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        <Desc>The Missouri Slope Lutheran Care Center Inc. (Care Center) provides a 48-bed nursing care facility for the elderly. The nursing care facility provides quality skilled nursing services regardless of individual status. The Care Center has earned Star status in OSHA's Voluntary Protection Program (VPP).Reimbursement for services rendered is critical to the continued operation and stability of the corporation. It is recognized that not all individuals served possess the ability to pay for the care provided. Thus, some care is provided through the North Dakota Medical Assistance Program.</Desc>
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        <Desc>Missouri Slope at Home exists to empower older adults in our region to age with independence, dignity and purpose in the community of their choice. Our program allows aging adults to get the assistance they need to live happily, healthy, and safely, while remaining in the home they love.</Desc>
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        <ExplanationTxt>The Organization is a member of certain organizations related to the industry which have lobbying expenses. The amount listed is the percentage of dues that were used for lobbying. Organization officers and directors will also from time to time contact legislators concerning health care issues and bills. Percentage of Dues that was lobbying: July 2024-December 2024, 12.68% January 2025-June 2025, 28.47%</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <AgentTrusteeEtcInd>0</AgentTrusteeEtcInd>
      <InclEscrowCustodialAcctLiabInd>1</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>223961</BeginningYearBalanceAmt>
        <ContributionsAmt>30000</ContributionsAmt>
        <EndYearBalanceAmt>253961</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>213911</BeginningYearBalanceAmt>
        <ContributionsAmt>10050</ContributionsAmt>
        <EndYearBalanceAmt>223961</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>208911</BeginningYearBalanceAmt>
        <ContributionsAmt>5000</ContributionsAmt>
        <EndYearBalanceAmt>213911</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>198161</BeginningYearBalanceAmt>
        <ContributionsAmt>10750</ContributionsAmt>
        <EndYearBalanceAmt>208911</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>113569</BeginningYearBalanceAmt>
        <ContributionsAmt>84592</ContributionsAmt>
        <EndYearBalanceAmt>198161</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <BoardDesignatedBalanceEOYPct>0.00000</BoardDesignatedBalanceEOYPct>
      <PrmnntEndowmentBalanceEOYPct>1.00000</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.00000</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>0</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>1</EndowmentsHeldRelatedOrgInd>
      <RelatedOrgListSchRInd>1</RelatedOrgListSchRInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>2749765</OtherCostOrOtherBasisAmt>
        <BookValueAmt>2749765</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>49715315</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>26157288</DepreciationAmt>
        <BookValueAmt>23558027</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>47711446</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>13284728</DepreciationAmt>
        <BookValueAmt>34426718</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>5569267</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2043295</DepreciationAmt>
        <BookValueAmt>3525972</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>64260482</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Refundable Advance</Desc>
        <Amt>74260</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Lease Liability</Desc>
        <Amt>181027</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>255287</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>48144872</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>187138</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>187138</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>47957734</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-31454</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-31454</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>47926280</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>49467606</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>34571</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>34571</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>49433035</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>5270</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>5270</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>49438305</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV, Line 2b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Resident Trust Funds and Security Deposits: The Company acts as custodian for the funds of the residents. These funds are included in cash and accounts payable in the consolidated financial statements. Resident trust funds totaled $32,878 and $33,325 at June 30, 2025 and 2024. As a condition of the rental agreement with the Company, residents of the assisted living complex are required to make a $1,000 refundable community fee. For residents receiving at-home services, private pay residents are required to make refundable security deposits of the greater of $500 or 2 weeks of services. These funds are deposited into an interest-bearing account. These funds are included in cash and accounts payable in the consolidated financial statements. Security deposits totaled $13,200 and $17,400 at June 30, 2025 and 2024.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part V, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The endowment funds are held by the Foundation for the benefit of the Care Center.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Company believes that it has appropriate support for any tax positions taken affecting their annual filing requirements, and as such, do not have any uncertain tax positions that are material to the consolidated financial statements. The Company 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. The Care Center's federal Form 990-T filing will be subject to federal tax examination by tax authorities through 2023.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Rental Expense -29,939. Loss included in expenses per audited financial statements -4,632. Hillview Doers Club Fund Revenues 3,117.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Rental Expenses 29,939. Loss included in expenses per audited financial statements 4,632.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Hillview Doers Club Fund Expenses 5,270.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <ClubDuesOrFeesInd>X</ClubDuesOrFeesInd>
      <WrittenPolicyRefTAndEExpnssInd>1</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>1</SubstantiationRequiredInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Reier Thompson</PersonNm>
        <TitleTxt>President/CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>238735</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>26254</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>7599</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>32871</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>305459</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Deniece Bauslaugh</PersonNm>
        <TitleTxt>Licensed Practical Nurse (LPN)</TitleTxt>
        <BaseCompensationFilingOrgAmt>119271</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>3925</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>29872</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>153068</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>LeAnn Hokanson</PersonNm>
        <TitleTxt>Vice President of Resident Services</TitleTxt>
        <BaseCompensationFilingOrgAmt>136249</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4166</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>9939</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>150354</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 1a</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization provides a membership for the President/CEO to the Apple Creek Country Club and this is reported properly on his Form W-2.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 1b</FormAndLineReferenceDesc>
        <ExplanationTxt>The independent Board of Directors approve the compensation package for the President/CEO and the golf membership is considered part of his compensation package.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc1053100001">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>Burleigh County North Dakota (B)</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>456002204</BondIssuerEIN>
        <CUSIPNum>120906FT4</CUSIPNum>
        <BondIssuedDt>2020-11-10</BondIssuedDt>
        <IssuePriceAmt>79879524</IssuePriceAmt>
        <PurposeDesc>Refund bonds issued 11/30/2006 and construction on SNF</PurposeDesc>
        <DefeasedInd>0</DefeasedInd>
        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>Burleigh County North Dakota (D1)</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>456002204</BondIssuerEIN>
        <CUSIPNum>120906FV9</CUSIPNum>
        <BondIssuedDt>2020-11-10</BondIssuedDt>
        <IssuePriceAmt>75606650</IssuePriceAmt>
        <PurposeDesc>Partial Refund 2020C Bonds</PurposeDesc>
        <DefeasedInd>0</DefeasedInd>
        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>71115000</RetiredAmt>
        <TotalProceedsAmt>79879524</TotalProceedsAmt>
        <InReserveFundAmt>799562</InReserveFundAmt>
        <CapitalizedInterestAmt>3877785</CapitalizedInterestAmt>
        <IssuanceCostsFromProceedsAmt>851000</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>43342176</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>31097823</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2021</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>1</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>0</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>1</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <RetiredAmt>1360000</RetiredAmt>
        <TotalProceedsAmt>75607788</TotalProceedsAmt>
        <InReserveFundAmt>6232676</InReserveFundAmt>
        <OtherSpentProceedsAmt>69353269</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2022</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>1</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>0</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>0</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>0</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00590</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.00590</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00000</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.00000</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>0</ExceptionToRebateInd>
        <NoRebateDueInd>0</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>0</ExceptionToRebateInd>
        <NoRebateDueInd>0</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part II, Line 4, Gross proceeds in reserve funds:</FormAndLineReferenceDesc>
        <ExplanationTxt>The amounts reported in columns A and B for Part II, Line 4 included interest of $88,822 and $375,978 investment income earned on the bonds.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part II, Line 3, Total proceeds of issue:</FormAndLineReferenceDesc>
        <ExplanationTxt>The amounts reported in columns B for Part II, Line 3 included interest of $1,138 investment income earned on the bond proceeds.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <LoansBtwnOrgInterestedPrsnGrp>
        <PersonNm>Reier Thompson</PersonNm>
        <RelationshipWithOrgTxt>President/CEO</RelationshipWithOrgTxt>
        <LoanPurposeTxt>In Lieu of compensation under a life insurance benefit plan</LoanPurposeTxt>
        <LoanFromOrganizationInd>X</LoanFromOrganizationInd>
        <OriginalPrincipalAmt>69231</OriginalPrincipalAmt>
        <BalanceDueAmt>69231</BalanceDueAmt>
        <DefaultInd>0</DefaultInd>
        <BoardOrCommitteeApprovalInd>1</BoardOrCommitteeApprovalInd>
        <WrittenAgreementInd>1</WrittenAgreementInd>
      </LoansBtwnOrgInterestedPrsnGrp>
      <TotalBalanceDueAmt>69231</TotalBalanceDueAmt>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>LeAnn Hokanson</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Family Relationship - Sibling of Vice President/CFO Stacy Hokanson</RelationshipDescriptionTxt>
        <TransactionAmt>152689</TransactionAmt>
        <TransactionDesc>Wages Paid: Salary and Benefits</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 1a</FormAndLineReferenceDesc>
        <ExplanationTxt>Governing Body- The Organization currently has three committees: the Executive, Ethics &amp; Investment Committee, the Budget and Personnel Committee, and the Bylaws Committee. Each of these committees are composed of current board members. All committees are organized to focus on the particular areas and to advise the board if need be.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>Membership in the corporation consists of the following congregations: Trinity Evangelical Lutheran Church of Bismarck, Faith Lutheran Church of Bismarck, Good Shepherd Lutheran Church of Bismarck, Lutheran Church of the Cross of Bismarck, Lord of Life Lutheran Church of Bismarck, First Lutheran Church of Bismarck, House of Prayer Evangelical Lutheran Church of Bismarck, First Lutheran Church of Mandan and Sunne Lutheran Church of Wilton. Additional members of the corporation may be admitted as determined by a majority of the delegates attending a corporate meeting. Application for membership shall be in the form prescribed by the Board of Directors.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Board of Directors- A majority of the directors shall be confirmed members of member congregations. Elections for director positions shall be held at each annual meeting. Prior to each annual meeting, the Board of Directors shall name a nominating committee which shall be responsible for obtaining nominees for any director positions to be filled at the annual meeting. The nominating committee shall try to obtain nominees so that the board will be fairly representative of the member congregations and of the community. Delegates to the annual meeting may also make nominations from the floor. Vacancies on the board shall be filled by appointment by the remaining members of the board for the unexpired term.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>Upon receipt of the draft Form 990, the board members will review a copy of the Form 990 at the next board meeting and prior to submission to the IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>All members of the board of directors are required to disclose any possible conflicts of interest to the board. In the event that the board determines that a conflict exists, any board members having a possible conflict of interest on any matter affecting the corporation shall not vote or use their personal influence on the matter.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>Annually, the independent board reviews employee salary increases as well as officer salaries. Comparable data is obtained from the ND Long Term Care Association and the board meeting minutes reflect the overall approval of the increases.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Governing documents, conflict of interest policy, and financial statements are available to the general public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Purchased Services: Program service expenses 4,036,145. Management and general expenses 557,074. Fundraising expenses 0. Total expenses 4,593,219. Professional Services: Program service expenses 1,209,305. Management and general expenses 41,795. Fundraising expenses 0. Total expenses 1,251,100.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Change in NA for Doers 2,153.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Missouri Slope North Campus - SNF LLC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>4916 North Washington Street</AddressLine1Txt>
          <CityNm>Bismarck</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58503</ZIPCd>
        </USAddress>
        <EIN>450279210</EIN>
        <PrimaryActivitiesTxt>Skilled Nursing Facility Second Location</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <TotalIncomeAmt>38111385</TotalIncomeAmt>
        <EndOfYearAssetsAmt>77849381</EndOfYearAssetsAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Missouri Slope Lutheran Care Center Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Missouri Slope At Home LLC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>4916 North Washington Street</AddressLine1Txt>
          <CityNm>Bismarck</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58503</ZIPCd>
        </USAddress>
        <EIN>450279210</EIN>
        <PrimaryActivitiesTxt>Home and Community Based Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <TotalIncomeAmt>713542</TotalIncomeAmt>
        <EndOfYearAssetsAmt>540292</EndOfYearAssetsAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Missouri Slope Lutheran Care Center Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Missouri Slope Lutheran Care Center Foundation</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>4916 North Washington Street</AddressLine1Txt>
          <CityNm>Bismarck</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58503</ZIPCd>
        </USAddress>
        <EIN>363589734</EIN>
        <PrimaryActivitiesTxt>Supporting Organization</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>ND</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>Line 12b, II</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Missouri Slope Lutheran Care Center Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>1</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>1</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Missouri Slope Lutheran Care Center Foundation</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>C</TransactionTypeTxt>
        <InvolvedAmt>494940</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Cash transferred</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>