Sage Memorial Hospital’s $80 million financing brings a new model to tribal health care. The unrated, tax-exempt bonds recapitalized construction of a replacement hospital, an expanded outpatient clinic, and badly needed workforce housing serving the Navajo community in Ganado, Arizona. Crucially, the team leveraged Sage’s status as a tribal contractor to pledge non-traditional revenue agreements alongside net patient revenues — opening a replicable path to market for indigenous health systems. The project restores nearby access to surgery, dialysis, intensive care, and labor and delivery, turning structural barriers on reservation land into a platform for long-term, community-centered care.