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        <BookValueAmt>2204000</BookValueAmt>
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        <DepreciationAmt>1107909</DepreciationAmt>
        <BookValueAmt>447845</BookValueAmt>
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        <DepreciationAmt>2101376</DepreciationAmt>
        <BookValueAmt>275588</BookValueAmt>
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        <OtherCostOrOtherBasisAmt>6161428</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3612</DepreciationAmt>
        <BookValueAmt>6157816</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>9085249</TotalBookValueLandBuildingsAmt>
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        <Desc>Operating Lease Liability</Desc>
        <Amt>1092264</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Finance Lease Liability</Desc>
        <Amt>207588</Amt>
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      <TotalLiabilityAmt>1299852</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>40193693</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>-1900938</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>-38995</OtherRevenueAmt>
      <RevenueNotReportedAmt>-1939933</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>42133626</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-462821</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-462821</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>41670805</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>33385839</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>462821</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>462821</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>32923018</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>32923018</TotalExpensesPerForm990Amt>
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        <FormAndLineReferenceDesc>Part V, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The stated purpose of the organization's endowment fund is to fulfill the board of director's policies ensuring the organization's stability through preservation of its assets and to allow for satisfactory total return on all funds.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Hospice believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. Hospice would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if such interest and penalties are incurred.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Change in Value of Charitable Trust -38,995.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Rental Expenses Included in Expenses in Audit -84,691. COGS Expenses Included in Expenses in Audit -378,130.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Rental Expenses Included in Revenue in Form 990 84,691. COGS Expenses Included in Revenue in Form 990 378,130.</ExplanationTxt>
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        <PersonNm>Tracie Mallber Sylvester</PersonNm>
        <TitleTxt>Medical Director</TitleTxt>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
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        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>315820</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Theresa Capron</PersonNm>
        <TitleTxt>Executive Director</TitleTxt>
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        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>10800</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>13659</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>315615</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Becky Pfau - Director</PersonNm>
        <TitleTxt>of Clinical Operational</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5684</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>162353</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Theresa Stahl</PersonNm>
        <TitleTxt>Director of Finance</TitleTxt>
        <BaseCompensationFilingOrgAmt>143599</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5506</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>11036</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>160141</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jennifer Johnson</PersonNm>
        <TitleTxt>Nurse Practitioner</TitleTxt>
        <BaseCompensationFilingOrgAmt>152517</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>2135</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>154652</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 1a</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Committee can act on behalf of the governing board in between board meetings. They can make any decision, with the exception of amending the governing documents. The Executive Committee consists of the President, Vice President, Secretary/Treasurer and Past President.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Form 990 will be provided to the board members for their review and approval prior to filing with the IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>All board members sign a conflict of interest policy on an annual basis. The corporate compliance officer investigates if any conflicts are disclosed. In addition, at the beginning of each board meeting, members are required to disclose if they have a conflict of interest regarding any agenda items. Depending on the conflict, the board member with the conflict may be excused from the discussion and is always excused from any vote.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>A full review of salaries is conducted annually and compared to wage and salary survey data (salary surveys are done annually; in 2022, a very comprehensive review was conducted finalized in the spring of 2023). The following resources were used to conduct the survey: ND Job Service, Multi-View (a national hospice financial and consulting company), HCS - Hospital and Healthcare Compensation Service, Mercer, and Eide Bailly. Based on the above and recommendation from the manager of human resources and budgetary constraints, the executive director approves the salaries of all staff except her own. The board of directors used the same information as the executive director in setting the salary for that position.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization does not make its governing documents, conflict of interest policy and financial statement available to the public.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Contracted Services: Program service expenses 10,034,207. Management and general expenses 104,472. Fundraising expenses 0. Total expenses 10,138,679. Consulting Fees: Program service expenses 0. Management and general expenses 44,334. Fundraising expenses 3,406. Total expenses 47,740.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Change in Value of Charitable Trust -38,995.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <BusinessNameLine1Txt>Red River Valley Health Care PC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1701 38th St South</AddressLine1Txt>
          <CityNm>Fargo</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58103</ZIPCd>
        </USAddress>
        <EIN>833810274</EIN>
        <PrimaryActivitiesTxt>Primary &amp; Palliative Care in patient home</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MN</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Hospice of the Red River Valley</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
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      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
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      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
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          <BusinessNameLine1Txt>Red River Valley Health Care PC</BusinessNameLine1Txt>
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        <TransactionTypeTxt>Q</TransactionTypeTxt>
        <InvolvedAmt>1373230</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Accrual</MethodOfAmountDeterminationTxt>
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