 31, 2023, THE ASSOCIATION WAS A FISCAL AGENT FOR THE STATE HOSPITAL ASSOCIATION EXECUTIVES FORUM (SHAEF) WHICH WAS FOUNDED TO PROVIDE STATE HOSPITAL ASSOCIATION EXECUTIVES THE OPPORTUNITY TO SHARE IDEAS, HEAR ABOUT TRENDS IN HEALTHCARE, BE A MORE EFFECTIVE ADVOCACY ARM FOR THE AMERICAN HOSPITAL ASSOCIATION, AND ENGENDER CAMARADERIE AMONG A DISPARATE GROUP OF ASSOCIATE EXECUTIVES. THE ASSOCIATION RECEIVED AND DISBURSED FUNDS ON BEHALF OF SHAEF. THE AMOUNTS ARE INCLUDED IN ASSETS HELD FOR SHAEF AND DUE TO SHAEF. SINCE THE ASSOCIATION IS A FISCAL AGENT, THESE ACTIVITIES ARE APPROPRIATELY NOT INCLUDED IN REVENUE. FOR THE YEAR ENDED DECEMBER 31, 2023 RELATING TO SHAEF, THE TOTAL SHAEF REVENUE WAS $148,500, AND THE TOTAL SHAEF EXPENSES WERE $191,855.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ASSOCIATION 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 CONSOLIDATED FINANCIAL STATEMENTS. THE ASSOCIATION 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>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <ClubDuesOrFeesInd>X</ClubDuesOrFeesInd>
      <WrittenPolicyRefTAndEExpnssInd>1</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>1</SubstantiationRequiredInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TIMOTHY RAVE</PersonNm>
        <TitleTxt>PRESIDENT/CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>375593</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>56977</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>43500</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>23544</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>499614</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TAMMY HATTING</PersonNm>
        <TitleTxt>COO</TitleTxt>
        <BaseCompensationFilingOrgAmt>143171</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>11760</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>15876</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>25720</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>196527</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHELLE SYBESMA</PersonNm>
        <TitleTxt>VP EDUCATION &amp; COMMUNICATION</TitleTxt>
        <BaseCompensationFilingOrgAmt>129924</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>11000</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>14750</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>25336</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>181010</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>A MEMBERSHIP TO MINNEHAHA COUNTRY CLUB WAS PURCHASED FOR TIM RAVE IN THE AMOUNT OF $8,594. THIS AMOUNT WAS NOT TAXABLE TO TIM AS THE BUSINESS PURPOSE WAS FOR OUTSIDE MEETINGS WITH BOARD AND OTHER COMMUNITY LEADERS. PERSONAL USE EXPENSES WERE REIMBURSED TO THE ASSOCIATION.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>PRESIDENT (BY-LAWS ARTICLE VII, SECTION 8) THE PRESIDENT SHALL SERVE AT THE PLEASURE OF THE BOARD OF TRUSTEES AND SHALL BE RESPONSIBLE TO THE BOARD OF TRUSTEES THROUGH THE CHAIRPERSON. HE/SHE SHALL BE AN EX-OFFICIO MEMBER OF THE BOARD OF TRUSTEES, WITHOUT VOTE; AND EX-OFFICIO MEMBER, WITHOUT VOTE, ON ALL COUNCILS, COMMITTEES, AND DISTRICTS OF THE ASSOCIATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>PAULETTE DAVIDSON AND MARK SCHULTE HAVE A BUSINESS RELATIONSHIP THROUGH THEIR PLACE OF EMPLOYMENT WITH MONUMENT HEALTH.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>INSTITUTIONAL MEMBERS HAVE VOTING RIGHTS. OTHER MEMBERSHIPS DO NOT HAVE VOTING RIGHTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE NUMBER OF VOTES HELD BY EACH INSTITUTIONAL MEMBER IS DEPENDENT ON THE TYPE OF MEMBERSHIP HELD. HOSPITAL AND POST-ACUTE (NURSING HOME) HAVE TWO VOTES. POST-ACUTE (OTHER) AND GOVERNMENT HOSPITAL HAVE ONE VOTE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>DECISIONS THAT REQUIRE MEMBER APPROVAL INCLUDE ELECTION OF BOARD MEMBERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE DRAFT OF FEDERAL FORM 990 WILL BE REVIEWED BY THE GOVERNING BODY AND BE APPROVED DURING A BOARD MEETING PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>A LETTER IS SENT OUT REQUESTING CONFLICTS OF INTEREST. ALL BOARD MEMBERS AND UPPER MANAGEMENT ARE REQUIRED TO COMPLETE AND FILE A CONFLICT OF INTEREST STATEMENT WITH THE ORGANIZATION EACH YEAR. INDIVIDUAL BOARD MEMBERS MUST DISCLOSE CONFLICTS OF INTEREST AT TIME OF VOTE. PRESIDENT/CEO HAS ACCESS TO ALL STATEMENTS FOR REVIEW. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY MEMBER OF THE BOARD OF TRUSTEES OF THE SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATIONS SHALL BE DISCLOSED AND KEPT ON FILE IN THE OFFICE OF THE PRESIDENT. AS A MATTER OF BUSINESS AT THE FIRST BOARD OF TRUSTEES MEETING SUBSEQUENT TO THE ASSOCIATION'S ANNUAL CONVENTION, THE BOARD SHALL REVIEW THE APPLICATION OF THIS POLICY AND ITS EFFECTIVENESS USING SUCH PROCEDURES AS THE PRESIDENT AND/OR CHAIRPERSON OF THE BOARD OF TRUSTEES SHALL DETERMINE. ANY MEMBER OF THE BOARD OF TRUSTEE'S HAVING A DUALITY OF INTEREST OR ANY POSSIBLE CONFLICT OF INTEREST WHICH COULD CONFLICT ON ANY MATTER WITH THE INTEREST OF THE ASSOCIATION, SHALL ABSTAIN FROM VOTING AND SHALL ABSTAIN FROM USING PERSONAL INFLUENCE IN ANY WAY ON THE MATTER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>PRESIDENT/CEO COMPENSATION: THE BOARD OF TRUSTEES EXECUTIVE COMMITTEE CONDUCTS AN ANNUAL PERFORMANCE APPRAISAL AND REVIEW OF COMPENSATION/BENEFITS. THE APPAISAL AND REVIEW IS BASED ON AN INDEPENDENT COMPENSATION SURVEY THAT IS CONDUCTED TWO TIMES PER YEAR THAT PROVIDES COMPARABLE DATA FOR INTERPRETATION FOR CONSIDERATION AND ACTION BY THE FULL BOARD OF TRUSTEES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL MEMBERS HAVE ACCESS TO REVIEWED FINANCIAL STATEMENTS. THE COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ALSO PROVIDED TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII:</FormAndLineReferenceDesc>
        <ExplanationTxt>TIMOTHY RAVE IS THE TOP FINANCIAL OFFICIAL OF THE ORGANZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN NET ASSETS OF PAC 13,343.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>SDAHO HRET</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>3708 W BROOK PLACE</AddressLine1Txt>
          <CityNm>SIOUX FALLS</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57106</ZIPCd>
        </USAddress>
        <EIN>371835290</EIN>
        <PrimaryActivitiesTxt>SUPPORTING MISSIONS OF SD ASSOCIATION OF HEALTHCARE ORGANIZATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 12B, II</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SD ASSOCIATION OF HEALTHCARE ORGANIZATION</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>SDAHO PAC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>3708 W BROOK PLACE</AddressLine1Txt>
          <CityNm>SIOUX FALLS</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57106</ZIPCd>
        </USAddress>
        <EIN>900038505</EIN>
        <PrimaryActivitiesTxt>POLITICAL ACTION COMMITTEE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>527</ExemptCodeSectionTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SD ASSOCIATION OF HEALTHCARE ORGANIZATION</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>SDAHO ENTERPRISES INC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>3708 W BROOKS PL</AddressLine1Txt>
          <CityNm>SIOUX FALLS</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57106</ZIPCd>
        </USAddress>
        <EIN>364851698</EIN>
        <PrimaryActivitiesTxt>PROVIDNG SUPPORT SERVICES FOR HEALTHCARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SD ASSOCIATION OF HEALTHCARE ORGANIZATIONS</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ShareOfTotalIncomeAmt>1243673</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>3472848</ShareOfEOYAssetsAmt>
        <OwnershipPct>1.00000</OwnershipPct>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <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>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>SDAHO-HRET</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>Q</TransactionTypeTxt>
        <InvolvedAmt>128155</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>COST</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>SDAHO-HRET</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>O</TransactionTypeTxt>
        <InvolvedAmt>389361</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>COST</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>SDAHO ENTERPRISES INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>O</TransactionTypeTxt>
        <InvolvedAmt>116901</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>COST</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>