| 1 | Sanford Sioux Falls, SD | $6.1B | $4.3B |
| 2 | Avera McKennan Sioux Falls, SD | $1.7B | $1.8B |
| 3 | Signatry Charitable Trust Sioux Falls, SD | $1.0B | $816.2M |
| 4 | Monument Health Rapid City Hospital INC Rapid City, SD | $1.0B | $1.4B |
| 5 | The Evangelical Lutheran Good Samaritan Society Sioux Falls, SD | $1.0B | $970.4M |
| 6 | Margot and Tom Pritzker Foundation Sioux Falls, SD | $423.3M | $449.6M |
| 7 | East River Electric Power Cooperative INC Madison, SD | $371.4M | $1.0B |
| 8 | Avera Health Plans INC Sioux Falls, SD | $307.1M | $97.1M |
| 9 | Avera Health Sioux Falls, SD | $278.4M | $2.3B |
| 10 | Monument Health Network INC Rapid City, SD | $220.0M | $160.9M |
| 11 | Sanford Health Foundation Sioux Falls, SD | $214.4M | $1.3B |
| 12 | Avera St. Lukes Aberdeen, SD | $197.1M | $150.1M |
| 13 | Prairie Lakes Health Care System INC Watertown, SD | $161.9M | $441.1M |
| 14 | Sacred Heart Health Services Yankton, SD | $156.8M | $429.2M |
| 15 | Avera Queen of Peace Mitchell, SD | $142.6M | $180.6M |
| 16 | Great Plains Tribal Leaders Health Board Rapid City, SD | $127.1M | $195.5M |
| 17 | Augustana University Association Sioux Falls, SD | $123.9M | $361.9M |
| 18 | Avera St. Marys Pierre, SD | $122.1M | $98.1M |
| 19 | Delta Dental of South Dakota Pierre, SD | $110.7M | $45.1M |
| 20 | Sioux Valley-southwestern Electric Cooperative INC Colman, SD | $108.1M | $384.7M |
| 21 | Sioux Falls Area Community Foundation INC Sioux Falls, SD | $106.8M | $364.5M |
| 22 | Southeastern Electric Cooperative INC Lennox, SD | $87.6M | $265.1M |
| 23 | Avera at Home Sioux Falls, SD | $83.2M | $41.5M |
| 24 | South Dakota State University Foundation Brookings, SD | $73.3M | $411.9M |
| 25 | Rural Health Care INC Ft Pierre, SD | $65.9M | $29.6M |
| 26 | South Dakota Community Foundation Pierre, SD | $60.1M | $939.2M |
| 27 | Black Hills Works INC Rapid City, SD | $50.1M | $25.2M |
| 28 | Oglala Lakota College Kyle, SD | $49.6M | $144.2M |
| 29 | Lewis and Clark Rural Water System INC Tea, SD | $49.2M | $595.8M |
| 30 | West River Electric Association INC Wall, SD | $49.0M | $179.3M |
| 31 | Childrens Care Hospital & School Sioux Falls, SD | $46.6M | $43.1M |
| 32 | South Dakota Achieve Sioux Falls, SD | $43.7M | $28.1M |
| 33 | University of Sioux Falls Sioux Falls, SD | $41.1M | $96.4M |
| 34 | Central Electric Cooperative INC Mitchell, SD | $39.9M | $126.6M |
| 35 | Oglala Lakota Housing Authority Pine Ridge, SD | $38.3M | $81.5M |
| 36 | University of South Dakota Foundation Vermillion, SD | $38.2M | $367.5M |
| 37 | Madison Community Hospital Madison, SD | $37.3M | $59.3M |
| 38 | Childrens Home Society of South Dakota Sioux Falls, SD | $36.1M | $58.9M |
| 39 | Sanford Sioux Falls, SD | $35.2M | $792.7M |
| 40 | Mount Marty University Yankton, SD | $34.7M | $76.4M |
| 41 | Horizon Health Care INC Howard, SD | $34.3M | $25.7M |
| 42 | Association of Hutterian Brethren Churches INC Aberdeen, SD | $33.6M | $30.5M |
| 43 | Fall River Health Services Hot Springs, SD | $33.1M | $40.8M |
| 44 | St. Benedict Health Center Parkston, SD | $32.8M | $91.1M |
| 45 | Feeding South Dakota Sioux Falls, SD | $32.2M | $22.9M |
| 46 | Northern Electric Cooperative Incorporated Bath, SD | $31.4M | $117.4M |
| 47 | Presbyterian Retirement Village of Rapid City INC Rapid City, SD | $31.1M | $158.7M |
| 48 | Hegg Memorial Hospital Sioux Falls, SD | $30.7M | $58.7M |
| 49 | Oahe Electric Cooperative INC Blunt, SD | $30.0M | $42.8M |
| 50 | Mobridge Regional Hospital Mobridge, SD | $30.0M | $58.8M |