﻿<?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>2025-08-08T13:27:33-05:00</ReturnTs>
    <TaxPeriodEndDt>2024-09-30</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>450250958</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>Eide Bailly LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>800 Nicollet Mall Ste 1300</AddressLine1Txt>
        <CityNm>Minneapolis</CityNm>
        <StateAbbreviationCd>MN</StateAbbreviationCd>
        <ZIPCd>554027033</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-10-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>450227391</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>Presentation Medical Center</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>PRES</BusinessNameControlTxt>
      <PhoneNum>7014773161</PhoneNum>
      <USAddress>
        <AddressLine1Txt>213 2nd Avenue NE</AddressLine1Txt>
        <CityNm>Rolla</CityNm>
        <StateAbbreviationCd>ND</StateAbbreviationCd>
        <ZIPCd>583670759</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>Christopher Albertson</PersonNm>
      <PersonTitleTxt>President &amp; CEO</PersonTitleTxt>
      <PhoneNum>7014773161</PhoneNum>
      <SignatureDt>2025-08-06</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>1</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>Kim Hunwardsen CPA</PreparerPersonNm>
      <PTIN>P00484560</PTIN>
      <PhoneNum>6122536500</PhoneNum>
      <PreparationDt>2025-08-06</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2025-03-06 01:10:19Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="8">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <DoingBusinessAsName>
        <BusinessNameLine1Txt>SMP Health - St Kateri</BusinessNameLine1Txt>
      </DoingBusinessAsName>
      <PrincipalOfficerNm>Christopher Albertson</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>213 2nd Avenue NE</AddressLine1Txt>
        <CityNm>Rolla</CityNm>
        <StateAbbreviationCd>ND</StateAbbreviationCd>
        <ZIPCd>583670759</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>14541256</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <GroupExemptionNum>0928</GroupExemptionNum>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>www.pmc-rolla.com</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1939</FormationYr>
      <LegalDomicileStateCd>ND</LegalDomicileStateCd>
      <ActivityOrMissionDesc>Acute care hospital that is a major medical provider for Rolette County</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>8</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>7</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>131</TotalEmployeeCnt>
      <TotalVolunteersCnt>7</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>266933</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>20386</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>14069022</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>14426120</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>61482</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>79521</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>-8300</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>6120</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>14389137</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>14532147</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>0</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>7307320</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>7769115</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>6897163</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>6973741</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>14204483</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>14742856</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>184654</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>-210709</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>9940257</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>10613288</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>2311721</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>2580620</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>7628536</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>8032668</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <MissionDesc>Presentation Medical Center in union with the Sisters of Mary of the Presentation, is a Catholic healthcare organization. Through the power and example of Jesus Christ and his gospel values, we are committed to joyfully provide wholistic care and healing with integrity, compassion and respect to all we serve.</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>11452960</ExpenseAmt>
      <RevenueAmt>14426120</RevenueAmt>
      <Desc>Presentation Medical Center (PMC) is a 25-bed not-for-profit, Critical Access Hospital (CAH) located in Rolla, Rolette County, ND. As a Critical Access Hospital, our organization is, by definition, a community benefit. PMC is a critical infrastructure to our community and is a major medical provider for Rolette County, providing inpatient, outpatient and surgical services. In addition, PMC is a key provider of emergency care with over 4,016 ER visits for fiscal year ending 2024. Services in the areas of Clinic, Lab, Radiology, Respiratory Therapy, Physical Therapy, Cardiac Rehab, and Outreach Specialty Physician services, are also provided.Continued on Schedule O.Presentation Medical Center had 186 acute patient days, 480 swing-bed days and 1,970 extended swing-bed days.The Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended September 30, 2024, were approximately $55,000.</Desc>
      <TotalProgramServiceExpensesAmt>11452960</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc1039100001">1</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd>0</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">0</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>0</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc1040000001">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc1040000001">1</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc1040000001">0</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc1040000001">1</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc1040000001">1</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc1040000001">1</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">1</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">1</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 referenceDocumentId="RetDoc1041500001">1</OperateHospitalInd>
      <AuditedFinancialStmtAttInd referenceDocumentId="RetDoc2317200001">1</AuditedFinancialStmtAttInd>
      <GrantsToOrganizationsInd>0</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc1042400001">1</ScheduleJRequiredInd>
      <TaxExemptBondsInd>0</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd referenceDocumentId="RetDoc1042800001">0</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd referenceDocumentId="RetDoc1042800001">0</PYExcessBenefitTransInd>
      <LoanOutstandingInd referenceDocumentId="RetDoc1042800001">0</LoanOutstandingInd>
      <GrantToRelatedPersonInd referenceDocumentId="RetDoc1042800001">0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd referenceDocumentId="RetDoc1042800001">0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd referenceDocumentId="RetDoc1042800001">1</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>0</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentId="RetDoc1043400001">0</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="RetDoc1043400001">0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>3</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>131</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>8</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>7</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>0</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>1</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>1</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>1</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>1</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>1</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>0</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>0</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>Paula J Wilkie</PersonNm>
        <PhoneNum>7014771951</PhoneNum>
        <USAddress>
          <AddressLine1Txt>213 2nd Avenue NE</AddressLine1Txt>
          <CityNm>Rolla</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>583670759</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>Christopher Albertson</PersonNm>
        <TitleTxt>President/CEO</TitleTxt>
        <AverageHoursPerWeekRt>20.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>335501</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>50633</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Matthew Odermann</PersonNm>
        <TitleTxt>Chair</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Derrick Dixon</PersonNm>
        <TitleTxt>Vice Chair</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Sr Debra Berry</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Sr Ann Germaine Picard</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Shelly Counts</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Seth Bercier</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Brian Grosinger</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Paula Wilkie</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>232092</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>45568</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Richard Larson MD</PersonNm>
        <TitleTxt>Emergency Services/Medical Director</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>290776</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>17723</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Rachelle Fischer FNP-C</PersonNm>
        <TitleTxt>Clinic Services</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>132076</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>30451</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lavonne Charbonneau PA</PersonNm>
        <TitleTxt>Emergency Medicine Physician Asst</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>148101</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>30641</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Laura Yoder RN</PersonNm>
        <TitleTxt>Infection Control, Head Nurse</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>167467</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>31513</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Lori Martinson RN</PersonNm>
        <TitleTxt>VP Patient Care/Dir of Nuring</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>123594</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>29879</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>862014</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>567593</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>236408</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>13</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>SMP Health Systems</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 10007</AddressLine1Txt>
            <CityNm>Fargo</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58106</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Administrative services</ServicesDesc>
        <CompensationAmt>760972</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Medical Solutions</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 850737</AddressLine1Txt>
            <CityNm>Minneapolis</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>55485</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Locum Staffing Services</ServicesDesc>
        <CompensationAmt>576751</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>One Staff Medical Solutions</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 3544</AddressLine1Txt>
            <CityNm>Omaha</CityNm>
            <StateAbbreviationCd>NE</StateAbbreviationCd>
            <ZIPCd>68103</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Locum Staffing Services</ServicesDesc>
        <CompensationAmt>509573</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Rodney Larson DBA Medigenous LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1210 Kings RD</AddressLine1Txt>
            <CityNm>Rapid City</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57702</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ED &amp; Nursing Locums Service</ServicesDesc>
        <CompensationAmt>208400</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>National Medical Resourse</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2792 E Broadway Ave</AddressLine1Txt>
            <CityNm>Bismarck</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58501</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ED &amp; Nursing Locums Service</ServicesDesc>
        <CompensationAmt>145617</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>20386</GovernmentGrantsAmt>
      <TotalContributionsAmt>20386</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient service revenue</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>14080273</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>14080273</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Outside Laundry Revenue</Desc>
        <BusinessCd>812300</BusinessCd>
        <TotalRevenueColumnAmt>171528</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>171528</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Pharmacy</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>113373</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>113373</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>60946</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>60946</RelatedOrExemptFuncIncomeAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>14426120</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>79521</TotalRevenueColumnAmt>
        <ExclusionAmt>79521</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>15229</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>9109</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>6120</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>6120</TotalRevenueColumnAmt>
        <ExclusionAmt>6120</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>14532147</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>14426120</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>85641</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompDisqualPersonsGrp>
        <TotalAmt>76934</TotalAmt>
        <ProgramServicesAmt>76934</ProgramServicesAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>6318127</TotalAmt>
        <ProgramServicesAmt>5261685</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1056442</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>148760</TotalAmt>
        <ProgramServicesAmt>124175</ProgramServicesAmt>
        <ManagementAndGeneralAmt>24585</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>764510</TotalAmt>
        <ProgramServicesAmt>637737</ProgramServicesAmt>
        <ManagementAndGeneralAmt>126773</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>460784</TotalAmt>
        <ProgramServicesAmt>384633</ProgramServicesAmt>
        <ManagementAndGeneralAmt>76151</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>696708</TotalAmt>
        <ManagementAndGeneralAmt>696708</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>4885</TotalAmt>
        <ManagementAndGeneralAmt>4885</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>50428</TotalAmt>
        <ManagementAndGeneralAmt>50428</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>2516576</TotalAmt>
        <ProgramServicesAmt>2313164</ProgramServicesAmt>
        <ManagementAndGeneralAmt>203412</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>19163</TotalAmt>
        <ProgramServicesAmt>163</ProgramServicesAmt>
        <ManagementAndGeneralAmt>19000</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>258352</TotalAmt>
        <ProgramServicesAmt>177937</ProgramServicesAmt>
        <ManagementAndGeneralAmt>80415</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <OccupancyGrp>
        <TotalAmt>270894</TotalAmt>
        <ProgramServicesAmt>268685</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2209</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>72485</TotalAmt>
        <ProgramServicesAmt>34213</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38272</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>47649</TotalAmt>
        <ProgramServicesAmt>26446</ProgramServicesAmt>
        <ManagementAndGeneralAmt>21203</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>118651</TotalAmt>
        <ProgramServicesAmt>94872</ProgramServicesAmt>
        <ManagementAndGeneralAmt>23779</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>555191</TotalAmt>
        <ProgramServicesAmt>443924</ProgramServicesAmt>
        <ManagementAndGeneralAmt>111267</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>118919</TotalAmt>
        <ProgramServicesAmt>118919</ProgramServicesAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Repairs and maintenance</Desc>
        <TotalAmt>1028962</TotalAmt>
        <ProgramServicesAmt>320240</ProgramServicesAmt>
        <ManagementAndGeneralAmt>708722</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>970923</TotalAmt>
        <ProgramServicesAmt>970923</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Food</Desc>
        <TotalAmt>152476</TotalAmt>
        <ProgramServicesAmt>152476</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Dues and subscriptions</Desc>
        <TotalAmt>90075</TotalAmt>
        <ProgramServicesAmt>45834</ProgramServicesAmt>
        <ManagementAndGeneralAmt>44241</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1404</TotalAmt>
        <ManagementAndGeneralAmt>1404</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>14742856</TotalAmt>
        <ProgramServicesAmt>11452960</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3289896</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>65533</BOYAmt>
        <EOYAmt>952483</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1447188</BOYAmt>
        <EOYAmt>2339442</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>257679</BOYAmt>
        <EOYAmt>220539</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>24640</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>11610621</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>8613603</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3414910</BOYAmt>
        <EOYAmt>2997018</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>3493444</BOYAmt>
        <EOYAmt>3437806</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>1236863</BOYAmt>
        <EOYAmt>666000</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>9940257</BOYAmt>
        <EOYAmt>10613288</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>795467</BOYAmt>
        <EOYAmt>1179846</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>1204728</BOYAmt>
        <EOYAmt>1131627</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>311526</BOYAmt>
        <EOYAmt>269147</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>2311721</BOYAmt>
        <EOYAmt>2580620</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>7628536</BOYAmt>
        <EOYAmt>8032668</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>7628536</BOYAmt>
        <EOYAmt>8032668</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>9940257</BOYAmt>
        <EOYAmt>10613288</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-210709</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>614841</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolAndSepBasisFinclStmtInd>X</ConsolAndSepBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>106798</OtherCostOrOtherBasisAmt>
        <BookValueAmt>106798</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>180619</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>6017783</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4329743</DepreciationAmt>
        <BookValueAmt>1868659</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>5240785</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4264783</DepreciationAmt>
        <BookValueAmt>976002</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>64636</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>19077</DepreciationAmt>
        <BookValueAmt>45559</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>2997018</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>SMP Health pooled investment funds</Desc>
        <BookValueAmt>3437806</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>3437806</TotalBookValueSecuritiesAmt>
      <OtherAssetsOrgGrp>
        <Desc>Estimated third-party payor settlements</Desc>
        <BookValueAmt>416000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Estimated Insurance Recoveries</Desc>
        <BookValueAmt>250000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>666000</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Estimated insurance payable on malpractice claims</Desc>
        <Amt>250000</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Finance lease liabilities</Desc>
        <Amt>19147</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>269147</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>15146988</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>614841</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>614841</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>14532147</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>14532147</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>14742856</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>14742856</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>14742856</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Medical Center 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 Medical Center 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>
    <IRS990ScheduleH documentId="RetDoc1041500001">
      <FinancialAssistancePolicyInd>1</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>1</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>1</FPGReferenceFreeCareInd>
      <Percent100Ind>X</Percent100Ind>
      <FPGReferenceDiscountedCareInd>1</FPGReferenceDiscountedCareInd>
      <Percent200DInd>X</Percent200DInd>
      <FreeCareMedicallyIndigentInd>1</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>1</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>1</ExpensesExceedBudgetInd>
      <UnableToProvideCareInd>0</UnableToProvideCareInd>
      <AnnualCommunityBnftReportInd>1</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>1</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>55000</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>55000</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00370</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>2870623</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>2209668</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>660955</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.04480</TotalExpensePct>
      </UnreimbursedMedicaidGrp>
      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>2925623</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>2209668</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>715955</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.04850</TotalExpensePct>
      </TotalFinancialAssistanceTyp>
      <SubsidizedHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>3110763</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>2363798</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>746965</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.05070</TotalExpensePct>
      </SubsidizedHealthServicesGrp>
      <TotalOtherBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>3110763</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>2363798</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>746965</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.05070</TotalExpensePct>
      </TotalOtherBenefitsGrp>
      <TotalCommunityBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>6036386</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>4573466</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>1462920</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.09920</TotalExpensePct>
      </TotalCommunityBenefitsGrp>
      <BadDebtExpenseReportedInd>1</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>781089</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>200740</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>4982177</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>5022340</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>-40163</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <OtherInd>X</OtherInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>1</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>1</FinancialAssistancePrvsnInd>
      <HospitalFacilitiesCnt>1</HospitalFacilitiesCnt>
      <HospitalFacilitiesGrp>
        <FacilityNum>1</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>Presentation Medical Center dba SMP Health - St Kateri</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>213 2nd Avenue NE</AddressLine1Txt>
          <CityNm>Rolla</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>583670759</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>www.smphealth.org/stkateri/</WebsiteAddressTxt>
        <StateLicenseNum>ND5045</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <CriticalAccessHospitalInd>X</CriticalAccessHospitalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <OtherDesc>1 provider based RHC clinic</OtherDesc>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1Txt>Presentation Medical Center</BusinessNameLine1Txt>
        </HospitalFacilityName>
        <FacilityNum>1</FacilityNum>
        <FirstLicensedCYOrPYInd>0</FirstLicensedCYOrPYInd>
        <TaxExemptHospitalCYOrPYInd>0</TaxExemptHospitalCYOrPYInd>
        <CHNAConductedInd>1</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <PriorCHNAImpactInd>X</PriorCHNAImpactInd>
        <CHNAConductedYr>21</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>1</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>0</CHNAConductedWithOtherFcltsInd>
        <CHNAConductedWithNonFcltsInd>1</CHNAConductedWithNonFcltsInd>
        <CHNAReportWidelyAvailableInd>1</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>https://smphealth.org/stkateri</OwnWebsiteURLTxt>
        <PaperCopyPublicInspectionInd>X</PaperCopyPublicInspectionInd>
        <ImplementationStrategyAdoptInd>1</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>21</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>1</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>https://smphealth.org/stkateri</StrategyWebsiteURLTxt>
        <OrganizationIncurExciseTaxInd>0</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>1</EligCriteriaExplainedInd>
        <FPGFamilyIncmLmtFreeDscntInd>X</FPGFamilyIncmLmtFreeDscntInd>
        <FPGFamilyIncmLmtFreeCarePct>100.000000000000</FPGFamilyIncmLmtFreeCarePct>
        <FPGFamilyIncmLmtDscntCarePct>200.000000000000</FPGFamilyIncmLmtDscntCarePct>
        <MedicalIndigencyCriteriaInd>X</MedicalIndigencyCriteriaInd>
        <InsuranceStatusCriteriaInd>X</InsuranceStatusCriteriaInd>
        <UnderinsuranceStatCriteriaInd>X</UnderinsuranceStatCriteriaInd>
        <OtherCriteriaInd>X</OtherCriteriaInd>
        <ExplainedBasisInd>1</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>1</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <ProvidedNonprofitContactInd>X</ProvidedNonprofitContactInd>
        <IncludesPublicityMeasuresInd>1</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>https://smphealth.org/stkateri</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>https://smphealth.org/stkateri</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>https://smphealth.org/stkateri</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <CommuntityNotifiedFAPInd>X</CommuntityNotifiedFAPInd>
        <FAPActionsOnNonpaymentInd>1</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>0</CollectionActivitiesInd>
        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>1</NondisEmergencyCarePolicyInd>
        <ProspectiveMedicareMedicaidInd>X</ProspectiveMedicareMedicaidInd>
        <AmountsGenerallyBilledInd>0</AmountsGenerallyBilledInd>
        <GrossChargesInd>0</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 5: Throughout the CHNA process Rolette County Public Health was involved. The qualitative primary research methodology consisted of stakeholder interviews and focus group discussions with key community stakeholders, policymakers, and residents. In total, ten one-on-one virtual phone interviews were conducted.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6b: Rolette Public Health</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 11: In 2022, SMP Health System St. Kateri's leadership worked with community leaders, underserved populations receiving services in the community, and others to complete its CHNA and identify 15 community health-related needs. The needs will be addressed over the next 3 years.1. Improve drug and other substance abuse early intervention and prevention services2. Increase access to affordable quality childcare3. Increase access to specialty health care providers in the community (e.g., neurologists, endocrinologists)4. Develop crisis or emergency care programs for mental health5. Increase availability of resources to help seniors stay in their homes (e.g., home health, senior meals, etc..)6. Increase the number of mental health providers for adults7. Increase case management services for people with complex chronic health conditions8. Increase drug and other substance abuse treatment services9. Improve general public transportation10. Increase the number of primary care services (such as a family doctor or other provider of routine care)11. Increase the number of mental health providers for children and youth12. Improve transportation services for people needing to go to doctor's appointments or the hospital13. More intentionally engage the Native American community in health and wellness initiatives14. Improve care coordination between the hospital and other clinics, private doctors, or other health service providers15. Enhance community programs to break out of the cycle of poverty (e.g., early childhood education, primary and secondary education, job training)The following needs were addressed in FY2024.1. Improve drug and other substance abuse early intervention and prevention services. a. A Physician Assistant is prescribing Medication Assisted Therapy drugs for opiod treatment.2. Increase access to affordable quality childcare. This need was not addressed in FY2024.3. Increase access to specialty health care providers in the community (e.g., neurologists, endocrinologists). This need was not addressed in FY2024.4. Develop crisis or emergency care programs for mental health. This need was not addressed in FY2024.5. Increase availability of resources to help seniors stay in their homes (e.g., home health, senior meals, etc..). This need was not addressed in FY2024.6. Increase the number of mental health providers for adults. a. Psychiatry Network has a provider seeing patients at St. Kateri Clinic. Dr. J. Mark Gingerich prescribes medications as medically appropriate for pediatric mental health patients.7. Increase case management services for people with complex chronic health conditions. a. SMP Health - St. Kateri in conjunction with Signify Health, has greatly increased its Chronic Care Management Program. The Chronic Care Management program continues to grow. There are currently 36 in the CCM program. 8. Increase drug and other substance abuse treatment services. This need was not addressed in FY2024. 9. Improve general public transportation.10. Increase the number of primary care services (such as a family doctor or other provider of routine care). a. SMP Health - St. Kateri added Dr. John Gingerich and Audrey Bercier, PA to its roster of Primary Care Providers. SMP Health - St. Kateri experienced a dramatic decrease in utilization in its clinic in 2024.11. Increase the number of mental health providers for children and youth. This need was not addressed in FY2024.12. Improve transportation services for people needing to go to doctor's appointments or the hospital. This need was not addressed in FY2024.13. More intentionally engage the Native American community in health and wellness initiatives. This need was not addressed in FY2024.14. Improve care coordination between the hospital and other clinics, private doctors, or other health service providers. This need was not addressed in FY2024.15. Enhance community programs to break out of the cycle of poverty (e.g., early childhood education, primary and secondary education, job training). This need was not addressed in FY2024.Some needs were not addressed in FY2024 but will be reviewed for the upcoming fiscal year.The Hospital will not address need #9 improve general public transportation. The need is out of the hospital's purview, and as such would be better addressed by other community partners.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Presentation Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 13h: SMP Health - St. Kateri also evaluates a patient's family size, income and demographics to determine eligibility for additional free or discounted care to low-income individuals.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3c:</FormAndLineReferenceDesc>
        <ExplanationTxt>St. Kateri also evaluates a patient's family size and demographics to determine eligibility for additional free or discounted care to low-income individuals.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 6a:</FormAndLineReferenceDesc>
        <ExplanationTxt>St. Kateri's community benefit report is available upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>An estimated 25.7% of implicit price concessions in 2023 are attributable to patients living below the federal poverty guidelines in Rolette County.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The footnote to the Organization's financial statements can be found on page 10 of the attached audited financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>SMP Health - St. Kateri had a Medicare shortfall providing services to Medicare patients. The Hospital knows they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $223,892.Medicare fee schedule revenue $ 116,528Medicare estimated costs of care relating to payments (340,240)Net (Shortage) $ (223,892)Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicaid and Medicare Services.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b:</FormAndLineReferenceDesc>
        <ExplanationTxt>St. Kateri believes it has an obligation to make every effort possible to collect for services rendered from all patients who have the ability to pay their account. There are no collection efforts for patients who qualify for charity care or financial assistance, indigent patients, or patients that have set up payment arrangements. If a portion of an account is written off to charity care, any personal portion due follows the same collection procedures as other accounts. For patients who are indigent, St. Kateri has a Charity Care provision with the appropriate application process. For self-pay patients, St. Kateri offers a prompt payment discount of 10% for payment in full within 30 days from the date of their first statement. Patients receive 3 statements at 30, 60, and 90 days and are informed that their account will be sent to a collection agency at 120 days. If the patient completes a Charity Care Application anytime up to 240 days of the first post-discharge billing statement, the Hospital will remove the accounts from collections and acknowledge it as Charity Care on the financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>SMP Health - St. Kateri strives to provide basic healthcare services to its communities. We have worked with the Rolette County Public Health, Rolette County Police Department, Rolla Community Ambulance, Rolette County Social Services and other community departments to provide basic care to the members of our community. Working with these organizations allows us to provide different services to our community and to make sure that one of these entities is able to provide care and or cover for one another.Our community health needs assessment is completed and posted to our website to meet the requirements of 501(r).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>SMP Health - St. Kateri is committed to providing care to persons who are uninsured, underinsured, ineligible for government programs, or otherwise unable to pay for medically necessary care. Our Community Caring Program was established in 2005. We have seen a continual increase every year in charity care as we try to get patients involved in the program before their accounts are sent to collections. A brochure is provided to every patient when they register outlining our payment expectations and explaining our Community Caring Program. Notification about charity care is available in emergency rooms, admitting and registration departments, the Business office, and other public areas within the Hospital. Information is also included in patient bills and patient information packets. At registration, patients are given the Payment Policy and Community Caring Program handout. This handout explains patient responsibilities, insurance billing guidelines, financing and payment options, and the Community Caring guidelines.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>SMP Health - St. Kateri is a 25-bed not-for-profit, Critical Access Hospital (CAH) located in Rolla, Rolette County, ND. As a Critical Access Hospital, our organization is, by definition, a community benefit. ST. KATERI is a critical infrastructure to our community and is a major medical provider for Rolette County, providing inpatient, outpatient and surgical services. In addition, St. Kateri is a key provider of emergency care. Services in the areas of Clinic, Lab, Radiology, Respiratory Therapy, Physical Therapy, Cardiac Rehab, and Outreach Specialty Physician services, are also provided.The Hospital is highly dependent upon government Payors. In the Fiscal Year ending 09/30/2024, Medicare was the payor for 77.6% of inpatients and 29.0% of outpatients, while Medicaid was the payor for 15.9% of inpatients and 44.2% of total outpatients. By virtue of where we are located and the services that we provide, we are a benefit to our community.The service area of SMP Health - St. Kateri includes Rolette and part of Towner County. Rolette County has a total population of 11,728 with 77.4% the population being Native American. With this census, 1.51% of North Dakota's population lives in Rolette County. The per capita income for Rolette County is $23,160 compared with North Dakota's per capita income of $53,806 with 25.7% of the county living below the poverty guidelines.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>SMP Health - St. Kateri works to address the basic healthcare needs in Rolette County and the surrounding communities. The Hospital is a major medical provider for the county providing inpatient, outpatient, and surgical services. In addition, the Hospital is a key provider of emergency care. The emergency room is open 24 hours and is available regardless of a person's ability to pay.SMP Health - St. Kateri extends medical staff privileges to all qualified physicians who meet the Medical Staff Bylaws. Surplus funds are used for equipment upgrades and facility improvements. A majority of the organization's governing body resides in Rolla, ND and none are employees nor contractors of the organization. The governing body does not have any family relationships with each other.In addition to our very existence, SMP Health - St. Kateri believes that there are additional areas that highlight our benefit to the community. By being what and who we are, we strive to be a good community citizen and an asset to the communities that we serve. The Hospital routinely provides a variety of services that address needs within the community.Sport Injury evaluation and screenings are provided to area High School students and staff members from Physical Therapy provide support at local athletic events.SMP Health - St. Kateri provides Pastoral Care services to all our patients and the community members. Pastoral Care serves as a liaison with the area Ministerial Associations. Laboratory students have the opportunity to obtain clinical experience at the Hospital.SMP Health - St. Kateri donated cash to various community groups and local school in FY 2024.Meals are also provided for caregivers and lodging is offered for family members who choose to remain in the hospital with their loved one.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 6:</FormAndLineReferenceDesc>
        <ExplanationTxt>We are an affiliate of the Sisters of Mary of the Presentation Health System dba SMP Health. SMP Health - St. Kateri operates in accordance with the mission, vision, and values of the SMP Health. Our annual budgeting process includes an assessment of how our budget demonstrates a commitment to the values of the system and the system works to ensure we are always mindful of our duty to care for the poor and those in need. SMP Health - St. Kateri has a Strategic Plan developed from themes set forth by the health system for all affiliates.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>1</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Christopher Albertson</PersonNm>
        <TitleTxt>President/CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>281460</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>32208</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>21833</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>20009</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>33271</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>388781</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>15833</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Richard Larson MD</PersonNm>
        <TitleTxt>Emergency Services/Medical Director</TitleTxt>
        <BaseCompensationFilingOrgAmt>290776</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17723</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>308499</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Paula Wilkie</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>212840</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>10385</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>8867</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>12943</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>34227</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>279262</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>8867</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Laura Yoder RN</PersonNm>
        <TitleTxt>Infection Control, Head Nurse</TitleTxt>
        <BaseCompensationFilingOrgAmt>167467</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5024</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>26489</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>198980</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lavonne Charbonneau PA</PersonNm>
        <TitleTxt>Emergency Medicine Physician Asst</TitleTxt>
        <BaseCompensationFilingOrgAmt>148101</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4443</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>26198</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>178742</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Rachelle Fischer FNP-C</PersonNm>
        <TitleTxt>Clinic Services</TitleTxt>
        <BaseCompensationFilingOrgAmt>132076</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>3962</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>26489</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>162527</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lori Martinson RN</PersonNm>
        <TitleTxt>VP Patient Care/Dir of Nuring</TitleTxt>
        <BaseCompensationFilingOrgAmt>123594</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>3708</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>26171</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>153473</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Presentation Medical Center does not pay compensation to the President &amp; CEO. This individual is compensated by Sisters of Mary of the Presentation Health System, a related organization, for services to the Medical Center. Sisters of Mary of the Presentation Health System uses one or more of the methods in Part I, question 3 to determine compensation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>SMP Health, related organization, has a nonqualified deferred compensation plan that complies with Section 409A of the IRC. SMP Health begins contributions into the plan after the employee's first year of service. The employee is vested based on a 20 year vesting schedule or becomes fully vested in the event of death, disability or reaching the age of 65. Employee name and amounts included on Schedule J are as follows: Name Part II, column B (iii) Part II, column C Paula Wilkie 8,867 62 Christopher Albertson 15,833 151</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>Gabrielle Wilkie</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Family relationship to CFO</RelationshipDescriptionTxt>
        <TransactionAmt>76934</TransactionAmt>
        <TransactionDesc>Compensation and benefits as an employee</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The sole member of the organization is the Sisters of Mary of the Presentation Health System dba SMP Health .</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>The member is entitled to vote in the election of Directors and to cast one vote for each Director to be elected. The member is also entitled to one vote on every other matter to be voted on by the member. Votes cast on behalf of the member are cast by the Chief Executive Officer of Sisters of Mary of the Presentation Health System dba SMP Health.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>The authority to act on the following matters are exclusively vested in the member of the organization: 1. any change in the philosophy, objectives and purposes of the organization; 2. amendment of the articles of incorporation and bylaws; 3. the election or removal of the Directors; 4. merger or consolidation with any other organization; 5. dissolution of the organization or the sale, lease or exchange of all or substantially all of its property or assets; 6. the sale, lease, transfer or encumbrance of any land, buildings or other assets owned by the organization or in which the organization has or will have equitable or legal title; 7. approval of the annual operating and capital budgets; 8. appointment of the Chief Executive Officer.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization does not have 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 Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Each Director must submit in writing to the Chairperson of the Board and the CEO a list of all business or other organizations of which the individual is an officer, director, trustee, member, owner (either as a sole proprietor or partner), shareholder with a 5% or greater interest in all outstanding voting shares, employee or agent, with which the organization has, or might reasonably in the future enter into, a relationship or a transaction in which the Director would have conflicting interests. Each written statement is resubmitted with any necessary changes each year. The Chairperson of the Board reviews the statements of the Directors and the Vice Chairperson of the Board reviews the statement filed by the Chairperson. When a conflict arises the affected Director makes known the potential conflict, whether disclosed by written statement or not, and after answering any questions, will withdraw from the meeting for as long as the matter continues under discussion. Should the matter be brought to a vote, the affected Director will not vote on it. In the event the Director does not withdraw voluntarily, the Chairperson of the Board has authority to require the Director to remove himself from the room during both the discussion and vote on the matter. In the event the conflict of interest affects the Chairperson, the Vice Chairperson has authority to require the Chairperson remove himself in the same matter. If the matter is the item of business for which a special meeting of the Board was called, the affected Director will not be counted to establish a quorum, and he will not participate in the deliberations or vote on it.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization's CEO and CFO are both compensated by Sisters of Mary of the Presentation Health System, a related organization. The compensation process is determined by the related organization. The Sisters of Mary of the Presentation Health System Board of Trustees directly engages a nationally recognized independent compensation consulting firm to review the total compensation arrangements of the officers and key employees. The Sisters of Mary of the Presentation Health System Board of Trustees approves all compensation based on comparable data and documents their decision in the meeting minutes.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon written request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Purchased services: Program service expenses 2,312,999. Management and general expenses 165,967. Fundraising expenses 0. Total expenses 2,478,966. Professional fees: Program service expenses 165. Management and general expenses 37,445. Fundraising expenses 0. Total expenses 37,610.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2c:</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing board of Sisters of Mary of the Presentation Health System dba SMP Health assumes responsibility for oversight of the audit for SMP Health - St. Kateri.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Illinois Valley Community Hospital Foundation</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>925 W St</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61354</ZIPCd>
        </USAddress>
        <EIN>371211780</EIN>
        <PrimaryActivitiesTxt>Support IV HealthCorp, Inc.</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>IV HealthCorp Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>IV HealthCorp Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>925 W St</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61354</ZIPCd>
        </USAddress>
        <EIN>371211890</EIN>
        <PrimaryActivitiesTxt>Support SMP affiliated entities</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>St Margaret's Health</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Sisters of Mary of the Presentation Health Ministry</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1202 Page Drive SW</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58106</ZIPCd>
        </USAddress>
        <EIN>320617468</EIN>
        <PrimaryActivitiesTxt>Supports SMP Health and the related entities</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Canonical Entity</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Sisters of Mary of the Presentation Health System</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1202 Page Drive SW</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58103</ZIPCd>
        </USAddress>
        <EIN>450359620</EIN>
        <PrimaryActivitiesTxt>Support related ND Catholic Health Care System</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Ministry</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Sisters of Mary of the Presentation Long Term Care</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1202 Page Drive SW</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58103</ZIPCd>
        </USAddress>
        <EIN>752999939</EIN>
        <PrimaryActivitiesTxt>Provide extended care and medically related services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health System</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>SMP Illinois Region Health System dba St Margaret's Health</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>600 E 1st St</AddressLine1Txt>
          <CityNm>Spring Valley</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61362</ZIPCd>
        </USAddress>
        <EIN>842023121</EIN>
        <PrimaryActivitiesTxt>Support related Illinois health care entities</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Aloisius Medical Center dba SMP Health - St Aloisius</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>325 East Brewster Street</AddressLine1Txt>
          <CityNm>Harvey</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58341</ZIPCd>
        </USAddress>
        <EIN>450226729</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health System</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Andrew's Health Center dba SMP Health - St Andrew's</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>316 Ohmer Street</AddressLine1Txt>
          <CityNm>Bottineau</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58318</ZIPCd>
        </USAddress>
        <EIN>450226426</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health System</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Andrew's Hospital Foundation dba SMP Health St Andrew's Foundation Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>316 Ohmer St</AddressLine1Txt>
          <CityNm>Bottineau</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58318</ZIPCd>
        </USAddress>
        <EIN>450413201</EIN>
        <PrimaryActivitiesTxt>Support SMP Health - St. Andrew's</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health Ministry</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Margaret's Health - Spring Valley</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>600 E 1st St</AddressLine1Txt>
          <CityNm>Spring Valley</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61362</ZIPCd>
        </USAddress>
        <EIN>362167884</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>St Margaret's Health</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Margaret's Health-Peru</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>925 W St</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61354</ZIPCd>
        </USAddress>
        <EIN>362852553</EIN>
        <PrimaryActivitiesTxt>Provision of health care services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>IV HealthCorp Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>St Margaret's Hospital Foundation</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>600 East First Street</AddressLine1Txt>
          <CityNm>Spring Valley</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61362</ZIPCd>
        </USAddress>
        <EIN>364042262</EIN>
        <PrimaryActivitiesTxt>Provide support to St. Margaret's Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12a, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>SMP Health System</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>SMP Enterprises</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>PO Box 10007</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>581060007</ZIPCd>
        </USAddress>
        <EIN>363486506</EIN>
        <PrimaryActivitiesTxt>Collection agency</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Valley Health Enterprises Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>925 W St</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61354</ZIPCd>
        </USAddress>
        <EIN>363476877</EIN>
        <PrimaryActivitiesTxt>Home medical equipment</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Illinois Valley Health Services Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>925 W St</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61354</ZIPCd>
        </USAddress>
        <EIN>364050682</EIN>
        <PrimaryActivitiesTxt>Inative</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Health Care Building Corp</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>925 W St</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61354</ZIPCd>
        </USAddress>
        <EIN>363306917</EIN>
        <PrimaryActivitiesTxt>Inactive</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>IVCH General Professional Liability Loss Fund</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>925 West Street</AddressLine1Txt>
          <CityNm>Peru</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>61354</ZIPCd>
        </USAddress>
        <EIN>366673231</EIN>
        <PrimaryActivitiesTxt>Inactive</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IL</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>T</EntityTypeTxt>
        <ControlledOrganizationInd>0</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>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>1</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>