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        <NondisEmergencyCarePolicyInd>true</NondisEmergencyCarePolicyInd>
        <ProspectiveMedicareMedicaidInd>X</ProspectiveMedicareMedicaidInd>
        <AmountsGenerallyBilledInd>false</AmountsGenerallyBilledInd>
        <GrossChargesInd>false</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 3E</FormAndLineReferenceDesc>
        <ExplanationTxt>SIGNIFICANT HEALTH NEEDS AS IDENTIFIED BY VARIOUS STAKEHOLDER GROUPS INCLUDED HOUSING, EMPLOYEES, AND ACTIVITIES FOR YOUTH. ADVERSE CHILDHOOD EXPERIENCES, SUBSTANCE USE DISORDERS, DIABETES, AND OBESITY/OVERWEIGHT RESIDENTS WERE ALSO IDENTIFIED AS HEALTH ISSUES. ACCESS TO AFFORDABLE HEALTH CARE AND MENTAL HEALTH, BEHAVIORAL HEALTH, AND SUBSTANCE MISUSE WERE IDENTIFIED AS PRIORITY NEEDS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMMUNITY HEALTH NEEDS ASSESSMENT EVALUATED COMMUNITY HEALTH FROM A NUMBER OF PERSPECTIVES INCLUDING STAKEHOLDER AND COMMUNITY SURVEYS, SURVEYS OF COMMUNITY LEADERS THAT HAVE SPECIAL KNOWLEDGE AND EXPERTISE REGARDING POPULATION ALONG WITH PUBLIC COMMENTS FROM PREVIOUS ASSESSMENTS, AND INSTITUTIONAL KNOWLEDGE BY COTEAU DES PRAIRIES HEALTH CARE SYSTEM EMPLOYEES LOCALLY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 11</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL FACILITY HAS IDENTIFIED TWO PRIORITY AREAS OF FOCUS: 1) IMPROVING ACCESS TO AFFORDABLE HEALTH CARE THROUGH A) THE BROADENING OF HEALTH EQUITY BY EXPANDING HEALTH CARE ASSESS AND SUPPORT RESOURCES FOR VULNERABLE AND UNDERSERVED POPULATIONS BY EXPLORING THE EXPANSION OF PRIMARY CARE CLINIC HOURS AND RECRUITMENT OF PROVIDERS, NURSING AND ANCILLARY POSITIONS AS WELL AS B) ADVANCING DELIVERY OF PREVENTATIVE CARE SCREENINGS, IMMUNIZATIONS AND VACCINATIONS IN PRIMARY CARE CLINICS THROUGH PROMOTION OF SCREENING AND VACCINATIONS DURING VISITS AND THROUGH COLLABORATION WITH COMMUNITY PARTNERS FOR SCREENINGS, RISK ASSESSMENTS, AND VACCINATION EVENTS. 2) ADDRESSING MENTAL HEALTH, BEHAVIORAL HEALTH, AND SUBSTANCE MISUSE THROUGH A) DECREASING SUSTANCE MISUSE BY THE PROMOTION OF TREATMENT REFERRAL PROGRAMS AND B) INCREASING ACCESS TO MENTAL AND BEHAVIORAL HEALTH BY PROMOTING DEPRESSION SCREENINGS IN THE CLINIC PRACTICE AS WELL AS BY EXPANSION OF THE UTILITIATION OF MENTAL HEALTH AND BEHAVIORAL HEALTH SERVICES. NEEDS IDENTIFIED DURING THE CHNA PROCESS NOT ADDRESSED AS A SIGNIFICANT NEED FOR THE PURPOSE OF THE PROCESS INCLUDE TRANSPORTATION, AFFORDABLE HOUSING, AND PHYSICAL ACTIVITY AS OTHER ORGANIZATIONS ARE ADDRESSING THESE NEEDS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 16J</FormAndLineReferenceDesc>
        <ExplanationTxt>A SUMMARY OF THE CHARITY CARE POLICY IS POSTED IN THE HOSPITAL'S MAIN ENTRANCE/ADMISSION AREAS, THE MAIN ENTRANCE/ADMISSION AREAS FOR EACH OF THE CLINICS, AND IN THE EMERGENCY ROOMS AND WAITING ROOMS. CDPH PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS, WHEN APPLICABLE. IN ADDITION, CDPH PERSONNEL DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSIST THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHEN APPLICABLE.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>4</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>BROWNS VALLEY CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>404 WEST BROADWAY</AddressLine1Txt>
            <CityNm>BROWNS VALLEY</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>56219</ZIPCd>
          </USAddress>
          <FacilityTxt>RURAL HEALTH CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>ROSHOLT CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>116 WEST MAIN STREET</AddressLine1Txt>
            <CityNm>ROSHOLT</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57260</ZIPCd>
          </USAddress>
          <FacilityTxt>RURAL HEALTH CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>HERMAN CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>204 5TH ST EAST</AddressLine1Txt>
            <CityNm>HERMAN</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>56248</ZIPCd>
          </USAddress>
          <FacilityTxt>FAMILY PRACTICE CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>SISSETON CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>205 ORCHARD DRIVE</AddressLine1Txt>
            <CityNm>SISSETON</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57262</ZIPCd>
          </USAddress>
          <FacilityTxt>RURAL HEALTH CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART I, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A 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. HEALTH PROFESSIONS EDUCATION, LINE 7F, IS COMPILED USING ACTUAL COSTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART II</FormAndLineReferenceDesc>
        <ExplanationTxt>CDP TRAVELS TO VARIOUS COMMUNITIES IN WITHIN 30 MILES FOR "TOE CLINICS" THIS SERVICE IS OFFERED TO ANYONE NO MATTER AGE, GENDER, ETHNICITY. CDP EMPLOYEES ARE ACTIVE IN COMMUNITY MEETINGS WITH IHS, ALIVE ROBERTS COUNTY, SD DEPT HUMAN SERVICES, SWO COLLEGE. MEETINGS HAVE A RANGE OF AGENDA'S THAT INCLUDE HEALTHY BABIES 0-5, SUICIDE PREVENTION, MENTAL HEALTH, COMMON PATIENTS IN THE COMMUNITY HEALTH &amp; WELLNESS, PROMOTING HEALTHY PREGNANCIES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, LINE 8</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL PROVIDES SERVICES TO MEDICARE PATIENTS KNOWING THERE COULD BE A SHORTFALL BECAUSE ACCESS TO HEALTHCARE AND INDIVIDUAL'S HEALTH IS IMPORTANT TO THE HOSPITAL. THEREFORE; THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. TOTAL REVENUE RECEIVED FROM MEDICARE (INCLUDING DSH AND IME) IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT (INCLUDING LSA). BOTH THE 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 CENTERS FOR MEDICAID AND MEDICARE SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART III, LINE 9B</FormAndLineReferenceDesc>
        <ExplanationTxt>FOR PATIENTS WHO QUALIFY FOR CHARITY CARE AND ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, COTEAU DES PRAIRIES HOSPITAL AND CLINIC MAY OFFER EXTENDED PAYMENT PLANS. THE HOSPITAL WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES AND WILL CEASE ALL COLLECTION ACTIONS SUCH AS WAGE GARNISHMENTS, LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS. THE HOSPITAL WILL FIRST MAKE REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PRIORITY OF CDPH IS TO PROMOTE THE HEALTH OF SISSETON AND ALSO THE SURROUNDING RURAL COMMUNITIES. PLEASE REFER TO SCHEDULE H, PART V, LINE 5.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>CDPH UTILIZES MULTIPLE METHODS FOR PATIENT EDUCATION OF FINANCIAL ASSISTANCE. PLEASE SEE SCHEDULE H, PART V, LINE 16.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL SERVES APPROXIMATELY 21,000 RESIDENTS IN THE GLACIAL LAKES REGION IN NORTHEAST SOUTH DAKOTA AS WELL AS WEST CENTRAL MINNESOTA. COMMUNITIES SERVED INCLUDE ROBERTS COUNTY, MARSHALL COUNTY, AND DAY COUNTY IN SOUTH DAKOTA AS WELL AS RICHLAND COUNTY IN NORTH DAKOTA AND TRAVERSE COUNTY IN MINNESOTA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>CDPH IS A SOLE COMMUNITY PROVIDER WITH AN 9 MEMBER VOLUNTEER BOARD OF DIRECTORS WHO ALL RESIDE IN THE PRIMARY SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED INDIVIDUALS AS THEY ARE REQUESTED. IF CDPH WERE TO HAVE SURPLUS FUNDS, THE FUNDS WOULD BE APPLIED TO PATIENT CARE IMPROVEMENTS AND ALSO TO REDUCE THE NEED FOR RATE INCREASES FOR THE PATIENTS. THE EMERGENCY ROOM IS STAFFED 24 HOURS A DAY, 7 DAYS A WEEK, AND PATIENTS ARE WELCOMED REGARDLESS OF RACE OR THE ABILITY TO PAY FOR THE SERVICES. CDPH PARTICIPATES IN ALL GOVERNMENT-SPONSORED HEALTH PROGRAMS INCLUDING MEDICARE, MEDICAID, INDIAN HEALTH SERVICES, AND VETERAN AFFAIRS BENEFITS. THE HOSPITAL AND CLINICS WELCOME STUDENTS FOR TRAINING AND COLLEGE ROTATIONS IN VARIOUS HEALTHCARE PROFESSIONS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE H, PART VI</FormAndLineReferenceDesc>
        <ExplanationTxt>PART I, LINE 3C: PLEASE REFER TO SCHEDULE H, PART V, LINE 13.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
    <IRS990ScheduleJ documentId="RetDoc5">
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>true</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>STANLEY GALLAGHER DO</PersonNm>
        <TitleTxt>FAMILY PRACTICE</TitleTxt>
        <BaseCompensationFilingOrgAmt>455954</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>16200</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>1425</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>3518</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>13800</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>21009</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>495706</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>16200</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JUDY BEUMER MD</PersonNm>
        <TitleTxt>FAMILY PRACTICE</TitleTxt>
        <BaseCompensationFilingOrgAmt>249330</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>1575</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>143</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10271</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>16674</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>277993</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL LOWE MD</PersonNm>
        <TitleTxt>FAMILY PRACTICE</TitleTxt>
        <BaseCompensationFilingOrgAmt>485633</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>19591</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>1902</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>13592</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>18193</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>538911</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANDREW HAPUTA MD</PersonNm>
        <TitleTxt>FAMILY PRACTICE</TitleTxt>
        <BaseCompensationFilingOrgAmt>332218</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>39041</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>289</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>9096</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>15070</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>395714</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JACKIE BARTLETT PA-C</PersonNm>
        <TitleTxt>FAMILY PRACTICE</TitleTxt>
        <BaseCompensationFilingOrgAmt>231755</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>12183</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>290</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>9893</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>11621</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>265742</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PAGE 1, PART I, LINE 5A</FormAndLineReferenceDesc>
        <ExplanationTxt>ONE PHYSICIAN IS PAID 38% OF THEIR RESPECTIVE PROVIDER/CPT CODE REVENUE. OTHER PHYSICIANS AND MID-LEVEL PROVIDERS ARE PAID UNDER PRIOR CONTRACTS NOT RELATED TO THE REVENUE GENERATED.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc6">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>CITY OF SISSETONSOUTH DAKOTA</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>466000460</BondIssuerEIN>
        <BondIssuedDt>2022-04-20</BondIssuedDt>
        <IssuePriceAmt>5687633</IssuePriceAmt>
        <PurposeDesc>TO REFINANCE BONDS ISSUED IN 2012 FOR FUNDING OF A HOSPITAL REMODELING AND BUILDING ADDITION PROJECT</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>2387355</RetiredAmt>
        <TotalProceedsAmt>5687633</TotalProceedsAmt>
        <OtherSpentProceedsAmt>5687633</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2022</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>true</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>false</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>false</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>false</RebateNotDueYetInd>
        <ExceptionToRebateInd>false</ExceptionToRebateInd>
        <NoRebateDueInd>false</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PURPOSE OF ISSUE DESCRIPTION</FormAndLineReferenceDesc>
        <ExplanationTxt>CITY OF SISSETON,SOUTH DAKOTA TO REFINANCE BONDS ISSUED IN 2012 FOR FUNDING OF A HOSPITAL REMODELING AND BUILDING ADDITION PROJECT.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="RetDoc7">
      <LoansBtwnOrgInterestedPrsnGrp>
        <PersonNm>TERRY JASPERS</PersonNm>
        <RelationshipWithOrgTxt>CHAIRPERSON</RelationshipWithOrgTxt>
        <LoanPurposeTxt>PURCHASE OF HOUSE</LoanPurposeTxt>
        <LoanToOrganizationInd>X</LoanToOrganizationInd>
        <OriginalPrincipalAmt>75000</OriginalPrincipalAmt>
        <BalanceDueAmt>55749</BalanceDueAmt>
        <DefaultInd>false</DefaultInd>
        <BoardOrCommitteeApprovalInd>true</BoardOrCommitteeApprovalInd>
        <WrittenAgreementInd>true</WrittenAgreementInd>
      </LoansBtwnOrgInterestedPrsnGrp>
      <TotalBalanceDueAmt>55749</TotalBalanceDueAmt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE L, PART V</FormAndLineReferenceDesc>
        <ExplanationTxt>HOSPITAL PURCHASED HOUSE OWNED BY TERRY AND SANDRA JASPERS FOR USE BY THE HOSPITAL. PAYMENTS FOR THE PURCHASE ARE MADE MONTHLY FOR 180 MONTHS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc8">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 2, PART III, LINE 4A</FormAndLineReferenceDesc>
        <ExplanationTxt>COTEAU DES PRAIRIES HOSPITAL (CDPH) IS A 25 BED ACUTE CARE HOSPITAL WITH PHYSICIAN CLINICS LOCATED IN SISSETON, SOUTH DAKOTA AND THE SURROUNDING AREA. THE HOSPITAL PROVIDES HEALTH CARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THEN ESTABLISHED RATES. SINCE THE HOSPITAL DOES NOT PURSUE COLLECTION OF THESE AMOUNTS, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE. THE ESTIMATED COST OF PROVIDING THESE SERVICES WAS 8,000 FOR THE YEAR ENDED DECEMBER 31, 2024. STATISTICS FOR THE PERIOD ENDED DECEMBER 31, 2024, ARE AS FOLLOWS: ACUTE PATIENT DAYS = 622, SWING-BED PATIENT DAYS = 745, NEWBORN NURSERY DAYS = 9, EMERGENCY ROOM VISITS = 4,722, CLINIC VISITS = 15,075, AND NUMEROUS OTHER OUTPATIENT VISITS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI</FormAndLineReferenceDesc>
        <ExplanationTxt>SECTION A, LINE 1: THE EXECUTIVE COMMITTEE CONSISTS OF THE PRESIDENT, VICE PRESIDENT, THE SECRETARY, THE TREASURER, AND ONE OTHER MEMBER OF THE BOARD TO BE ELECTED BY THE BOARD AT THE ANNUAL MEETING. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL &amp; CLINIC DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD. SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD. MINUTES OF THE EXECUTIVE COMMITTEE MEETINGS ARE AVAILABLE TO THE BOARD.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 AFTER FILING. THE CEO REVIEWS THE 990 IN DETAIL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CONFLICT OF INTEREST POLICY IS COMPLETED ANNUALLY AND COVERS OFFICERS AND BOARD MEMBERS. THE BOARD IS GIVEN A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS TO SIGN. THE DETERMINATION OF WHETHER A CONFLICT EXISTS IS MADE AT THE BOARD OF THE DIRECTORS LEVEL, AS IS THE REVIEW OF ACTUAL CONFLICTS. ANY PERSON DETERMINED TO HAVE A CONFLICT WILL HAVE AN OPPORTUNITY TO EXPLAIN THE SITUTATION, AND HE/SHE WILL BE REQUIRED TO REFRAIN FROM VOTING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CEO IS PROVIDED THROUGH THE HOSPITAL'S MANAGEMENT SERVICE AGREEMENT WITH SANFORD HEALTH. COMPENSATION FOR THE CEO IS DETERMINED THROUGH INDIVIDUAL NEGOTIATIONS WITH SANFORD HEALTH, THE HOSPITAL EXECUTIVE COMMITTEE AND THE CEO. SANFORD HEALTH AND THE HOSPITAL EXECUTIVE COMMITTEE USE SALARY SURVEYS TO DETERMINE WHAT CONSTITUTES REASONABLE COMPENSATION. NEGOTIATIONS WITH SANFORD HEALTH AND THE HOSPITAL EXECUTIVE COMMITTEE INCLUDE A PERFORMANCE EVALUATION. AN EVALUATION IS DONE ANNUALLY BY SANFORD HEALTH AND THE HOSPITAL'S EXECUTIVE COMMITTEE, AND APPROVED BY THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION OF THE CDPH'S OFFICERS IS DETERMINED THROUGH DISCUSSIONS BETWEEN THE EXECUTIVE COMMITTEE AND THE CEO. THE EXECUTIVE COMMITTEE USES SALARY SURVEYS TO DETERMINE WHAT CONSTITUTES REASONABLE COMPENSATION. DISCUSSIONS WITH THE EXECUTIVE COMMITTEE INCLUDE A PERFORMANCE EVALUATION. AN EVALUATION IS DONE ANNUALLY BY THE EXECUTIVE COMMITTEE, AND APPROVED BY THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>PURCHASED SERVICES 3,086,184 826,258 0 REPAIRS &amp; MAINTENANCE 414,486 12,638 0 PROFESSIONAL FEES 1,520,877 1,087 0 CONTRACT LABOR 1,371 387,900 0 TOTAL 5,022,918 1,227,883 0</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>COTEAU DES PRAIRIES FOUNDATION</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>205 ORCHARD DRIVE</AddressLine1Txt>
          <CityNm>SISSETON</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>572622398</ZIPCd>
        </USAddress>
        <EIN>800446054</EIN>
        <PrimaryActivitiesTxt>FUNDRAISE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501C3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>7</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>TEKAKWITHA NURSING CENTER INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>6 E CHESTNUT ST</AddressLine1Txt>
          <CityNm>SISSETON</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57262</ZIPCd>
        </USAddress>
        <EIN>411809912</EIN>
        <PrimaryActivitiesTxt>LTC</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501C3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>TEKAKWITHA NURSING CENTER INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>15000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>MONTHLY FEE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>