While T. Denny Sanford didn’t come up with the idea of using prodigious wealth to reshape his home region in his image, he embraced the model to an astonishing degree over his 20-plus years of mega-giving. As he did so, he cut a distinctive, if controversial, figure in the wider world of billionaire donors.
Sanford, who passed away on July 18 at the age of 90, donated more than $4 billion to healthcare and research institutions, children’s causes and education initiatives, with an emphasis on organizations based in his adopted home state of South Dakota. Roughly $2 billion flowed to Sanford Health, which, as the largest rural nonprofit health system in the United States, serves more than 2 million patients and approximately 415,000 health plan members across the upper Midwest. Sanford had a second home in La Jolla, California, and donated more than $1 billion to groups in San Diego County, including at least $355 million to UC San Diego.
As clichéd as it may sound, Sanford, who made at least six nine-figure gifts between 2007 and 2025, was a man of his time. Like many other megadonors, he favored “eds and meds” support amid prolonged government retrenchment, driven by the belief that big-ticket capital projects can elevate the recipient organization’s stature, provide critical services — especially in rural health — and catalyze regional economic development.
Sanford embraced the era’s heady philanthro-optimism, telling Forbes’ David Whelan in 2007 — three years before he signed the Giving Pledge — of his intention to “die broke.” He also laid out something of a giving manifesto in the interview, showcasing how many business leaders of his generation approached large-scale charity through the lens of strategic philanthropy. “Very plainly, very succinctly, I look at life as an investor,” he said. “What will give me or my community the best return?”
Sanford also embodied some of the complexities endemic to the philanthrosphere over the past 20 years, and wasn’t a stranger to controversy. Consumer advocates have argued that his company, First Premier Bank, preyed on vulnerable consumers by specializing in credit cards for high-risk borrowers. “We provide a lifeline for credit-impaired people,” Sanford told Whelan, in what became a recurring talking point as his philanthropy exploded over the next two decades, and as critics accused major donors of using big giving to launder reputations.
In his last decade, Sanford was also embroiled in a darker matter — a child pornography investigation. Charges were never filed, but his name was removed from the Giving Pledge site in 2023 after a court unsealed the trove of documents related to the probe.
These factors complicate his legacy, but the fact remains that having emerged from humble beginnings in a working-class Minnesota neighborhood, Sanford, by embracing what he called “large projects,” put an indelible mark on South Dakota and the organizations he supported. And while it appears he didn’t pull a Chuck Feeney and give close to everything away before he died, he served as a powerful role model for his legion of billionaire peers, many of whom only move a fraction of their net worth out the door during their lifetimes.
“His contributions will not be forgotten, and South Dakota will forever be impacted by his legacy,” said South Dakota Gov. Larry Rhoden. “Put simply, he was the greatest philanthropist in South Dakota history.”
A brief overview of Sanford’s giving history
Born in 1935, Sanford grew up in East St. Paul, Minnesota. His mother, Edith, died of breast cancer when he was four. After graduating from the University of Minnesota, Sanford worked in sales before establishing Contech Inc., which manufactured sealants, coatings and adhesives, in the 1960s. Sanford took the company public in 1972, sold it 10 years later, and became a multimillionaire.
His next big move came in 1986 when he bought a bank in Sioux Falls, South Dakota, changed its name to First Premier Bank, and eventually rolled out the Premier Bankcard, a high-interest credit card geared toward people with bad or no credit. The bank’s financial success made Sanford a billionaire and fueled his large-scale philanthropy.
In 2004, he made his first major donation — a $16 million gift to Sioux Valley Hospitals & Health System — for a state-of-the-art children’s hospital.
Sanford spent the next two decades firing off a barrage of mega-gifts. There was 2007’s $400 million gift to Sioux Valley Hospitals & Health System, which, in recognition of what was the largest donation ever given to a healthcare organization at the time, changed its name to Sanford Health. Other examples include a $100 million gift in 2011 to launch the Edith Sanford Breast Center; and, in 2021, $350 million to create the Sanford Virtual Care Center, which serves rural areas of the Midwest. Sanford frequently made large gifts earmarked for care, education and health-related programming, and supported organizations all across the country, including the Florida Hospital for Children and the Virginia-based Horatio Alger Association of Distinguished Americans.
He kept his giving operation very lean
Speaking to Forbes’ Whelan in 2007, former House Speaker Newt Gingrich called Sanford “the kind of hard-nosed guy who says, ‘I don’t want to create a permanent foundation staff doing things I don’t approve of because it fits their cultural values.’”
Here, Gingrich articulates a perspective that often animates philanthropists on the right. Sanford, who was a prominent Republican donor, told Whelan, “The Ford Foundation is the example of the worst thing that could happen.”
He certainly walked the walk in terms of how he managed his Denny Sanford Foundation. Though only some of his charitable giving flowed through the foundation, a look at its Form 990s shows that he ran an incredibly lean shop, earmarking a total of $27,695 in non-grant-related operating and administrative expenses from fiscal years ending June 2023 to 2025. “I have a bookkeeper and a great assistant who directs traffic for me, but no, I just do it [his giving] myself,” Sanford told the Philanthropy Roundtable in 2016. “I focus on large projects, usually things that I’ve created or that really catch my eye.”
Still, despite the ambition of Sanford’s charitable experiment, he didn’t follow through on his intention to die penniless.
According to Forbes, his net worth increased by 33% over the past decade or so, from $1.8 billion in 2017 to $2.4 billion in 2026. In fairness, three years ago, Sanford Health said Sanford “declared his legacy giving intentions that Sanford Health will be the primary beneficiary of his estate.” That would technically fulfill the Giving Pledge, considering pledgers can always commit the majority of their assets posthumously. But the larger point, which we’ve repeatedly made here on Inside Philanthropy, still stands: Thanks to skyrocketing wealth, even some of the most generous and intentional megadonors can’t seem to make a meaningful dent in their net worth.
Sanford faced criticism in his role as the owner of First Premier Bank
As is the case with any megadonor, a discussion of Sanford’s philanthropy requires a look at how he earned his fortune. Taking advantage of South Dakota’s lenient banking laws, First Premier Bank issued high-interest cards to people with bad or no credit, which consumer advocates “view as a notch above predatory payday loans,” wrote the Star Tribune’s Jennifer Bjorhus in 2013.
At the time, the Minnesota Attorney General was looking into merger talks between Sanford Health and Fairview Health Services — the merger was canceled 10 years later — and some watchdogs argued that First Premier Bank’s business practices should be factored into the AG’s calculus since the merger would affect low-income community members. (In 2007, First Premier Bank agreed to pay, without admitting any wrongdoing, $4.5 million in refunds to settle the New York attorney general’s accusations that it deceptively marketed its cards.)
Sanford forcefully pushed back against the criticism. “We help people restore their credit,” he said. “How can you find fault with that?”
The bottom line here is that while discussion surrounding Sanford’s business practices occasionally commingled with questions regarding his philanthropic persona, none of his grantees, from what I can tell, returned his donations in protest. Nor should we bother trying to speculate about whether he, however subconsciously, saw giving as a form of reputation burnishing, though his donations arguably did have that effect. Rather, the tension is yet another reminder that wealth isn’t created in a vacuum. Donors often earn their fortunes in ways that subjectively conflict with commonly held values, and nonprofit leaders often lack the luxury, wherewithal or appetite to refuse critical funding on moral grounds.
We also need to note again that in 2019, South Dakota began investigating Sanford for possible possession of child pornography. Three years later, the state’s attorney general declined to file charges, saying it found no “prosecutable offenses” within the state’s jurisdiction. The investigation does not appear to have prompted or coincided with any great change in how Sanford conducted his public philanthropy.
“He’s transformed what philanthropy means in the healthcare space”
Looking back on Sanford’s legacy, Sanford Health President and CEO Bill Gassen said, “As much as he has transformed healthcare through his decision to continue to give and invest in Sanford Health, I think in that way and more, he’s transformed what philanthropy means in the healthcare space.”
A steady stream of place-based gifts earmarked for “large projects” may very well be transformational, especially for a state with relatively few large donors and foundations.
But it’s important to remember that the approach comes with its own set of risks. Capital projects often go over budget and add indefinite maintenance costs to the ledger, putting added pressure on development teams and executives tasked with squeezing out cost efficiencies — a challenge that can be particularly fraught in the healthcare industry, where fiscal belt-tightening can affect patient care.
Don’t just take my word for it. In 2002, Sanford pledged $35 million toward a $125 million football stadium for the University of Minnesota’s Golden Gophers. The university doubled the stadium’s cost and, to make matters worse, administrators refused to give Sanford naming rights unless he upped his commitment. He withdrew his gift.
Sanford shrugged off the episode and kept the huge donations flowing. Fittingly, last November, Sanford Health announced that he made a $300 million gift to — you guessed it — establish a new, state-of-the-art medical center called the Sanford Black Hills Medical Center campus in Rapid City, South Dakota.
Of course, the question of whether it should fall upon Sanford and his peers to bankroll such institutions in the absence of more robust public support — and take generous tax deductions in the process — underpins this entire conversation. While the debate is as old as philanthropy itself, it’s grown in resonance in recent years, and in the process, it’s made Sanford’s muscular brand of philanthropy — particularly in the healthcare space — look somewhat prescient.
As I write this, healthcare systems across the country are bracing for the One Big Beautiful Bill’s cascading funding cuts. We can reasonably expect other billionaires to be called upon — whether they follow through or not — to channel their inner T. Denny Sanfords.
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