Service Above Self combines the history of the first fifty years of the Lutheran Hospitals and Homes Society (LHHS) with events that took place in rural health and nursing home care from 1938 through 1987. The Society is unique in healthcare because it pioneered the system s approach for the industry and became one of the giants in the business. LHHS is an offshoot of the Lutheran Evangelical Good Samaritan Society which was founded in 1922 in a small North Dakota farming community. Many of the basic concepts came from the Bethel movement in Germany. The changing structure of the sparsely-populated, natural resource-based economies of farming, ranching, energy, and forestry of the rural west made it difficult for the small communities to support proper health and geriatric care facilities. The old time doctors hospitals or the small community- or county-owned hospitals, could no longer meet the demands of a shrinking but increasingly sophisticated populace. This provided a setting for these not-for-profit, privately-operated systems which were alert to the opportunity and pioneered a new approach for the healthcare industry.