The San Carlos Apache Tribe issued the bonds for its healthcare nonprofit, the San Carlos Apache Healthcare Corp., to finance the construction of a 100-bed long-term care, hospice care and nursing facility on their tribal lands in Arizona. KeyBanc Capital Markets purchased the notes as the transaction’s broker-dealer and helped the healthcare organization, known locally as Izeé Baa Gowáh, secure an A- rating from Fitch – “one of the highest ever credit ratings for a Native American tribe or tribally chartered corporation,” according to KeyBanc.
The new facility, which will cost about $134 million, is slated to open in December 2026 next to the tribe’s 12-bed critical care facility.
The San Carlos Apache Tribe operates two health campuses for its more than 17,000 enrolled members.
Bond rating
Fitch rated the bonds based on the strength of San Carlos Apache Healthcare Corp.’s revenue streams, modest debt obligations and operational efficiency.
The nonprofit generates most of its patient revenues from Medicare and Medicaid plans, which Fitch in June noted “provides stability and predictable cash flows.” Republicans’ One Big Beautiful Bill Act has since cut Medicaid funding by 15%, however.
The tribe also has $50.6 million in low-interest New Markets Tax Credit financing to support the new facility’s construction, which was factored into the bond rating.
The tribe issued the bonds without third-party guarantees – a rarity for tribal entities.
“This structure may help pave the way for other tribes’ health systems and tribally chartered corporations to issue debt secured solely by health system revenues, facilitating future capital projects,” noted KeyBanc.
