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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>RUDY PAPAKEE</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>CLYDE ESTES</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DOUGLAS YANKTON</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>HAROLD FRAZIER</PersonNm>
        <TitleTxt>Director</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>PETER LENGKEEK</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>KEVIN KILLER</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DUANE RABBE Jr</PersonNm>
        <TitleTxt>Director</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>SCOTT HERMAN</PersonNm>
        <TitleTxt>Director</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JAMIE AZURE</PersonNm>
        <TitleTxt>Director</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>REBECCA SULLIVAN</PersonNm>
        <TitleTxt>Director</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>VICTORIA KITCHEYAN</PersonNm>
        <TitleTxt>Director</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JANET ALKIRE</PersonNm>
        <TitleTxt>Director</TitleTxt>
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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ANTHONY REIDER</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MARK FOX</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DELBERT HOPKINS JR</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <IndivRcvdGreaterThan100KCnt>11</IndivRcvdGreaterThan100KCnt>
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      <CompensationFromOtherSrcsInd>true</CompensationFromOtherSrcsInd>
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        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>INDIAN HEALTH SERVICE GREAT PLAINS AREA</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>115 4TH AVE SE RM 309</AddressLine1Txt>
            <CityNm>ABERDEEN</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57401</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACTED SERVICES</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CASEY PETERSON LTD</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>909 ST JOSEPH ST STE 101</AddressLine1Txt>
            <CityNm>RAPID CITY</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57701</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <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 SERVICES</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MONUMENT HEALTH RAPID CITY HOSPITAL</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>353 FAIRMONT BLVD</AddressLine1Txt>
            <CityNm>RAPID CITY</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MEDICAL &amp; HOSPITAL SERVIC</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BLACK HILLS SURGICAL HOSPITAL LLP</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; HOSPITAP SERVI</ServicesDesc>
        <CompensationAmt>585709</CompensationAmt>
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      <GovernmentGrantsAmt>55728262</GovernmentGrantsAmt>
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      <NoncashContributionsAmt>400000</NoncashContributionsAmt>
      <TotalContributionsAmt>56151691</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>CHARGES FOR CHARGES</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>17909071</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>17909071</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CHARGES FOR SERVICES</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>126562</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>126562</RelatedOrExemptFuncIncomeAmt>
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        <TotalRevenueColumnAmt>300483</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>300483</RelatedOrExemptFuncIncomeAmt>
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        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetRentalIncomeOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetGainOrLossInvestmentsGrp>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS INCOME</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>3829</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3829</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueTotalAmt>3829</OtherRevenueTotalAmt>
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        <TotalRevenueColumnAmt>74491636</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>18339945</RelatedOrExemptFuncIncomeAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>848521</TotalAmt>
        <ProgramServicesAmt>848521</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>10379</TotalAmt>
        <ProgramServicesAmt>10379</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2098622</TotalAmt>
        <ProgramServicesAmt>1700332</ProgramServicesAmt>
        <ManagementAndGeneralAmt>398290</ManagementAndGeneralAmt>
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      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>22447791</TotalAmt>
        <ProgramServicesAmt>19695025</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2752766</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>350255</ProgramServicesAmt>
        <ManagementAndGeneralAmt>191751</ManagementAndGeneralAmt>
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        <TotalAmt>4097310</TotalAmt>
        <ProgramServicesAmt>2813803</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1283507</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>1024276</ProgramServicesAmt>
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        <ProgramServicesAmt>130555</ProgramServicesAmt>
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        <ManagementAndGeneralAmt>310767</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>940407</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
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      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
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      </FeesForSrvcInvstMgmntFeesGrp>
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        <TotalAmt>20470525</TotalAmt>
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        <ProgramServicesAmt>2000</ProgramServicesAmt>
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      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
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        <ProgramServicesAmt>579088</ProgramServicesAmt>
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      </RoyaltiesGrp>
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        <ProgramServicesAmt>371696</ProgramServicesAmt>
        <ManagementAndGeneralAmt>210804</ManagementAndGeneralAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>320953</ProgramServicesAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
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      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
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        <ProgramServicesAmt>698328</ProgramServicesAmt>
        <ManagementAndGeneralAmt>156039</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>41683</ProgramServicesAmt>
        <ManagementAndGeneralAmt>72741</ManagementAndGeneralAmt>
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      <PaymentsToAffiliatesGrp>
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      </PaymentsToAffiliatesGrp>
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        <ProgramServicesAmt>340115</ProgramServicesAmt>
        <ManagementAndGeneralAmt>145889</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>110479</ManagementAndGeneralAmt>
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        <Desc>SUPPLIES</Desc>
        <TotalAmt>6875545</TotalAmt>
        <ProgramServicesAmt>6453948</ProgramServicesAmt>
        <ManagementAndGeneralAmt>421597</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>RENTAL EXPENSE</Desc>
        <TotalAmt>1010750</TotalAmt>
        <ProgramServicesAmt>716017</ProgramServicesAmt>
        <ManagementAndGeneralAmt>294733</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>765029</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Postage and Shipping</Desc>
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        <ProgramServicesAmt>275452</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4936</ManagementAndGeneralAmt>
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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>954226</ProgramServicesAmt>
        <ManagementAndGeneralAmt>-1154354</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>58213513</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7066073</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <CashNonInterestBearingGrp>
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      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>57213201</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>3691622</BOYAmt>
        <EOYAmt>4155665</EOYAmt>
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      <ReceivablesFromOfficersEtcGrp>
        <EOYAmt>0</EOYAmt>
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      <RcvblFromDisqualifiedPrsnGrp>
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      <OthNotesLoansReceivableNetGrp>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>312703</BOYAmt>
        <EOYAmt>921482</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>2286176</BOYAmt>
        <EOYAmt>873950</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>8835817</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>1095441</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3314028</BOYAmt>
        <EOYAmt>7740376</EOYAmt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JERILYN CHURCH</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>246813</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>4266</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2180</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>253259</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARK HARLOW</PersonNm>
        <TitleTxt>MEDICAL DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>283853</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>81224</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>4038</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>20925</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>390040</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MAURICO EHLERT-BIRRIEL</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>284707</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>15269</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>20615</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>320591</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>8877</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>20233</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>180587</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TODD WARREN</PersonNm>
        <TitleTxt>CHIEF HEALTH ADMINISTRATOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>216976</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>119</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>216976</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>119</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleM documentId="IRS990ScheduleM" softwareId="21013475" softwareVersionNum="2021v4.1">
      <RealEstateCommercialGrp>
        <NonCashCheckboxInd>X</NonCashCheckboxInd>
        <ContributionCnt>1</ContributionCnt>
        <NoncashContributionsRptF990Amt>400000</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>SEE SCHEDULE O</MethodOfDeterminingRevenuesTxt>
      </RealEstateCommercialGrp>
      <AnyPropertyThatMustBeHeldInd>false</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>false</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>false</ThirdPartiesUsedInd>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="21013475" softwareVersionNum="2021v4.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b: Form 990 Review Process</FormAndLineReferenceDesc>
        <ExplanationTxt>PRIOR TO FILING THE 2021 FORM 990, IT WAS REVIEWED BY THE ORGANIZATION'S INTERIM CONTROLLER, SENIOR VICE PRESIDENT FOR FINANCIAL OPERATIONS, AND CHIEF EXECUTIVE OFFICER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S CONFLICTS POLICY IS REVIEWED WITH THE DIRECTORS AND OFFICERS ANNUALLY. EACH DIRECTOR AND OFFICER IS REQUIRED TO DISCLOSE RELATED PARTIES AND ANY POTENTIAL CONFLICTS NEAR THE BEGINNING OF EACH FISCAL YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a: Compensation Review &amp; Approval Process - CEO, Top Management</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S CEO IS EVALUATED BY THE ORGANIZATION'S EXECUTIVE COMMITTEE, WHICH IS A BOARD COMMITTEE. PRIOR TO APPROVING ANY CHANGE TO THE CEO'S COMPENSATION, THE COMMITTEE IS PROVIDED WITH REFERENCE MATERIALS FROM RELEVENT SOURCES ALONG WITH A COMPENSATION EVALUATION PREPARED BY AN OUTSIDE COMPENSATION CONSULTANT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees</FormAndLineReferenceDesc>
        <ExplanationTxt>AN OUTSIDE COMPENSATION CONSULTANT PERFORMS AN INITIAL COMPENSATION EVALUATION. THE CEO EVALUATES EACH OFFICER AND AN OFFICER EVALUATES EACH KEY EMPLOYEE. COMPENSATION CHANGES, IF ANY, ARE BASED ON EMPLOYEE PERFORMANCE AND CHANGES IN THE COST OF LIVING. ANY PERFORMANCE COMPENSATION IS APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19: Other Organization Documents Publicly Available</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE ORGANIZATION'S ANNUAL AUDITED FINANCIAL STATEMENTS ARE ALSO INCLUDED WITH FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other Changes In Net Assets Or Fund Balances - Other Increases</FormAndLineReferenceDesc>
        <ExplanationTxt>ROUNDING = $3</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IV, SECTION A, ITEM 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CHAIR OR PRESIDENT OF EACH OF THE EIGHTEEN MEMBER TRIBES IS THE APPLICABLE TRIBE'S MEMBER OF THE GPTLHB'S GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>AN EXTERNAL CERTIFIED PUBLIC ACCOUNTANT PREPARES FORM 990, WHICH WAS THEN REVIEWED BY THE CONTROLLER, CHIEF OPERATING OFFICER AND CHIEF EXECUTIVE OFFICER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, SCHEDULE B, PART II, ITEM 1</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GPTLHB PURCHASED A COMMERCIAL OFFICE BUILDING LOCATED AT 2611 ELDERBERRY BLVD., RAPID CITY, SD, IN MARCH 2022. AT CLOSING, THE SELLER, COMMUNITY ENHANCEMENT II, LLC, DONATED TO THE GPTLHB $400,000 OF THE AMOUNT DUE. THIS AMOUNT WAS CREDITED TO THE PURCHASE PRICE, REDUCING THE AMOUNT DUE FROM GPTLHB.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE M, PART I, LINE 16 - COMMERCIAL REAL ESTATE</FormAndLineReferenceDesc>
        <ExplanationTxt>FIRST NATIONAL BANK OF GORDON FINANCED THE GPTLHB'S PURCHASE OF THIS OFFICE BUILDING IN RAPID CITY, SOUTH DAKOTA. THE BANK REQUIRED A THIRD PARTY APPRAISAL TO VALIDATE THE AGREED-UPON PURCHASE PRICE. AT CLOSING, THE UNAFFILIATED SELLER DONATED $400,000 TO THE GPTLHB, WHICH WAS APPLIED AS A CREIDT THUS REDUCING THE AMOUNT DUE FROM THE BUYER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE R, PART IV, NO. 1-L</FormAndLineReferenceDesc>
        <ExplanationTxt>GPTLHB IS A PARTY TO A RENEWABLE CONTRACT WITH THREE INDIAN TRIBES, SPECIFICALLY, THE CHEYENNE RIVER SIOUX, OGLALA SIOUX, AND ROSEBUD SIOUX TRIBES. THE CONTRACT ASSIGNS EXCLUSIVE RESPONSIBILITY FOR MANAGING AND OPERATING THE OYATE HEALTH CENTER, LOCATED IN RAPID CITY, SOUTH DAKOTA, TO THE GPTLHB. A REPRESENTATIVE FROM EACH OF THESE THREE TRIBES IS ALSO A VOTING MEMBER OF THE GPTLHB'S EIGHTEEN MEMBER BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
