That figure compared with operating income of $367.6 million in 2021 when federal pandemic funds were higher. The system saw a net loss of $151.3 million as investments dragged down its performance.
Sanford Health, which is due to merge with Minneapolis-based Fairview Health Services, serves more than 1 million patients in 46 medical centers.
The system had $1.5 billion debt at the end of 2022, down 4.5 percent on 2021.
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