Dr. Leland Leonard has initiated an incredible concept of utilizing 100% Navajo services. He has given our firm to demonstrate our quality products and service.

1. ANNUAL REPORT
TSÉHOOTSOOÍ
M e d i c a l C e n t e r
2011

2. MISSION STATEMENT
Providing Superior
and Compassionate
healthcare to our
community by raising
the level of health,
hózhó, and quality of
life.
Table of Contents
Chief Executive Officer’s Message............1
Board of Directors..................................2
Organization History..............................4
Our Services...........................................5
A Model of Best Practice.........................6
Patient Centered Model..........................7
FY 2010 - Financial Summary..................8
FY 2010 - Expenditures/Revenues...........9
Our Elders............................................11
Telehealth...........................................11

3. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
Chief Executive
A
Officer’s Message
Greetings dóó Yá’át’ééh Naat áaníi!
As the Chief Executive Officer (CEO) I am honored to provide the 2011 Annual Report
including the 2010 Fiscal Report to the Fort Defiance Indian Hospital Board of Directors
(FDIHB). We hope this information will clarify and serve as a reference of the overall
operations of Tséhootsooí Medical Center (TMC) and Nahat’á Dziil Health Center
(NDZHC).
The mission of FDIHB is to provide superior and compassionate healthcare to
our community by raising the level of health, hózhó and quality of life. A Strategic Plan
was completed in February 2011, the goals, objectives, evaluation format and funds were
identified to assure superior and compassionate health care. The leadership team supports
the need to fully embrace hózhó embedded health care services in all operations. We will
continue to collaborate with the Navajo Nation, Indian Health Services, the states of
Arizona and New Mexico and other affiliates to secure resources needed to provide superior
health care. The Center for Medicare and Medicaid Services (CMS) monitors health care
compliance for TMC and NDZHC; we anticipate a monitoring visit at any time.
The FDIHB 2010 operating budget exceeds $100 million; this included salaries,
employee benefits, professional services, supplies, contract health services, utilities, travel
and other. The Revenues are generated from net patient service revenue, Title I, Tribal
Grant Funds, and other revenues. Our first audit, as a non-profit 638 entity was conducted
by Moss Adams Certified Public Accountants. The audit was classified as “Unqualified”
which means there were no findings.
The total number of patients served in 2010 is approximately 32,000. Currently,
there are approximately 900 FDIHB employees.
On March 28, 2010 the FDIHB officially became a 638 certified health care facility.
Since that time the administration has diligently worked on making the transition from
Indian Health Service (IHS) to a corporate status with a focus on employee transition.
The FDIHB administration continues to identify and address the medical needs
of our patients from the 16 chapters and others who use TMC and NDZHC. I applaud the
entire FDIHB staff for their services as they go above and beyond to serve all patients. Dr. Leland Leonard,
I am committed to building elite health care services using the PL 93-638, Indian Chief Executive Officer
Self Determination and Education Assistance Act. I sincerely believe that we have qualified Tséhootsooí Medical Center
and competent staff who consistently promote the mission of FDIHB. We will continue
to provide superior and compassionate health care to our community by
raising the level of health, hózhó and quality of life.
Please contact me if you have any questions, I can be contacted
at 928-729-8000.
Sincerely,
Dr. Leland Leonard
Chief Executive Officer 1

4. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
Board of Directors
ROY DEMPSEY, LELAND ANTHONY, LORRAINE NELSON,
Vice Chairman Treasurer Secretary
Caleb Roanhorse,
Board President,
Fort Defiance Indian Hospital
Board, Inc.
MARTIN ASHLEY, Jerry Freddie, TIM GOODLUCK,
Board Member Board Member Board Member
Elmer Milford, DR. RAYMOND REID,
Board Member Board Member
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5. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
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health 3

6. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
T
Organization History
1851 The history of healthcare in the Fort Defiance area stems back to the mid 1800’s when
U.S. Calvary built a fort and the federal government was establishing military forts and placing physicians at those
named it Fort Defiance forts. The first Fort Defiance Indian Hospital was built in 1912. The hospital was under
1897 - 1929 the control of the Bureau of Indian Affairs until 1955 when Congress transferred the
Federal Government employees Indian Health Program to the Indian Health Service department within the U.S. Public
field matrons to raise living Health Service. This facility was located in the same vicinity as the original Fort Defiance
standards, improve hygiene and military post.
to perform preventative health By 1965 the Fort Defiance Indian Hospital, operated by the Indian Health
measures.
Service (IHS), became an accredited hospital.
1908 - 1914 In the early 1980s, a grassroots effort kicked off the planning stages to request
Federal Gov. built four hospitals. a new IHS facility. The group known as the Fort Defiance Hospital Steering Committee
1955 was composed of community members and elected community leaders, along with the
Congress transfers Indian Health Navajo Nation Division of Health and the Navajo Area Indian Health Service. The
Program to US Public Health efforts of the committee paid off with the allocation of funds to construct a new hospital.
Service. In August 2002 the new 54 bed; 24,000 square foot hospital opened for business.
1965 Since that time, the hospital continued its growth and acquired the Nahat’a
Fort Defiance Indian Hospital Dziil Health Center in Sanders, Arizona. It also initiated efforts to become one of several
becomes an accredited hospital. self-determined PL 93-638 hospital organizations on the Navajo Nation. The ‘638
status gives the community control of the management and operation of the facility.
1980s
On March 28, 2010 the hospital won approval and officially became the fourth ‘638
Community members begin
petitioning for a new hospital on the Navajo Nation and no longer under the control of the Indian Health
facility. Service.
The FDIHB, Inc. Board of Directors voted unanimously on April 15, 2011,
2001
to change its name to the Tséhootsooí Medical Center and commissioned a new logo.
Construction of new facility
begins. Today FDIHB, Inc. is the parent to Tséhootsooí Medical Center and the Nahat’a Dziil
Health Center.
2002
Doors open for business. Legal Entity
2004 The Fort Defiance Indian Hospital Board, Inc. is incorporated under the Navajo Nation
Non-profit status by the Internal Corporation Code, and Arizona Corporation Commission as a 501(c)(3) nonprofit
Revenue Service corporation. The Internal Revenue Service has also certified FDIHB, Inc. as a nonprofit
2004 entity
638-Contract is completed.
Organization Summary
The Fort Defiance Indian Hospital Board, Inc. (FDIHB, Inc.) is a tribally chartered,
501(c)(3) nonprofit healthcare organization that operates and manages the Tséhootsooí
Medical Center (TMC) and the Nahat’a Dziil Health Center (NDZHC). FDIHB, Inc. is
certified by the Center for Medicare & Medicaid Services (CMS) to offer a wide range
of acute and ambulatory care services to patients. The two facilities provide healthcare
services to an estimated 32,000 people; a majority of whom are members of the Navajo
Nation and reside within 16 Navajo communities in the Fort Defiance service area.
TMC is a 240,000 square feet facility which is located at the Northwest corner
of Navajo Route 7 and Navajo Route 12 in Fort Defiance, Arizona. TMC is a 56 bed
inpatient and outpatient facility with a 24-hour Emergency Room and NDZHC is
located off Interstate 40 and State Highway 191 in Sanders, Arizona. NDZHC provides
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1 basic outpatient services in a family practice atmosphere with a small lab, a pharmacy,
and four exam rooms. It is open Monday through Friday from 8:00 am to 5:00 pm.

7. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
Our Services
Inpatient services include the following: Outpatient services include the following:
• Adolescent Care Unit • Obstetrical e Unit (OBU) • Radiology Department • Adult Medicine Clinic • Counseling Services • Office of Traditional
(ACU) • Sterile Processing • Physical Therapy (PT) (AMC) • Emergency Department Services
• Inpatient Social Services Department • Inpatient Pharmacy
• Pediatric Clinic (Peds) • Home Based Care (Elder • Outpatient Pharmacy
• Intensive Care Unit (ICU) • Multi-Service Unity • Dietary • Women’s Health Clinic Care, Hospice, Palliative • Orthopedics
(WHC) Service) • Podiatry
• OR/Post Anesthesia Care • Respiratory Therapy (RT) • Medical Records
• Diabetes Program • Health Promotion and • Surgical Clinic
Unit (OR/PACU) • Laboratory Department • Dental Clinic Disease Prevention • Physical Therapy
• Optometry Clinic • Public Health Nutrition • Radiology
• Ear, Nose, Throat (ENT) • Wellness Center • Respiratory Therapy
Clinic • Behavioral • Specialty Care Clinic
Health/ • Social Services
Mental Health
• Public Health
Nursing
Compassionate 5
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8. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
A Model
of Best
Practice
The Navajo Area Indian Health Services
recognizes Fort Defiance Indian Hospital
Board, Inc.’s Tséhootsooí Medical Center as
a leader in immunizing children. NAIHS says
TMC’s Pediatric Clinic is “one service unit that
has had consistently high immunization rates.”
The Navajo Area consists of 13 healthcare
facilities.
For the past three years, Tséhootsooí
Medical Center demonstrated “Best Practice”
when it comes to getting children immunized.
Best Practices recognized include:
1. Assignment of nursing staff member as an
Immunization Manager
• The Immunization Manager works with
clinical staff to orients them on proper
reporting.
• Develops policies for immunization at all
clinical opportunities/reduction of missed
opportunities
• Educates on the true reasons or factors
that parents/guardians may not want
their child immunized
• Establishes a clinic “culture” of
immunizations at any clinic visit regardless
of Purpose of Visit.
• Works with Public Health Nurse staff to
assist with finding families not accessing
the clinic for care and determining if they
are getting care elsewhere
• Interface with parents by contacting
parents by phone or letter when children
are delinquent in their immunizations.
• Improving the reliability and accuracy
of the data reporting system for active
patients
Life
2. Active management of the childhood
population using the data reporting system
tools to
• track delinquent children and notify
parents of deficient immunizations
• inactivate children no longer in the service
unit to give more accurate statistics about
immunizations.
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9. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
Patient Centered Model
H
T
Hospital leadership and administration have embraced a patient
centered model of providing care. This model is grounded in Diné
philosophy of using a holistic and balanced approach in providing
quality healthcare to achieve Hózhó, and wellness.
IMPROVING PATIENT CARE
Tséhootsooí Medical Center is taking a proactive role to ensure
that each patient receives the best health care. The customer service
and quality of service are improving through the Quality Assessment and Performance
Improvement plans, policies, and procedures. TMC is implementing the Improved Patient
Care model which focuses on the Plan, Do, Study, Act process in determining challenges
and identifying ways to improve deficiencies. This process has led to improved care. In the
Emergency Department a Performance Improvement project led to a dramatic decrease in
the “Left Without Being Seen” rate and patients’ wait times have decreased.
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10. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
FY 2010
Financial Summary
(Data from Audited FY 2010 Financial Statements – March 28, 2010 to September 30, 2010)
2010 EXPENDITURES EXPENDITURES
Salaries $ 26,332,481.
Professional Services $ 8,721,00.
Supplies $ 4,928,685.
Contract Health Services $ 3,529,610.
Employee Benefits $ 3,235,078.
Utilities $ 737,956.
Travel $ 607,315.
Other $ 1,576,825.
TOTAL $ 49,669,550.
2010 REVENUES
Net Patient Service Revenue $ 28,672,731.
Title 1 $ 24,551,861.
Tribal Grant Funds $ 200,409.
Other Revenue $ 690,570,
TOTAL $ 54,115,571.
Expenditures as a Percent of Revenues: 91.8% +$4,446,021
Fiscal Year 2010 FISCAL YEAR 2010
Net Income Revenues FDIHB Benchmark
Profit Margin - 4,483,594.00 54,115,571.00 8.29% 11.42%
Net Income/Revenues
Labor Net Oper Revs
Total labor costs - 29,587,559.00 53,224,592.00 55.55% 41.26%
Net Operating Revenues
Oper Income Revenues
Total Operating Profit 4,446,021.00 54,115,571.00 8.22% 9.60%
Margin = Operating/
Revenues
Curr Assets Curr Liab
Working Capital = 53,604,371.00 4,983,380.00 48,620,941.00
Current Assets -
Liabilities
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Reference: Becker’s Hospital Review, http://www.beckershospitalreview.com/hospital-financial-and-business-news/40-hospital-benchmarks.html

11. Salaries $ 26,332,481 Net Patient Service Revenue $ 28,672,731
Professional ServicesE D I C A L$ C E N T E R • 2 0 1 0
T S É H O O T S O O Í M 8,721,600 A N N U A L TitleP1 O R T
R E $ 24,551,861
Supplies $ 4,928,685 Tribal Grant Funds $ 200,409
Contract Health Services $ 3,529,610 Other Revenue $ 690,570
Employee Benefits $ 3,235,078 TOTAL $ 54,115,571
FY 2010
Utilities
Travel
$
$
737,956
607,315 Expenditures as a Percent of Revenues
Expenditures/Revenues
Other $ 1,576,825
TOTAL $ 49,669,550
*Numbers are from FY2010 audited financial statements
91.8% + $ 4,446,021
(Data from Audited FY 2010 Financial Statements – March 28, 2010 to September 30, 2010)
Expenditures
EXPENDITURES Revenues
Travel,
$607,315
Other
Utilities, Revenue,
Other, Tribal Grant
$737,956
Hospital Board, Inc.Employee
*
$1,576,825 Funds,
$200,409
$690,570
Contract Benefits,
2010 Revenues
Health $3,235,078
Services,
32,481 Net Patient Service Revenue
$3,529,610 $ 28,672,731
21,600 Title 1 $ 24,551,861
28,685 Tribal Grant Funds $ 200,409
29,610 Other Revenue $ 690,570 Title 1, Net Patient
35,078 TOTAL Supplies, $ 54,115,571 $24,551,861 , Service
Salaries, 45% Revenue,
37,956 $4,928,685
$26,332,481 , $28,672,731 ,
07,315 Expenditures as a Percent of Revenues 53% 53%
76,825
91.8% ,
Professional
69,550 Services,
statements $8,721,600 + $ 4,446,021
18%
res Revenues
revenues
Other
Other, Tribal Grant Revenue,
1,576,825 Funds, $690,570
$200,409
Title 1, Net Patient
$24,551,861 , Service
Salaries, 45% Revenue,
$26,332,481 , $28,672,731 ,
53% 53%
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12. T S É H O O T S O O Í M E TD SI É H O O CT ES N TO EÍ R M • E D2 I0 C1 A0 L A C NE NN UT AE LR R• E 2 0 1R 0
C A L O P O T A N N U A L R E P O R T
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13. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
T
Our Elders
The Tséhootsooí Medical Center’s Home Based Care Clinic is a
comprehensive elder care services that includes medical, psychosocial,
nursing, dental, rehabilitative, behavioral health and spirituality.
The services are provided by an interdisciplinary team of medical
professionals who make home visits and/or treat the elders and/or patients
at the clinic. The Home Based Care Clinic is recognized internationally
for breaking cultural barriers in preparing Navajo elders with end of life
care. The Home Based Care established pathways to implement and
develop traditional and culturally sensitive for elders and patients with
chronic and long term health care needs. The clinic honors and respects
I
the elders’ and patients’ wishes for comfort care and quality of life in
the last days of their lives. Support for community based resources
for in-home and personal care services are identified, established and
implemented in partnership with the Arizona and New Mexico Long
Term Care Services.
TELEHEALTH
In partnership with the University of New Mexico, Fort Defiance Indian
Hospital Board, Inc. ventures into the world of Telehealth, which is using
electronic information and telecommunication technology to deliver
health care, health information, and health education, from a distance.
This innovative and technical endeavor allows Tséhootsooí Medical
Center and Náhátá Dzííl Health Center to deliver healthcare services
to the most remote communities within our service area. Navajo Nation
Chapters within our service area will play a key role in this groundbreaking
project. We anticipate providing technology equipment to some of the
Navajo Nation Chapters within our service area so our patients will
receive their health care at the Chapter buildings.
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14. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 1 A N N U A L R E P O R T
TMC’s
Pediatric
Clinic
staff
promote
literacy
Staff
gather
in the
hospital
rotunda
for a
general
staff
meeting
TMC
Dancers
promote
healthy
and
active
lifestyles
Weekly
Cultural
sessions
Hózhó
in the
hospital’s
Hogan
draws
big
crowds
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15. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0
T S A NHN O O LT S EOP O ÍR T M E D I C A L C E N T E R
É UA R O
Leadership Council
Dr. David Downing, Tori Davidson, Rachel Sorrell,
Chief Medical Officer Chief Nurse Executive Interim Chief Financial Officer
Dr. Janet Slowman-Chee, Vivian Santistevan, Valonia Hardy,
Chief Planning Officer Chief Human Resources Officer Chief Community Health Officer
Dr. J
ulianna
Reece
Ahehee.
EEN,
A AHAST
JAMESCIT Control Nurse
ion
TESHINA
CODY, cer TMC Infect
Control Offi
TM C Infection 1

16. T S É H O O T S O O Í M E D I C A L C E N T E R • 2 0 1 0 A N N U A L R E P O R T
TSÉHOOTSOOÍ
M e d i c a l C e n t e r
TSÉHOOTSOOÍ Medical Center
P. O. Box 649 / Hwy. 12 7
Fort Defiance, Arizona 86504
Office: 928-729-8000
1
www.fdihb.org