When Catherine was just over a year old, she turned a Dr. Seus book over and placed the frame of a United States foam puzzle over it and exclaimed: "Look Daddy! I made a city!"

I'm not saying that the evolution of America's middle-market is going to be that fast or that simple but the growth in South Dakota- and the Midwest in general, has been both exponential and inevitable.

When you have both coasts of the country growing on top of themselves, it’s only a matter of time before generations that are increasingly more mobile (as they were four and five generations ago in the old country) affect the fluid dynamics of economic overflow into the middle of the country. After all, you can't have sprawl into the ocean.

Another driving force behind this growth is what I like to call “The Delaware Factor” -which is the creation of a tax friendly environment for corporations and dynastic trusts. Corporations and families being able to thrive in soil like this results in more Fortune 500 companies relocating their corporate headquarters… which serves as a catalyst to attract other businesses... that holistically contribute: more jobs, more rooftops, more retail and finally more advanced medical and educational development (Take note Obama).

In the last three years, the population of Sioux Falls alone has gone from 75,000 people to almost 180,000. From 2010 to 2011, the departures and arrivals from the airport (which you pull into like a lifestyle center) doubled which prompted the construction of two additional terminals and an initiative to establish Sioux Falls as an international hub. In the first quarter of 2012, the number of flights has already doubled the total amount of flights in 2011.

Two major hotel flags have recently been planted in the area in addition to to the already significant number of beds. One by Hilton and the other by Hamilton Suites. The construction of the Midwest’s largest sports and entertainment arena, scheduled to be completed in 2013, will bring with it zoning for an entirely new "Entertainment District" and one of the country's largest state-of-the-art Convention Center. The fact that the mayor’s office recently announced that they would be submitting an RFP for another large hotel across from the new Convention Center (contiguous to a championship golf course) has a lot of developers, as far as New York, peeking over their Chemex to get a better look at what’s going on here. But after speaking with quite a few of the old guard in this small city, one is left with the feeling that an RFP is more of an exercise in protocol than of a genuine offering. The deals seem to be locked up before they’re even made public and with a surge of Ag[riculture] money in the market from farmers who profited greatly over the last few years with the corn belts spreading. Farmers and local developers are buying up land and investing in commercial development almost as fast as those profiting from the oil boom in North Dakota. According to Gov. Ed Schafer and Paul Hegg of Hegg Companies, development of the Bakken oil patch is a 25 year play, and it’s not too late for businesses to participate in the economic boom here. This is looking more and more like a better short-term opportunity for developers and operators from the coasts than for the newly relocating fund managers, institutional investors or capital intermediaries. But there does seem to be a long-term play here. I left the East Coast with the luxury of never needing to waiver from my sense of integrity and commitment to fair-play. Those principles may not have brought me as much action as I would have liked, but definitely enabled me to grow with like-minded colleagues, learn from benevolent leaders, and forge a few lasting friendships built on trust and respect. Perhaps not the most popular of business practices employed by ambitious young professionals in America’s biggest cities… but certainly seems to be the way of life in a city of less than 200,000.

Sioux Falls feels like an instant culture-fit for my family and me. If, over time, I’m fortunate enough to earn the trust and respect of my new neighbors, I am confident that the numerous opportunities here will bear fruit.

The mayor’s just announced that a total of $200MM has been spent in the last year on new road construction and repairs of existing roads. Although I am still trying to adapt to things such as driving 35mph on long stretches of road with four to five lanes that could benefit from a few extra signalized intersections; there is a tremendous amount of investment in infrastructure to support and sustain development of the 43rd fastest growing state in the country.

Is Sioux Falls the best kept secret in America? I'll have to pay close attention to my 3yr old daughter's musings and get back to you.

As a specialist, my wife receives letters and postcards (sometimes twice a week) from recruiters and health systems all over North America. They never explicitly state which hospital it is specifically but they all guarantee: top salaries, high quality of life, national sports teams, major universities and “…a wonderful place to raise children”.

My wife is working very hard with a practice covering seven hospitals in three states and feels as though her employers’ commitment to her is as not as significant as her commitment to them. She always says “Your first job is never your last…” So, after 5+ years of interest from Sanford Hospital in South Dakota, we’ve decided to take a look. Although we couldn’t imagine living in South Dakota... we did some research on Sanford Health and decided it was worth the visit. At the very least, it would be an opportunity for my wife to catch up with an old friend and former colleague for whom she has a tremendous amount of respect.

FAST FORWARD 7 WEEKS…

When we arrived in Sioux Falls South Dakota, we were simply blown away at this hospital’s whisper of a “Talk” and thunderous “Walk”. Thanks to Premier One Bankcard founder Denny Sanford (and his $700MM in gifts so far…), Sioux Valley Hospital has been renamed “Sanford Hospital” (surprisingly) and transformed into a region-shaping health care network with an infrastructure of physicians in leadership and an outreach spanning 126 communities throughout 8 states. They are implementing several initiatives including global children's clinics, multiple research centers and finding a cure for type 1 diabetes and breast cancer. With both domestic and overseas satellites opening at a record-pace, Denny Sanford is creating an unprecedented momentum of ensuring the highest caliber of healthcare both in the Midwest and in 18 countries throughout the world (now developing international clinics in Ireland, Ghana, Israel and Mexico). Organizational growth and development with cutting-edge medicine, sophisticated research and advanced education like this isn’t seen in cities ten times their size.

We arrived the weekend of Sanford Hospital’s Annual Gala ( benefiting the expansion of their cardiac division) and graciously accepted what we believed would simply be an opportunity to meet some folks on the team and have a nice dinner. I’ve been to a lot of these events and they always seem to follow the same syllabus: cocktails followed by a President’s greeting, a few words of promise by the CEO or COO then a video presentation of the good work being done by talented physicians and administration’s plans for the future. Then it’s back to dinner and some dancing afterwards.

The Sanford Healthcare gala we attended not only brought one of the better meals I’ve had this year to our table (a perfect medium rare filet, roasted brussel sprouts and truffled potato gratin), but also tears to my eyes…and handkerchief. Never before have I been so moved by the parents of children whose life-changing stories were shared …or by the teams of dedicated people working orchestrally, from top to bottom, who selflessly make such a monumental difference. But the Sanford story did not end when the lights came back on. This was not a benefit injected with a presentation of “good work being done”. This was simply a spotlight on life at Sanford whose message of “Improving the human condition through exceptional care, innovation and discovery” didn’t end with a video. Improving the lives of children, specifically, didn’t seem like “just a job” people are doing here…it seemed more like a calling. An ingrained way of living life. A belief system that is evident in everything from the conversations between fulfilled guests at every table and the LED-illuminated spinning magic wands handed out on the dance floor (that surely made many a baby-sat children at home delighted in the morning) to the child prodigy pianist who led the orchestra all evening long.

I guess it’s just an overall feeling of genuine commitment to care and to the community of people who provide it…and there doesn’t seem to be a sense of (or pre-occupation with) time clocks, budgets or superfluous layers of administration associated with it. The passion was palpable and contagious. It’s hard to be around people like that and not feel a moral imperative to join them. It’s hard to be a father and not want an amenity like them for your own child.

Now that some of our preconceived notions regarding the Midwest have been obliterated, we have a lot to talk about on the flight home.