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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>RUDY PAPAKEE</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CLYDE ESTES</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DOUGLAS YANKTON</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>HAROLD FRAZIER</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PETER LENGKEEK</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KEVIN KILLER</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DUANE RABBE Jr</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SCOTT HERMAN</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JAMIE AZURE</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
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        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>EVERETT BAXTER</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>VICTORIA KITCHEYAN</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MIKE FAITH</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ANTHONY REIDER</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK FOX</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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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>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <TotalOtherCompensationAmt>178041</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>10</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>true</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <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>
      <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>
        <CompensationAmt>394215</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>VISTA STAFFING SOLUTIONS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2800 E COTTONWOOD PKWY SUITE 400</AddressLine1Txt>
            <CityNm>COTTONWOOD HEIGHTS</CityNm>
            <StateAbbreviationCd>UT</StateAbbreviationCd>
            <ZIPCd>84121</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HEALTH CARE STAFFING</ServicesDesc>
        <CompensationAmt>374682</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BLACK HILLS SURGICAL HOSPITAL LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>353 FAIRMONT BLVD</AddressLine1Txt>
            <CityNm>RAPID CITY</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57701</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HOSPITAL &amp; MEDICAL SERVIC</ServicesDesc>
        <CompensationAmt>3340700</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>34196284</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>141217</AllOtherContributionsAmt>
      <TotalContributionsAmt>34337501</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>SERVICE CHARGES</Desc>
        <BusinessCd>621400</BusinessCd>
        <TotalRevenueColumnAmt>10435798</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>10435798</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>10435798</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>179454</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>179454</RelatedOrExemptFuncIncomeAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <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>FORGIVENESS OF PPP LOAN</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>1693641</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1693641</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS INCOME</Desc>
        <BusinessCd>624100</BusinessCd>
        <TotalRevenueColumnAmt>19788</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>19788</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueTotalAmt>1713429</OtherRevenueTotalAmt>
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        <TotalRevenueColumnAmt>46666182</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12328681</RelatedOrExemptFuncIncomeAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>1141384</TotalAmt>
        <ProgramServicesAmt>1141384</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>84728</TotalAmt>
        <ProgramServicesAmt>84728</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1909629</TotalAmt>
        <ProgramServicesAmt>1468932</ProgramServicesAmt>
        <ManagementAndGeneralAmt>440697</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>16075135</TotalAmt>
        <ProgramServicesAmt>13957774</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2117361</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>370048</ProgramServicesAmt>
        <ManagementAndGeneralAmt>191751</ManagementAndGeneralAmt>
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      <OtherEmployeeBenefitsGrp>
        <TotalAmt>3322026</TotalAmt>
        <ProgramServicesAmt>2950134</ProgramServicesAmt>
        <ManagementAndGeneralAmt>371892</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
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        <ProgramServicesAmt>766724</ProgramServicesAmt>
        <ManagementAndGeneralAmt>199769</ManagementAndGeneralAmt>
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      <FeesForServicesManagementGrp>
        <TotalAmt>235005</TotalAmt>
        <ManagementAndGeneralAmt>235005</ManagementAndGeneralAmt>
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      <FeesForServicesLegalGrp>
        <TotalAmt>190423</TotalAmt>
        <ProgramServicesAmt>157794</ProgramServicesAmt>
        <ManagementAndGeneralAmt>32629</ManagementAndGeneralAmt>
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        <TotalAmt>589581</TotalAmt>
        <ManagementAndGeneralAmt>589581</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
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        <TotalAmt>8716633</TotalAmt>
        <ProgramServicesAmt>8716633</ProgramServicesAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>0</TotalAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>0</TotalAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>0</TotalAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
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      <OccupancyGrp>
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        <ProgramServicesAmt>204635</ProgramServicesAmt>
        <ManagementAndGeneralAmt>351421</ManagementAndGeneralAmt>
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      <TravelGrp>
        <TotalAmt>94323</TotalAmt>
        <ProgramServicesAmt>60402</ProgramServicesAmt>
        <ManagementAndGeneralAmt>33921</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
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      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>246873</TotalAmt>
        <ProgramServicesAmt>167403</ProgramServicesAmt>
        <ManagementAndGeneralAmt>79470</ManagementAndGeneralAmt>
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      <InterestGrp>
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        <ProgramServicesAmt>12337</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7778</ManagementAndGeneralAmt>
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      <PaymentsToAffiliatesGrp>
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        <ProgramServicesAmt>288913</ProgramServicesAmt>
        <ManagementAndGeneralAmt>56112</ManagementAndGeneralAmt>
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      <InsuranceGrp>
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        <ProgramServicesAmt>530</ProgramServicesAmt>
        <ManagementAndGeneralAmt>71075</ManagementAndGeneralAmt>
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        <Desc>SUPPLIES</Desc>
        <TotalAmt>4308576</TotalAmt>
        <ProgramServicesAmt>3835061</ProgramServicesAmt>
        <ManagementAndGeneralAmt>473515</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>RENTAL EXPENSE</Desc>
        <TotalAmt>906642</TotalAmt>
        <ProgramServicesAmt>906642</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS AND MAINTENANCE</Desc>
        <TotalAmt>622448</TotalAmt>
        <ProgramServicesAmt>622448</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Postage and Shipping</Desc>
        <TotalAmt>223709</TotalAmt>
        <ProgramServicesAmt>222897</ProgramServicesAmt>
        <ManagementAndGeneralAmt>812</ManagementAndGeneralAmt>
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      <AllOtherExpensesGrp>
        <TotalAmt>413967</TotalAmt>
        <ProgramServicesAmt>314129</ProgramServicesAmt>
        <ManagementAndGeneralAmt>99838</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>41602175</TotalAmt>
        <ProgramServicesAmt>36249548</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5352627</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
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      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>42938191</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>741812</BOYAmt>
        <EOYAmt>3691622</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <EOYAmt>0</EOYAmt>
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      <RcvblFromDisqualifiedPrsnGrp>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>444247</BOYAmt>
        <EOYAmt>312703</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>594291</BOYAmt>
        <EOYAmt>2286176</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>3923465</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>609437</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>1288224</BOYAmt>
        <EOYAmt>3314028</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <EOYAmt>0</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
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        <GrantTypeTxt>TRIBAL HEALTH GRANT</GrantTypeTxt>
        <RecipientCnt>1</RecipientCnt>
        <CashGrantAmt>10077</CashGrantAmt>
      </GrantsOtherAsstToIndivInUSGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Grantmaker's Description of How Grants are Used</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 SUCCESSOF THE VARIOUS 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 DISBURSING ANY SCHOLARSHIP. STUDENTS ARE REQUIRED TO PARTICIPATE IN MENTORSHIP MEETINGS AND CAREER SUCCESS CLASSES AS WELL AS COMPLETE SURVEYS. HONORARIUMS ARE PROVIDED TO DRUMMERS, DANCERS, OR SPECIAL PRESENTERS WHO APPEAR AT MEETINGS OR CONFERENCES ORGANIZED BY THE ORGANIZATIONS. ANY HONARIUM IS DISTRIBUTED AT THE EVENT SO ADDITIONAL MONITORING IS NOT REQUIRED.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ" softwareId="20011551" softwareVersionNum="2020v4.0">
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <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>FRANCINE MOUSSEAU</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>213471</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>11957</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>8520</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>233948</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JEFFREY MECKFESSEL</PersonNm>
        <TitleTxt>DENTIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>168439</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>4848</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>8040</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>181327</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JERILYN CHURCH</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>191004</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>3859</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2174</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>197037</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOAN GIBSON</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>216357</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>12404</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>2704</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>231465</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARK HARLOW</PersonNm>
        <TitleTxt>MEDICAL DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>248859</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>79433</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>14423</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>39548</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>382263</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MAURICO EHLERT-BIRRIEL</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>239947</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>14157</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>20242</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>274346</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>PETER MANINGAS</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>178147</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>178147</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>SUNNY COLOMBE</PersonNm>
        <TitleTxt>COO</TitleTxt>
        <BaseCompensationFilingOrgAmt>143030</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>8846</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>19919</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>171795</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TODD WARREN</PersonNm>
        <TitleTxt>CHIEF HEALTH ADMINISTRATOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>203712</BaseCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>203712</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="20011551" softwareVersionNum="2020v4.0">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b: Form 990 Review Process</FormAndLineReferenceDesc>
        <ExplanationTxt>PRIOR TO FILING THIS AMENDED 2020 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>Amended Explanation</FormAndLineReferenceDesc>
        <ExplanationTxt>THIS AMENDED RETURN INCLUDES AMOUNTS FROM GREAT PLAINS TRIBAL LEADERS HEALTH BOARD'S AUDITED FINANCIAL STATEMENTS AS OF AND FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021. THE FISCAL YEAR 2021 AUDIT WAS COMPLETED SUBSEQUENT TO THE EXTENDED FILING DUE DATE OF THE ORIGINALLY FILED 2020 FORM 990.</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 IS THEN REVIEWED BY THE CONTROLLER, CHIEF OPERATING OFFICER AND CHIEF EXECUTIVE OFFICER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE R, PART IV, NO. 1-L</FormAndLineReferenceDesc>
        <ExplanationTxt>GPTLHB IS A PARTY TO A RENEWABLE CONTRACT WITH TWO INDIAN TRIBES, SPECIFICALLY, THE CHEYENNE RIVER SIOUX AND OGLALA 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 TWO TRIBES IS ALSO A VOTING MEMBER OF THE GPTLHB'S EIGHTEEN MEMBER BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
