Community Benefit Insight - Tax-exempt hospital

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Navajo Health Foundation - Sage Memorial Hospital Inc

Sage Memorial Hospital

Highway 264
Ganado, AZ 86505

Bed count	25	Medicare provider number	031309	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 237314364

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

41.2%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 0 0 %
Medicaid as % of operating expenses	$ 12,533,989 29.70 %
Costs of other means-tested government programs as % of operating expenses	$ 4,677,811 11.09 %
Health professions education as % of operating expenses	$ 170,800 0.40 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 262,834 0.62 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 26019259 including grants of $ 0) (Revenue $ 42193137)
NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL CONTRACTED WITH INDIAN HEALTH SERVICES WITH A SELF-DETERMINATION CONTRACT WHICH PROVIDED CARE TO INPATIENTS, OUTPATIENTS, ER PATIENTS, DENTAL, PHYSIOTHERAPY, BEHAVIORAL HEALTH, OPTOMETRY AND RADIOLOGY. SAGE MEMORIAL HOSPITAL SERVES PRIMARILY MEMBERS OF THE NAVAJO NATION. SAGE MEMORIAL HOSPITAL ALSO ADMINISTERED SPECIAL DIABETES PREVENTION AND TREATMENT FOR NAVAJOS. THE ORGANIZATION HAS DEVELOPED A PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY RESPONSE PLAN.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

SAGE MEMORIAL HOSPITAL
"PART V, SECTION B, LINE 5: SAGE MEMORIAL HOSPITAL (""SMH"") ASSEMBLED AN ASSESSMENT TEAM CONSISTING OF HOSPITAL ADMINISTRATION AND EXECUTIVE LEADERSHIP, PUBLIC HEALTH PROFESSIONALS, AND CLINICAL STAFF. THE TEAM CONDUCTED SURVEYS WITH COMMUNITY MEMBERS AND FOCUS GROUPS AND RESEARCHED SECONDARY DATA SOURCES TO OBTAIN RELEVANT COMMUNITY HEALTH INFORMATION. THIS INFORMATION WAS THEN ANALYZED AND CROSS-REFERENCED TO PUBLIC DATABASES TO IDENTIFY THE TOP HEALTH CARE NEEDS OF THE COMMUNITY. THE TEAM TOOK A COMPREHENSIVE APPROACH TO ASSESSING THE NEEDS. FIRST THEY ENGAGED WITH THE COMMUNITY TO CAPTURE INPUT ABOUT HEALTH NEEDS AND FACTORS AFFECTING THE ACCESS AND DELIVERY OF HEALTH CARE SERVICES IN THE REGION. THE ASSESSMENT TEAM INDENTIFIED 2 GROUPS TO REPRESENT THE COMMUNITY'S HEALTH INTEREST. (1) INDIVIDUAL MEMBERS OF THE COMMUNITY AND (2) SAGE'S BOARD OF DIRECTORS WHO ALSO RESIDE WITHIN THE COMMUNITIES OF THE NAVAJO NATION. THESE GROUPS PARTICIPATED IN SURVEYS AND FOCUS GROUPS COORDINATED BY ASSESSMENT TEAM MEMBERS WITH PUBLIC HEALTH EXPERTISE. THE TEAM ALSO RESEARCHED SECONDARY DATA SOURCES TO BETTER UNDERSTAND THE DEMOGRAPHICS OF THE COMMUNITY AND ASSOCIATED HEALTH ISSUES. THE RESULTS WERE ANALYZED AND REVIEWED WITH THE SMH EXECUTIVE TEAM, MEDICAL STAFF AND PUBLIC HEALTH EXPERTS IN ORDER TO IDENTIFY AND PRIORITIZE THE COMMUNITY'S HEALTH NEEDS."

SAGE MEMORIAL HOSPITAL
PART V, SECTION B, LINE 7D: PAMPHLETS DISTRIBUTED IN THE LOCAL COMMUNITY.

SAGE MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: THE HOSPITAL HAS IDENTIFIED AND PRIORITIZED THE TOP 5 SIGNIFICANT NEEDS OF THE COMMUNITY AND IS ADDRESSING THOSE NEEDS AS FOLLOWS: (1) BEHAVIORAL HEALTH - THE HOSPITAL IS EXPANDING BEHAVIORAL HEALTH SERVICES AND SUBSTANCE ABUSE REHABILITATION PROGRAMS, INCLUDING IMPLEMENTING AN OUTREACH PROGRAM AND COLLABORATING WITH SCHOOLS AND IMPLEMENTING TELEMEDICINE; (2) PEDIATRIC CARE - THE HOSPITAL IS EXPANDING PUBLIC IMMUNIZATION PROGRAMS, NUTRITIONAL EDUCATION OUTREACH PROGRAMS, RECRUITMENT AND RETENTION OF BOARD-CERTIFIED PEDIATRICIANS AND EXPANDING CAPACITY FOR PEDIATRIC SERVICES; (3) OBESITY PREVENTION - THE HOSPITAL PLANS TO FACILITATE ADDITIONAL COMMUNITY OUTREACH ACTIVITIES SUCH AS EXERCISE AND PHYSICAL FITNESS GROUP ACTIVITIES, EDUCATION ABOUT HEALTHY LIFESTYLES AND THE DEVELOPMENT OF A RECREATIONAL FACILITY; (4) ACCESSIBLE HEALTH CARE SERVICES - THE HOSPITAL PLANS TO EXPAND SERVICES WITHIN CHAPTER COMMUNITIES WITH THE PURCHASE OF A MOBILE HEALTH RV, REVIEW VIABILITY OF TELEMEDICINE PROGRAMS, COORDINATE PATIENT HOME VISITS AND COLLABORATE WITH THE COMMUNITY HEALTH REPRESENTATIVES; AND (5) DIABETES CARE AND PREVENTION - THE HOSPITAL WILL CONTINUE TO EDUCATE THE COMMUNITY ABOUT DIABETES AND INCREASE COMMUNITY ACTIVITIES THAT ENCOURAGE HEALTHY LIFESTYLE HABITS, RECRUIT AND RETAIN A NURSE CARE MANAGER FOR THE DIABETES PROGRAM, DEVELOP AND SUPPORT THE NATIVE DIABETES WELLNESS PROGRAM, CONTINUE TO EXPAND THE SAGE COMMUNITY GARDEN TO INCREASE AWARENESS AND SUPPLEMENT NUTRIONAL RESOURCES AND EXPAND HEALTH SCREENINGS. LONG TERM PLANS INCLUDE AN OUTPATIENT MEDICAL CENTER AND NEW HOSPITAL.

SAGE MEMORIAL HOSPITAL
PART V, SECTION B, LINE 13H: THE HOSPITAL USES THE FEDERAL PROVERTY LEVEL AS DETERMINED ANNUALLY BY THE FEDERAL GOVERNMENT ON A SLIDING SCALE WITH 0 TO 100% OF FEDERAL POVERTY LEVEL RECEIVING A 90% DISCOUNT, WITH A REDUCTION IN THE DISCOUNT AS THE INCOME LEVEL INCREASES IN RELATION TO THE POVERTY LEVEL.MEMBERS OF THE NAVAJO NATION ARE SERVED UNDER AGREEMENTS WITH THE INDIAN HEALTH SERVICE. IF TRIBAL MEMBERS DO NOT HAVE INSURANCE AND/OR ARE NOT ELIGIBLE FOR MEDICARE OR MEDICAID, THE HOSPITAL BEARS THE COST OF PROVIDING MEDICAL SERVICES. PRIOR TO COVERING THE COSTS, THE HOSPITAL VERIFIES ALL ALTERNATIVE INSURANCE OPTIONS HAVE BEEN APPLIED FOR AND OBTAINS PROOF OF INDIAN HERITAGE.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
THE ORGANIZATION PRIMARILY SERVICES MEMBERS OF THE NAVAJO NATION UNDER AGREEMENTS WITH THE INDIAN HEALTH SERVICE. IF TRIBAL MEMBERS DO NOT HAVE INSURANCE AND/OR ARE NOT ELIGIBLE FOR MEDICARE OR MEDICAID, THE HOSPITAL BEARS THE COST OF PROVIDING MEDICAL SERVICES. PRIOR TO COVERING THE COSTS, THE HOSPITAL VERIFIES ALL ALTERNATIVE INSURANCE OPTIONS HAVE BEEN APPLIED FOR AND OBTAINS PROOF OF INDIAN HERITAGE.

PART III, LINE 2:
NATIVE AMERICANS AND OTHER ALASKA NATIVE TRIBES BENEFICIARIES DO NOT PAY ANY OUT-OF-POCKET AMOUNT FOR THEIR SERVICES AS THEY ARE COVERED THROUGH THE ANNUAL FUNDING FOR NATIVE AMERICANS AND OTHER ALASKA NATIVE TRIBES BENEFICIARIES. HOWEVER, NON-BENEFICIARY PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE GENERALLY RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.

PART III, LINE 4:
FROM NOTE 1, PAGE 14 OF THE AUDITED FINANCIAL STATEMENTS: NATIVE AMERICANS AND OTHER ALASKA NATIVE TRIBES BENEFICIARIES DO NOT PAY ANY OUT-OF-POCKET AMOUNT FOR THEIR SERVICES AS THEY ARE COVERED THROUGH THE ANNUAL FUNDING FOR NATIVE AMERICANS AND OTHER ALASKA NATIVE TRIBES BENEFICIARIES. HOWEVER, NON-BENEFICIARY PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE GENERALLY RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. FOR THE YEARS ENDED SEPTEMBER 30, 2022 AND 2021, NO SIGNIFICANT ADDITIONAL REVENUE WAS RECOGNIZED DUE TO CHANGES IN THE HOSPITAL'S ESTIMATES OF IMPLICIT PRICE CONCESSIONS, DISCOUNTS, AND CONTRACTUAL ADJUSTMENTS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.

PART III, LINE 8:
IT IS A COMMUNITY BENEFIT FOR THE HOSPITAL TO PROVIDE SERVICES REGARDLESS OF MEDICARE SURPLUS OR SHORTFALL. THE SOURCE USED IS MEDICARE'S COST REPORT COMPLETED BY THE HOSPITAL FOR FISCAL YEAR END 2022.

PART VI, LINE 2:
THE HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2020 (TAX YEAR 2019).

PART VI, LINE 3:
UPON ADMITTANCE, PATIENTS ARE INFORMED OF THE POLICIES, EDUCATED ON THE VARIOUS ASSISTANCE PROGRAMS AVAILABLE, AND GIVEN FORMS TO ASSIST IN COMPLETING FINANCIAL ASSISTANCE PAPERWORK. THE EMPLOYEES IN ADMITTING HAVE A CHECKLIST OF INFORMATION AND FORMS THEY ARE TO PROVIDE TO THE PATIENTS.

PART VI, LINE 4:
THE ORGANIZATION PRIMARILY SERVICES THE NAVAJO NATION COMMUNITIES AND CHAPTERS OF CORNFIELDS, GANADO, KINLICHEE, KLAGETOH, GREASEWOOD SPRINGS, STEAMBOAT, WIDE RUINS, AND THE PORTION OF NAZLINI THAT INCLUDES COMMUNITIES SOUTH OF ROUTE 26. THE REGION IS PREDOMINANTLY PART OF APACHE COUNTY OF ARIZONA, WITH SOME OVERLAP INTO NAVAJO COUNTY.

PART VI, LINE 5:
BASED ON THE FINDINGS OF PAST AND CURRENT CHNAS, SAGE'S LEADERSHIP ADOPTED AND BEGAN EXECUTING AN IMPLEMENTATION STRATEGY TO MEET THE HIGH PRIORITY HEALTH CARE NEEDS OF THE COMMUNITY. SAGE CONTINUES TO EXPAND UPON ITS STRATEGY THROUGH THE FOLLOWING ACTIONS THAT ADDRESS THE COMMUNITY'S HEALTH CARE NEEDS. COMMUNITY HEALTH CARE NEEDS INCLUDE BEHAVIORAL HEALTH, PEDIATRIC CARE, OBESITY PREVENTION, ACCESSIBILITY TO HEALTH CARE SERVICES, AND DIABETES CARE AND PREVENTION. CAPACITY IN ALL CATEGORIES IS BEING EXPANDED AND COMMUNITY OUTREACH PROGRAMS IMPLEMENTED TO EDUCATE AND ASSIST INDIVIDUALS.

Operating expenses	$ 42,195,097
Total amount spent on community benefits as % of operating expenses	$ 17,382,600 41.20 %