2011-08-13T11:01:53-05:00 2010-09-30 EIDE BAILLY LLP 1601 NW EXPRESSWAY SUITE 1900 OKLAHOMA CITY OK 73118 990 2009-10-01 237314364 Navajo Health Foundation Sage Memorial Hospital Inc NAVA 9287554500 PO Box 457 Ganado AZ 86505 Charity L Askie 9287554500 2011-08-12 1 Carolyn Levings 4054783334 2011-08-12 2009 2016-02-24 21:20:13Z Ahmad Razaghi PO Box 457 Ganado AZ 86505 26347843 0 X www.sagememorial.org X 1974 AZ Provision of health care services 8 8 322 20 0 0 761120 479995 24177392 25810665 43889 57183 5550 0 24987951 26347843 500 1632 0 7902313 9801072 0 10377 16726657 17530625 24629470 27333329 358481 -985486 15135726 15619706 6040517 7437792 9095209 8181914 Our mission is to provide high quality healthcare services to the residents of the area in accordance with the Joint Commission on Accreditation of Healthcare Organization's holistic approach to healthcare, focusing on the patient's physical social and spiritual well being. We are committed to the prevention of illness and promotion of health; delivery of quality primary inpatient and outpatient care; and promotion of education and training of qualified Native American healthcare professionals. To fulfill this mission, we will provide preventive healing and rehab services through a system that links native culture with western medicine; preserve the dignity of each individual regardless of creed, race, sex, religion, social status or physical handicap; strive to achieve and maintain excellence in all aspects of healthcare; promote the education and training of Native American healthcare professionals; and operate the facility in a cost-effective and financially responsible manner. 0 1 21153175 25810665 Navajo Health Foundation-Sage Memorial Hospital contracted with Indian Health Service with a self-determination contract which provided care to approximately 417 inpatients and 45,842 outpatients, as well as providing emergency care and dental care services. Sage Memorial Hospital serves primarily members of the Navajo Nation. Sage Memorial Hospital administered special diabetes prevention and treatment projects for Navajos. Developed public health and social services emergency response plan. 21153175 1 1 0 0 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 159 0 322 1 0 0 0 0 0 0 0 8 8 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0 0 0 1 0 AZ X Charity L Askie 9257554615 PO Box 457 Ganado AZ 86505 KelewoodMaybelle 1.00 X X 12500 0 0 Dedman April N 1.00 X 4000 0 0 Shepherd Ambrose 1.00 X 6750 0 0 Simpson Andrew 1.00 X X 11250 0 0 Yazzie Linda A 1.00 X X 7500 0 0 Wauneka Stetson 1.00 X X 5500 0 0 Baldwin Dorothy 1.00 X 14500 0 0 Moore Joyce 1.00 X 4000 0 0 RazaghiAhmad- Mgmt Company 60.00 X 114198 0 17454 AskieCharity- Mgmt Company 60.00 X 49901 0 10000 AndemichaelMeron 40.00 X 212059 0 12626 Labib-Kiyarash Farid 80.00 X 534315 0 10133 Taylor Marsha 80.00 X 100585 0 118 Erickson Miles 80.00 X 116062 0 2456 Stewart-Joseph Nicole S 80.00 X 132559 0 101 Wilson Gordon 80.00 X 133477 0 1124 Yazzie Angela 80.00 X 114450 0 6300 1573606 0 60312 8 0 1 1 Morgan & Associates 1338 Foothill Dr 160 Salt Lake City UT 84108 Other Services 1325952 APG LLC 7500 W Lake Mead Blvd Ste 9104 Las Vegas NV 89128 Other Services 1261088 Skilled Staffing Solutions 7910 Hosbrook Lane Cincinnati OH 45243 Professional Staffing 418625 Staff Care Inc PO Box 281923 Atlanta GA 30384 Professional Staffing 393268 AMN Healthcare Inc File 56157 Los Angeles CA 90074 Professional Staffing 370508 20 256890 223105 479995 Capitation Revenue 900099 15964016 15964016 Net Patient Revenue 900099 9644951 9644951 Miscellaneous 900099 165560 165560 Other Rev-Pharmacy 900099 31238 31238 Other Rev-Therapeutic 900099 4900 4900 25810665 57183 57183 26347843 25810665 0 57183 1632 1632 993927 343711 650216 7113905 5727004 1384612 2289 49110 36771 12325 14 1042881 780855 261732 294 601249 450183 150896 170 189456 189456 37549 37549 10574103 8543499 2030604 92724 2439 90285 4177740 3450566 719564 7610 22577 22577 333968 324523 9445 503946 423253 80693 165033 93613 71420 50244 50244 727496 545622 181874 539375 378900 160475 Miscellaneous 99559 11172 88387 Bad Debt Expense 16855 16855 27333329 21153175 6169777 10377 4420387 5553356 2682037 1735150 278711 283156 62810 21103764 14532016 6392157 6571748 1362434 1413486 15135726 15619706 4150063 5342139 1563857 2073672 326597 21981 6040517 7437792 X 7477522 6564227 964699 964699 652988 652988 9095209 8181914 15135726 15619706 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 705976 100340 806316 680080 25896 705976 0 0 59145 59145 11475572 6754617 4720955 9569047 7777399 1791648 6571748 Housing Deposits 21981 21981 26347843 27333329 -985486 72191 72191 -913295 26420034 72191 72191 26347843 0 26347843 27333329 0 27333329 0 27333329 Part III, Line 4: The Organization's collections are objects and artifacts in accordance to proper museum standards and conditions. An outgoing loan agreement is in place with Hubbell Trading Post, Navajo Park Service and will be returned before expiration date, unless justified. Part V, Line 4: Description of Intended Use of Endowment Funds: The hospital's endowment consists of Scandling Memorial Scholarship funds established to provide financial scholarship opportunities for full-time Navajo college students. 1 1 X 0 1 X 0 0 0 0 0 16855 4887 4067474 4052681 14793 0 Navajo Health FdnSage Mem Hospital Inc

PO Box 457 Ganado AZ 86505

X X X X Dental Care Part I, Line 3c: It is the policy of Sage Memorial Hospital to provide essential medical services regardless of the patient's ability to pay. Discounts are offered based upon household income and size. A sliding fee schedule is used to calculate the basic discount and is updated each year using the federal poverty guidelines. Once approved, the discount will be honored for six months, after which the patient must reapply. All patients are eligible to apply for Sage Memorial's Charity Care program. The full amount of charges will be determined to be charity care for a patient whose gross family income is at or below 100 percent of the current federal poverty level. A sliding fee schedule shall be used to determine the amount that shall be written off for patients with incomes between 101 and 300 percent of the current poverty level. Charity care is not used very often as most patients qualify for medical services under the Indian Health Services federal program. Patients must prove they are Native American and live in the area to be eligible for the program. Part I, Line 7f: Bad Debt is reported at actual costs written off and that all bad debt can be attributable to charity care patients based on the population of the area that they serve as noted in Part I line 3c. Part III, Line 4: Bad debt was convertd to cost using the cost-to-charge ratio derived from Worksheet 2. Part III, Line 8: Financial Statement Note:The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision.Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. Part VI, Line 2: Sage Memorial Hospital works with the Navajo Area Office to determine needs assessments of their service area. This office supplies the needs assessment based on needs that have been identified through all facilities serving the area and who send in quarterly reports on services provided. After reviewing the services that the facilities have provided, the NAO does a needs analysis and passes the information on to the facilities. Part VI, Line 3: The majority of the patients are Native American and qualify for the Indian Health Service program. These patients qualify for the federal program and do not carry separate health insurance. There are very few patients that would fall outside the IHS program. Currently there is no information in the patient registration area and no discussion with patients on participating in the charity care program. Part VI, Line 4: Navajo Health Foundation/Sage Memorial Hospital is located in Apache County in Arizona. It is one of four facilities located in Apache County. Ganado is located in a rural area with the city's population being 660 and the overall county population of 38,737 (2005-2009 Census). The per capita income for the city was $9,993. About 29% of the families and 39.2% of the population were below the poverty line. Navajo Health Foundation/Sage Memorial Hospital delivers quality healthcare services mostly to Navajo members in its catchment area, defined in agreement with the Indian Health Services as the eight area chapters that add up to about 20,000 people in 1,500 square miles. These local chapters are: Ganado, Kinlichee, Klagetoh, Wide Ruins, Greasewood, Cornfields, Nazlini and SteamboatAdditionally, dental services are provided to Navajos from three more chapters:Houck, Lupton and SandersTo facilitate non-urgent care to people more than 15 miles from Ganado, Sage Memorial Hospital operates three field clinics: Greasewood, Wide Ruins and Sanders. Also arrangements can be made for transportation of patients that have trouble getting a ride to and from the hospital. Part VI, Line 5: Currently, Navajo Health Foundation/Sage Memorial Hospital does not have a Community Building Activity in place at this time. Part VI, Line 6: There are eight Navajo community members that make up the Board of Directors. There are eight chapters (communities) and each chapter elects their representative on a local level and those elected individuals serve as the board of directors. Those board members go back to their communities and educate their community members on what is happening at the hospital and on the services being provided.The facility extends medical staff to all qualified physicians in its communities. If there is a surplus, the funds would go into patient care areas including education, increasing patient services, wellness, and preventative care to it's patients.The Navajo Health Foundation mission is to provide high quality healthcare services to the residents of the area in accordance with the Joint Commission on Accreditation of Healthcare Organization's holistic approach to healthcare, focusing on the patient's physical, social and spiritual well being. We are committed to the prevention of illness and promotion of health; delivery of quality primary inpatient and outpatient care; and promotion of education and training of qualified Native American healthcare professionals.To fulfill this mission, we will provide preventive healing and rehabilitative services through a system that links native culture with western medicine; preserve the dignity of each individual regardless of creed, race, sex, religion, social status or physical handicap; strive to achieve and maintain excellence in all aspects of healthcare; promote the education and training of native American healthcare professionals; and operate the facility in a cost-effective and financially responsible manner.Sage Dental Clinic provides services to persons of all ages. With our full-time dentists and hygienist, we are committed to providing you with professional and quality services. It services a wide area of 1,800 square miles and 22,000 patients and over 10% of the Navajo Nation.Sage Dental offers services at field clinics in Greasewood (two chairs) and Sanders (four chairs) with a rotating dentist from the main clinic four times a week. Our main clinic in Ganado consists of eight chairs and five dentists. We are reaching only 20% of our potential need. The continued growth of the Dental Clinic has been a major project for Director Andemichael. Constant search and recruitment of dentists with talent and a willingness to practice in a rural and remote environment remains a priority.With the rising demand, Sage Dental only accepts new patients one day per month. Walk-ins are accepted every day for emergency visits.Sage Dental has sealant programs with the local schools and we offer diagnosis and treatment for children so that good dental habits and cavity prevention can begin at an early age. 0 0 0 0 0 0 0 0 0 AndemichaelMeron 212059 0 0 0 0 0 0 0 0 0 212059 0 0 0 Labib-Kiyarash Farid 534315 0 0 0 0 0 0 0 0 0 534315 0 0 0 Supplemental Information Part III The organization's CEO & Director of Finance are paid by Morgan and Associates, an unrelated management company. The organization relies on the management company to determine the compensation paid for services rendered to the organization. Charity Askie, Director of Finance was compensated by the management company $49,901 plus $10,000 in other compensation. Amad Razaghi was compensated by the management company $114,198 plus $17,454 in other compensation. Form 990, Part III, line 3 Changes in Program Services One clinic, Wide Ruins Clinic, was discontinued in 2010. Form 990, Part VI, Section A, line 3 There are currently not employees under the management company in 2010. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the Director of Finance and the Chief Financial Officer before filing. It is then presented to the Board of Directors. Form 990, Part VI, Section B, line 12c The employees and Board of Directors are covered by the policy. The level at which a determination of whether a conflict exists is made at the Executive Level. The Executive Level also actually reviews the conflicts. Form 990, Part VI, Section B, line 15b The organization's CEO & Director of Finance are paid by Morgan and Associates, an unrelated management company. The organization relies on the management company to determine the compensation paid for services rendered to the organization. Form 990, Part VI, Section C, line 19 Documents are available upon request.