COMMUNITY IMPACT REPORT
A LETTER FROM SANFORD HEALTH PRESIDENT & CEO
At Sanford Health, we believe every person deserves access to world-class healthcare, no matter where they live. As the nation’s leading nonprofit provider of rural healthcare, our commitment to those we serve reaches far beyond the walls of our clinics, hospitals and facilities. It is in this spirit that I am honored to share the 2026 Sanford Health Community Impact Report highlighting our 2024–2025 results.
In the following pages, you’ll see how Sanford Health is advancing a more equitable, a ordable and high-quality healthcare experience for individuals and families across our footprint. Through significant investments, we are committed to meeting the greatest needs in our communities. I’m proud to share that in 2024, Sanford Health reinvested more than $1 billion in local programs and initiatives that help ensure continued access to care, wellbeing and community resources for those we serve.
At Sanford Health, we consider it a privilege to provide world-class healthcare services to every patient, regardless of their ability to pay. The patients we serve across our rural footprint are often uninsured or underinsured. We are dedicated to making sure financial challenges never prevent patients from accessing needed healthcare services. In 2024, Sanford delivered more than $206.6 million in uncompensated care, an investment that reduced financial barriers for thousands of patients, ensuring they were able to receive care when they needed it, close to home.
By embracing virtual care innovations, developing a robust clinical workforce and leading groundbreaking medical research, Sanford Health is improving outcomes and ensuring access to high-quality healthcare in the communities we serve, not just today but for generations to come. I encourage you to continue reading this report to learn more about the needs our communities face and what Sanford Health is doing to address them.
Sanford Health’s team of more than 55,000 caregivers are called to serve and driven by our mission to care, comfort and cure. As you explore this report, you will find countless examples of how Sanford Health, in partnership with the communities we call home, is helping build a healthier, stronger future for all.
BILL GASSEN President & CEO | Sanford Health
ABOUT THIS REPORT
This report represents a comprehensive overview of how Sanford Health reinvests resources to support the communities we serve.
Sanford Health’s annual community impact report is organized around the IRS Form 990 Schedule H, which requires nonprofit health systems to demonstrate how their investments deliver community benefit and advance public health.
For rural communities, these investments help sustain essential services that public program reimbursement alone does not cover. Sanford Health’s nonprofit model allows the organization to absorb financial pressures, maintain services across geographically dispersed regions and invest in programs aligned with Community Health Needs Assessment priorities.
The sections that follow reflect seven core Schedule H categories:
Together, investments in these categories reflect what it means to be a nonprofit health system that cares not just for patients, but for the communities and infrastructure that make rural health possible.
ABOUT SANFORD HEALTH
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization has 55,000 employees and serves more than 2 million patients and nearly 415,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan.
55,000+ EMPLOYEES
4,500+ PHYSICIANS & PROVIDERS
58 HOSPITALS
145 SENIOR CARE COMMUNITIES
2 MILLION+ PATIENTS
415,000 HEALTH PLAN MEMBERS
289 CLINIC LOCATIONS
The integrated nonprofit health system includes a network of 58 hospitals, 289 clinic locations, 145 senior care communities, 4,500 physicians and advanced practice providers and 1,100 active clinical trials and studies. The organization’s transformational virtual care initiative brings patients closer to care with access to nearly 80 specialties. More than 400 residents and fellows are trained each year through graduate medical education with Sanford Health fully funding and supporting 29 of the 40 available programs. Sanford Health also includes 92 retail pharmacies, including Sanford and Lewis Drug pharmacies with locations in 6 states, and more than 300 pharmacists. Learn more about Sanford Health’s commitment to shaping the future of rural health care across the lifespan at sanfordhealth.org or Sanford Health News.
CARING FOR OUR PATIENTS AND OUR COMMUNITIES
As the nation’s largest rural nonprofit health system, Sanford Health reinvests resources to sustain essential services, strengthen community health and expand access to care.
In 2024, Sanford’s reinvestment totaled more than $1 billion.
This reinvestment supports the clinical services, workforce, research and community programs that help ensure people across our communities can access care close to home, regardless of where they live or their ability to pay.
These clinical programs are essential to rural healthcare access
SUBSIDIZED HEALTH SERVICES
Subsidized health services are clinical services that Sanford maintains even when the cost of providing them exceeds what reimbursement covers, because access to care in rural communities depends on it. Without this investment, patients would face long distances to reach essential services like obstetrics, behavioral health, oncology and emergency care, with delays that directly affect outcomes. In 2024, Sanford absorbed approximately $320.4 million in subsidized service losses, sustaining the local healthcare infrastructure that rural communities rely on and would struggle to replace.
UNCOMPENSATED CARE
Sanford Health believes that financial circumstances should never determine whether someone can access care. Across our rural footprint, many patients are uninsured, underinsured or facing coverage gaps that can cause uncertainty about whether they can afford the care they need.
In 2024, Sanford delivered more than $206.6 million in uncompensated care, supporting tens of thousands of patients across our footprint and ensuring that hospitals and clinics across our communities could continue providing services to everyone who needed them. Uncompensated care includes the financial assistance and charity care Sanford provides regardless of a patient’s ability to pay.
Reducing financial barriers for thousands of patients
Care For All
Sanford Health never denies medically necessary care based on a patient’s financial situation. For more than a decade, a presumptive charity care model has allowed Sanford to identify patients who may qualify for assistance before any bill is sent, with 25 to 30 percent of recipients qualifying automatically. For patients who need additional support, Sanford works proactively to connect them with coverage options and flexible payment plans.
Financial Assistance Policy
All patients receiving emergency or medically necessary care can apply for financial assistance. Each year, 95 percent of applicants receive financial support, and among those approved, 85 percent receive full assistance. On average, Sanford provides approximately $1,300 per qualifying patient, reducing or eliminating out-of-pocket costs for tens of thousands of people across our communities each year.
Applicants who received 100% financial assistance
Applicants who received some financial assistance
Applicants who were not eligible to receive support
Treating all patients regardless of their ability to pay
MEDICAID & MEDICARE
In 2024, Sanford absorbed $302.4 million in Medicaid and Medicare underpayments, representing the gap between what government programs reimburse and the actual cost of providing care.
The communities Sanford serves are older and experience higher rates of chronic illness than national averages, with Medicare accounting for approximately 47 percent of gross charges and Medicaid for an additional 13 percent. This concentration of public payers reflects the reality of rural healthcare, where the populations with the greatest need rely most heavily on programs that consistently reimburse below the cost of care.
Delivering care across wide geographic areas requires maintaining emergency services, staffing rural facilities and sustaining specialty programs regardless of patient volume. Government reimbursement rates do not account for these realities, and the gap between what Sanford receives and what it costs to serve these communities is absorbed as part of our commitment to the people we serve.
Investing in the health of our communities now and for the future
COMMUNITY HEALTH IMPROVEMENT SERVICES
Community health improvement services extend Sanford’s reach beyond clinical settings, supporting the prevention programs, population health initiatives and community-based services that help people stay healthy before they need acute care. These investments are guided by Community Health Needs Assessment priorities, ensuring resources are directed toward the issues communities themselves have identified as most urgent.
In rural communities — where chronic disease rates are higher, transportation is limited, and early intervention can mean the difference between managing a condition and a preventable hospitalization — this work is essential. In 2024, Sanford invested approximately $118.4 million in these services, strengthening the health of communities across our footprint in ways that go well beyond what happens inside a hospital or clinic.
HEALTH PROFESSIONS EDUCATION
One of the most persistent challenges facing rural healthcare is having enough providers to meet community needs. Nearly 20 percent of the U.S. population lives in rural areas, yet only 11 percent of physicians practice there. Rural communities have 30 specialists per 100,000 residents compared to 263 per 100,000 in urban areas, and three out of five federally designated health professional shortage areas are in rural regions.
In 2024, Sanford invested more than $61.6 million in health professions education — supporting learners across the full pipeline from students entering the health professions to advanced clinical training, including more than 400 residents and fellows across a range of specialties. This investment reflects one of the most meaningful ways Sanford works to ensure the communities we serve have access to the care they need, now and in the future.
COMMUNITY BUILDING ACTIVITIES
Addressing drivers that shape health outcomes
Healthy communities are shaped by more than the care delivered inside a clinic. Community building activities address the social, economic and environmental conditions that influence health outcomes, including access to stable employment, strong local institutions and the kinds of community investments that make rural areas places where people and providers want to stay.
In 2024, Sanford invested approximately $27.4 million in these activities, supporting coalition building with local chambers of commerce, workforce and leadership development programs.
MEDICAL RESEARCH
Access to medical research and clinical innovation has historically been concentrated in large urban academic centers, leaving rural populations with fewer opportunities to benefit from emerging therapies and advances in care. Sanford is committed to changing that.
In 2024, Sanford invested $19.7 million in medical research, supporting nearly 1,100 active clinical trials that connect patients across our rural footprint to cutting-edge treatments and evidence-based care they would otherwise need to travel far from home to access. Clinical trial participation among eligible Sanford cancer patients exceeds 10 percent, compared to a national average of about 3 percent, a difference that reflects what becomes possible when research infrastructure is built into the fabric of rural care delivery. This investment reflects Sanford’s belief that where someone lives should never limit the quality or advancement of the care available to them.
COMMUNITY IMPACT REPORT
THIRD EDITION
sanfordhealth.org/about/community-impact