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      <Form990PartVIISectionAGrp>
        <PersonNm>LONNA JACKSON-STREET</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CYNTHIA JACOBS</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DUANE RABBE JR</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>VICTORIA KITCHEYAN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RYMAN LEBEAU</PersonNm>
        <TitleTxt>CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PETER LENGKEEK</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHRISTINE OLSON</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>FRANK STAR COMES OUT</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RUDY PAPAKEE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GARRET RENVILLE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CHEYENNE ROBINSON</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KAMERON RUNNELS</PersonNm>
        <TitleTxt>VICE CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CANDACE SCHMIDT</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2290315</TotalReportableCompFromOrgAmt>
      <TotalOtherCompensationAmt>182677</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>10</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>INDIAN HEALTH SERVICE</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>115 4TH AVE</AddressLine1Txt>
            <CityNm>ABERDEEN</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57401</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACTED SERV</ServicesDesc>
        <CompensationAmt>8318277</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MONUMENT HEALTH RAPID CITY</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>353 FAIRMONT BLVD</AddressLine1Txt>
            <CityNm>RAPID CITY</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57709</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL&amp; HOSPIT</ServicesDesc>
        <CompensationAmt>5094189</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>CASEY PETERSON</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>909 ST JOSEPH ST</AddressLine1Txt>
            <CityNm>RAPID CITY</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ACCOUNTING &amp; CO</ServicesDesc>
        <CompensationAmt>662099</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BLACK HILLS SURGICAL HOSPITAL</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 129</AddressLine1Txt>
            <CityNm>RAPID CITY</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57709</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL &amp; HOSPI</ServicesDesc>
        <CompensationAmt>585709</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>AVEL ECARE LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>3900 W AVER DR</AddressLine1Txt>
            <CityNm>SIOUX FALLS</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57108</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>TELE HEALTH</ServicesDesc>
        <CompensationAmt>489226</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>22</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>82583654</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>368757</AllOtherContributionsAmt>
      <TotalContributionsAmt>82952411</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>CHARGES FOR SERVICES</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>23973015</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>23973015</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>23973015</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>1617590</TotalRevenueColumnAmt>
        <ExclusionAmt>1617590</ExclusionAmt>
      </InvestmentIncomeGrp>
      <OtherRevenueMiscGrp>
        <Desc>NEGOTIATED SETTLEMENT OF DEBT</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>82140</TotalRevenueColumnAmt>
        <ExclusionAmt>82140</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>31218</TotalRevenueColumnAmt>
        <ExclusionAmt>31218</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>113358</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>108656374</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>23973015</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>1730948</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>1245871</TotalAmt>
        <ProgramServicesAmt>1245871</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>10545</TotalAmt>
        <ProgramServicesAmt>10545</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>433846</TotalAmt>
        <ManagementAndGeneralAmt>433846</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>29459952</TotalAmt>
        <ProgramServicesAmt>25832620</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3627332</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>1045489</TotalAmt>
        <ProgramServicesAmt>899769</ProgramServicesAmt>
        <ManagementAndGeneralAmt>145720</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>3645579</TotalAmt>
        <ProgramServicesAmt>3078070</ProgramServicesAmt>
        <ManagementAndGeneralAmt>567509</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1681817</TotalAmt>
        <ProgramServicesAmt>1376418</ProgramServicesAmt>
        <ManagementAndGeneralAmt>305399</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>210246</TotalAmt>
        <ManagementAndGeneralAmt>210246</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>909507</TotalAmt>
        <ManagementAndGeneralAmt>909507</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>18039252</TotalAmt>
        <ProgramServicesAmt>17520348</ProgramServicesAmt>
        <ManagementAndGeneralAmt>518904</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>79601</TotalAmt>
        <ProgramServicesAmt>79584</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1838198</TotalAmt>
        <ProgramServicesAmt>1487186</ProgramServicesAmt>
        <ManagementAndGeneralAmt>351012</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>1016926</TotalAmt>
        <ProgramServicesAmt>734500</ProgramServicesAmt>
        <ManagementAndGeneralAmt>282426</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>3566031</TotalAmt>
        <ProgramServicesAmt>3037812</ProgramServicesAmt>
        <ManagementAndGeneralAmt>528219</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>1210710</TotalAmt>
        <ProgramServicesAmt>951879</ProgramServicesAmt>
        <ManagementAndGeneralAmt>258831</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>904233</TotalAmt>
        <ProgramServicesAmt>644025</ProgramServicesAmt>
        <ManagementAndGeneralAmt>260208</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>202164</TotalAmt>
        <ProgramServicesAmt>39220</ProgramServicesAmt>
        <ManagementAndGeneralAmt>162944</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>1187958</TotalAmt>
        <ProgramServicesAmt>750632</ProgramServicesAmt>
        <ManagementAndGeneralAmt>437326</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>148919</TotalAmt>
        <ManagementAndGeneralAmt>148919</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>SUPPLIES</Desc>
        <TotalAmt>8710560</TotalAmt>
        <ProgramServicesAmt>8233336</ProgramServicesAmt>
        <ManagementAndGeneralAmt>477224</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PARTICIPANT COSTS</Desc>
        <TotalAmt>233711</TotalAmt>
        <ProgramServicesAmt>233711</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BUY BACK EXPENSE</Desc>
        <TotalAmt>228158</TotalAmt>
        <ProgramServicesAmt>228158</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT</Desc>
        <TotalAmt>4057</TotalAmt>
        <ManagementAndGeneralAmt>4057</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>76013330</TotalAmt>
        <ProgramServicesAmt>66383684</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9629646</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <InfoInScheduleOPartXInd>X</InfoInScheduleOPartXInd>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>57213201</BOYAmt>
        <EOYAmt>107942742</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>4155665</BOYAmt>
        <EOYAmt>1882167</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>921482</BOYAmt>
        <EOYAmt>1150904</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>873950</BOYAmt>
        <EOYAmt>190696</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>13961548</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>2280951</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>7740376</BOYAmt>
        <EOYAmt>11680597</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>1484727</BOYAmt>
        <EOYAmt>4519192</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>72389401</BOYAmt>
        <EOYAmt>127366298</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>10858783</EOYAmt>
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      <DeferredRevenueGrp>
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        <EOYAmt>51358033</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>5429520</EOYAmt>
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      <UnsecuredNotesLoansPayableGrp>
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      <OtherLiabilitiesGrp>
        <BOYAmt>1434685</BOYAmt>
        <EOYAmt>2234054</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>47546537</BOYAmt>
        <EOYAmt>69880390</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrgDoesNotFollowFASB117Ind>X</OrgDoesNotFollowFASB117Ind>
      <RtnEarnEndowmentIncmOthFndsGrp>
        <BOYAmt>24842864</BOYAmt>
        <EOYAmt>57485908</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>24842864</BOYAmt>
        <EOYAmt>57485908</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>72389401</BOYAmt>
        <EOYAmt>127366298</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>32643044</ReconcilationRevenueExpnssAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc7">
      <PublicOrganization170Ind>X</PublicOrganization170Ind>
      <GiftsGrantsContriRcvd170Grp>
        <CurrentTaxYearMinus4YearsAmt>15343762</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>42836408</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>34337501</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>56151691</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>82952411</CurrentTaxYearAmt>
        <TotalAmt>231621773</TotalAmt>
      </GiftsGrantsContriRcvd170Grp>
      <TotalCalendarYear170Grp>
        <CurrentTaxYearMinus4YearsAmt>15343762</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>42836408</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>34337501</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>56151691</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>82952411</CurrentTaxYearAmt>
        <TotalAmt>231621773</TotalAmt>
      </TotalCalendarYear170Grp>
      <PublicSupportTotal170Amt>231621773</PublicSupportTotal170Amt>
      <GrossInvestmentIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>85321</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>174639</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>179454</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>300483</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1617590</CurrentTaxYearAmt>
        <TotalAmt>2357487</TotalAmt>
      </GrossInvestmentIncome170Grp>
      <OtherIncome170Grp>
        <CurrentTaxYearMinus4YearsAmt>233044</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>8933</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1713429</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>3829</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>113358</CurrentTaxYearAmt>
        <TotalAmt>2072593</TotalAmt>
      </OtherIncome170Grp>
      <TotalSupportAmt>236051853</TotalSupportAmt>
      <GrossReceiptsRltdActivitiesAmt>23973015</GrossReceiptsRltdActivitiesAmt>
      <PublicSupportCY170Pct>0.98120</PublicSupportCY170Pct>
      <PublicSupportPY170Pct>0.98290</PublicSupportPY170Pct>
      <ThirtyThrPctSuprtTestsCY170Ind>X</ThirtyThrPctSuprtTestsCY170Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART II, LINE 10</FormAndLineReferenceDesc>
        <ExplanationTxt>MISCELLANEOUS 265,594 FORGIVENESS OF PPP LOAN 1,693,641</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="RetDoc3">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>1067285</OtherCostOrOtherBasisAmt>
        <BookValueAmt>1067285</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>4686083</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>260299</DepreciationAmt>
        <BookValueAmt>4425784</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>221780</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>36862</DepreciationAmt>
        <BookValueAmt>184918</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>7986400</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1983790</DepreciationAmt>
        <BookValueAmt>6002610</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>11680597</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>COMPENSATED ABSENCES</Desc>
        <Amt>1147382</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>LEASE, SUBSCRIPTION &amp; OTHER</Desc>
        <Amt>1086672</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>2234054</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>108656374</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>108656374</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>108656374</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>76013330</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>76013330</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>76013330</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 3, PART X</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GPTLHB IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE IRS HAS ALSO DETERMINED IT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2) OF THE INTERNAL REVENUE CODE. ITS FORMS 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, FOR THE TAX YEARS ENDING SEPTEMBER 30, 2020,2021 AND 2022 ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER EACH RETURN IS FILED.</ExplanationTxt>
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    <IRS990ScheduleI documentId="RetDoc4">
      <GrantRecordsMaintainedInd>false</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>FLANDREAUX SANTEE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>403 W BROAD AVE</AddressLine1Txt>
          <CityNm>FLANDREAU</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57028</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>LOWER BRULE SIOUX TRIBE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>187 OYATE CIRCLE</AddressLine1Txt>
          <CityNm>LOWER BRULE</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57548</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>70507</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>MISSOURI BREAKS INDUSTRIES RESEARCH</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 1824</AddressLine1Txt>
          <CityNm>EAGLE BUTTE</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57625</ZIPCd>
        </USAddress>
        <CashGrantAmt>118000</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>OAYE LUTA OKOLAKICIYE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 2792</AddressLine1Txt>
          <CityNm>RAPID CITY</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57709</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>30960</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>OMAHA TRIBE OF NEBRASKA</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>101 MAIN STREET</AddressLine1Txt>
          <CityNm>MACY</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68039</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>58043</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>OYATE TECA PROJECT</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 316</AddressLine1Txt>
          <CityNm>KYLE</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57752</ZIPCd>
        </USAddress>
        <CashGrantAmt>118000</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>PONCA TRIBE OF NEBRASKA</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 288</AddressLine1Txt>
          <CityNm>NIOBRARA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68760</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>ROSEBUD SIOUX TRIBE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 430</AddressLine1Txt>
          <CityNm>ROSEBUD</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57570</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>122994</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>SANTEE HEALTH AND WELLNESS CENTER</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>110 S VISITING EAGLE</AddressLine1Txt>
          <CityNm>NIOBRARA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68760</ZIPCd>
        </USAddress>
        <CashGrantAmt>90000</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>SANTEE SIOUX TRIBE OF NEBRASKA</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>425 FRAZIER AVE</AddressLine1Txt>
          <CityNm>NIOBRARA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68760</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>SINTE GLESKA UNIVERSITY</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 105</AddressLine1Txt>
          <CityNm>MISSION</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57570</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>98026</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>SISSETON WAHPETON OYATE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 509</AddressLine1Txt>
          <CityNm>AGENCY VILLAGE</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57262</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>38341</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>SISSETON WAHPETON OYATE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 509</AddressLine1Txt>
          <CityNm>AGENCY VILLAGE</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57262</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>SPIRIT LAKE TRIBE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 359</AddressLine1Txt>
          <CityNm>FT TOTTEN</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58335</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>118000</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>TURTLE MOUNTAIN BAND OF CHIPPEWA</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 900</AddressLine1Txt>
          <CityNm>BELCOURT</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58316</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>WHERE ALL WOMEN ARE HONORED</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 166</AddressLine1Txt>
          <CityNm>PORCUPINE</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57772</ZIPCd>
        </USAddress>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>WILD HORSE BUTTE COMMUNITY DEVELOPM</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 488</AddressLine1Txt>
          <CityNm>MARTIN</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57551</ZIPCd>
        </USAddress>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>WINNEBAGO COMPREHENSIVE HEALTH CARE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>225 S BLUFF ST</AddressLine1Txt>
          <CityNm>EINNEBAGO</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68701</ZIPCd>
        </USAddress>
        <CashGrantAmt>128000</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>YANKTON SIOUX TRIBE</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 1153</AddressLine1Txt>
          <CityNm>WAGNER</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57380</ZIPCd>
        </USAddress>
        <IRCSectionDesc>GOV</IRCSectionDesc>
        <CashGrantAmt>31875</CashGrantAmt>
        <PurposeOfGrantTxt>SUPPORT PROGRAMS</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>16</Total501c3OrgCnt>
      <TotalOtherOrgCnt>2</TotalOtherOrgCnt>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>SCHOLARSHIP</GrantTypeTxt>
        <RecipientCnt>1</RecipientCnt>
        <CashGrantAmt>10545</CashGrantAmt>
        <ValuationMethodUsedDesc>CASH</ValuationMethodUsedDesc>
      </GrantsOtherAsstToIndivInUSGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE I, PAGE 1, PART I, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>ENTITIES PROVIDING TRIBAL HEALTH PROGRAMS IN THE GREAT PLAINS REGION RECEIVE GRANTS FROM THE ORGANIZATION. PROGRAM MANAGERS MAKE SITE VISITS AND REVIEW PROGRAM REPORTS TO MONITOR THE SUCCESS OF THE PROGRAMS. THE ORGANIZATION PROVIDES SCHOLARSHIPS THAT DEFRAY THE COST FOR STUDENTS WHO ARE PURSUING HIGH-DEMAND HEALTHCARE TRAINING OR POST-SECONDARY HEALTHCARE EDUCATION AT A QUALIFIED HEALTHCARE TRAINING PROGRAM. STUDENTS MUST DEMONSTRATE ACADEMIC MERIT AND FINANCIAL NEED. THE ORGANIZATION VERIFIES ENROLLMENT IN A QUALIFIED PROGRAM PRIOR TO DISBURSEMENT OF SCHOLARSHIP FUNDS. STUDENTS ARE REQUIRED TO PARTICIPATE IN MENTORSHIP MEETINGS AND CAREER SUCCESS CLASSES AND TO COMPLETE SURVEYS. HONORARIUMS ARE PROVIDED TO DRUMMERS, DANCERS, AND SPECIAL PRESENTERS WHO APPEAR AT MEETINGS OR CONFERENCES. HONORARIUMS ARE DISTRIBUTED AT THE EVENT.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
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      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARK HARLOW</PersonNm>
        <TitleTxt>MEDICAL DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>365077</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>24963</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>390040</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MAURICO EHLERT-BIRRIEL</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>284707</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>35884</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>320591</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>GRACIELA REYES</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>242497</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>30505</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>273002</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANTONIO REYES</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>243922</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>15441</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>259363</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JERILYN CHURCH</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>246813</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>6446</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>253259</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JEFFERY MECKFESSEL</PersonNm>
        <TitleTxt>DENTIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>212041</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>30692</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>242733</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TODD WARREN</PersonNm>
        <TitleTxt>CHIEF HEALTH ADMINIS</TitleTxt>
        <BaseCompensationFilingOrgAmt>216976</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>119</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>217095</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>PETER MANINGAS</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>216336</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>216336</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>SUNNY COLOMBE</PersonNm>
        <TitleTxt>COO</TitleTxt>
        <BaseCompensationFilingOrgAmt>151477</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>29110</DeferredCompensationFlngOrgAmt>
        <TotalCompensationFilingOrgAmt>180587</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc6">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 - ORGANIZATION'S MISSION</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GREAT PLAINS TRIBAL LEADERS' HEALTH BOARD IS COMMITTED TO IMPROVING HEALTH OUTCOMES IN INDIAN COUNTRY. THROUGH ADVOCACY, PUBLIC HEALTH EDUCATION, DIRECT CARE, AND EPIDEMIOLOGICAL SUPPORT THEY PROVIDE TRIBAL NATIONS AND TRIBAL CITIZENS THE TOOLS THEY NEED TO IMPROVE THE LIVES OF THE PEOPLE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 1, PART I, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>BOARD MEMEBERS SERVE WITHOUT COMPENSATION</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 2, PART III, LINE 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>EPIDEMIOLOGY: THE GREAT PLAINS TRIBAL EPIDEMIOLOGY CENTER (GPTEC) IS ONE OF 12 EPIDEMIOLOGY CENTERS ACROSS THE NATION FUNDED BY THE INDIAN HEALTH SERVICE DIVISION OF EPIDEMIOLOGY AND DISEASE PREVENTION. GPTECS MISSION IS TO PROVIDE LEADERSHIP, TECHNICAL ASSISTANCE, SUPPORT, AND ADVOCACY TO TRIBAL NATIONS AND COMMUNITIES IN THE GREAT PLAINS IN ORDER TO ELIMINATE THE DISPARITIES IN HEALTH THAT CURRENTLY EXIST FOR TRIBAL PEOPLE IN THE AREA. OTHER PROGRAM SERVICES IN FYE ENDED 09/30/23 INCLUDE: MATERNAL AND CHILD HEALTH: THE MATERNAL AND CHILD HEALTH (MCH) DEPARTMENT IS COMMITTED TO SERVING THE NEEDS OF MOTHERS, CHILDREN, AND FATHERS IN THE GREAT PLAINS REGION. THE DEPARTMENTS MISSION IS TO PROMOTE THE HEALTH AND WELL-BEING OF AMERICAN INDIAN FAMILIES IN GREAT PLAINS TRIBAL COMMUNITIES THROUGH DIRECT SERVICE, RESEARCH, EPIDEMIOLOGY, AND TECHNICAL ASSISTANCE. MCH PROVIDES BREASTFEEDING SUPPORT, HOME VISITS, AND THE PROMOTION OF MALE INVOLVEMENT FOR MOTHERS AND INFANTS, INCLUDING DURING THE PRENATAL STAGE. TRAINING AND EDUCATION: THE TRAINING &amp; EDUCATION DEPARTMENT (ED) IS DESIGNED TO WORK WITH THE REPRESENTATIVE TRIBES AND COLLABORATIVE PARTNERS TO IDENTIFY TRAINING AND RESOURCE NEEDS AS REQUESTED. PROGRAMS PROVIDE TRAINING, EDUCATION, AND SUPPORT SERVICES DESIGNED TO ENCOURAGE SELF-SUFFICIENCY AND IMPROVE HEALTHCARE. COVID 19 RESPONSE &amp; TESTING</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 990, WHICH IS PREPARED BY AN EXTERNAL CERTIFIED PUBLIC ACCOUNTANT,IS REVEIWED BY THE ORGANIZATION'S CONTROLLER, SENIOR VICE PRESIDENT FOR FINANCIAL OPERATIONS, AND CHIEF EXECUTIVE OFFICER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REVIEWED WITH THE DIRECTORS AND OFFICERS ANUALLY. THEY ARE REQUIRED TO DISCLOSE RELATED PARTIES AND POTENTIAL CONFLICTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S CEO IS EVALUATED BY THE EXECUTIVE COMMITTEE. PRIOR TO APPROVING ANY CHANGE TO THE CEO'S COMPENSATION, THE COMMITTEE IS PROVIDED WITH REFERENCE MATERIALS FROM RELEVANT SOURCES WITH A COMPENSATION EVALUATION PREPARED BY AN OUTSIDE COMPENSATION CONSULTANT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>AN OUTSIDE COMPENSATION CONSULTANT PERFORMS A COMPENSATION EVALUATION. THE CEO EVALUATES EACH OFFICER AND AN OFFICER EVALUATES KEY EMPLOYEES. COMPENSATION CHANGES, IF ANY, ARE BASED ON EMPLOYEE PERFORMANCE AND CHANGES IN THE COST OF LIVING. PERFORMANCE COMPENSATION IS APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 18</FormAndLineReferenceDesc>
        <ExplanationTxt>GUIDESTAR.COM</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>ON REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>CONTRACTS 549,345 7,720 0 CONTRACTS 639,209 0 0 CONTRACTS 223,383 0 0 CONTRACTS 1,152,896 0 0 EVALUATOR/FACILITATOR 173,555 0 0 HUMAN RESOURCES 145 145,418 0 MARKETING &amp; OUTREACH 10,668 305,560 0 MARKETING &amp; OUTREACH 141,760 0 0 OUTSIDE SERVICES-OTHER 1,359,519 60,206 0 OUTSIDE SERVICES-OTHER 10,725 0 0 OUTSIDE SERVICES-OTHER 43,568 0 0 PURCHASED REFERRED CARE 12,646,912 0 0 TELEHEALTH SERVICES 246,083 0 0 EVALUATOR/FACILITATOR 35,500 0 0 PROGRAM PROMOTION 279,080 0 0 OUTSIDE SERVICES-OTHER 8,000 0 0 TOTAL 17,520,348 518,904 0</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART X</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD IS A PARTY TO SIX SUBSCRIPTION-BASED INFORMATION TECHNOLOGY ARRANGEMENTS THAT MEET THE GASBS CAPITALIZATION CRITERIA AS OF SEPTEMBER 30, 2023. THESE ARRANGEMENTS ORIGINATED AT VARIOUS DATES BEGINNING IN 2020 THROUGH 2023 WITH SUBSCRIPTION TERMS RANGING FROM THREE TO FIVE YEARS. FIVE REQUIRE EITHER A FIXED ANNUAL OR MONTHLY PAYMENT AND THE SIXTH REQUIRES A VARIABLE ANNUAL PAYMENT. THE RIGHT-TO-USE SUBSCRIPTION-BASED INFORMATION TECHNOLOGY ARRANGEMENT INTANGIBLE ASSET AND ACCUMULATED AMORTIZATION BALANCES WERE APPROXIMATELY 449,000 AND 156,000, RESPECTIVELY, AS OF SEPTEMBER 30, 2023.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>