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HUMBLE BEGINNINGS ON a tenant farm in Lumberton, N.C., have shaped the way Bobbie Jacobs-Ghaffar and Lesa Jacobs run their homegrown health-care agency, Native Angels.

The sisters, members of the Lumbee Indian Tribe, treat the rural population throughout North Carolina's Robeson County, providing hospice services to the terminally ill and in-home nursing care to the elderly, disabled and chronically ill. Many patients are low-income and, like themselves, Lumbee Indians. "We specialize in taking care of those people who get left in the cracks," says Jacobs-Ghaffar, 40 years old. "They might not live behind a white picket fence. They might live down a dirt road, or in a trailer."

The focus on the under-served has led to an abundance of success for the sisters, who started the business in 2000 with a cellphone and two patients. Now Native Angels employs 322 people, provides care to 760 patients a day, and last year posted $11 million in revenue — a track record so robust that the Small Business Administration recently named the sisters Small Business Persons of the Year, besting out the owners of a 32-year-old Illinois grain-shipping company and a 28-year-old North Dakota sheet-metal firm.

How did the sisters grow the business so quickly? Jacobs-Ghaffar says it has a lot to do with their mesh of talents. She considers herself the "numbers" person, having developed a flair for accounting as a grant writer for two community centers, while sister Lesa, 42, is a registered nurse with a knack for bonding with patients. A deep understanding of the community they serve and a respect for elders — a major part of Indian culture — also has helped Native Angels' growth, she says.

The sisters were prompted to start a hospice agency after a personal experience left them concerned about how the elderly and terminally ill spend their final days. "We lost two aunts back-to-back with lung cancer," Jacobs-Ghaffar says. One aunt was treated at the hospital, where up until her final days the routine, cure-focused medical care included chemotherapy and radiation. "She was in a lot of pain [and] died in the hospital," she says. "The other was able to die at home, and we were able to spend a lot of time with her."

Top 3

Native Angels co-founder Bobbie Jacobs-Ghaffar offers these tips to other small businesses:

Stay true to your mission.

Bring other people up with you. Don't forget: Your employees are the reason you're successful.

Ignore the competition. "We can't control what others are doing," she says. "We can only control what we do and who we are serving."

The experience taught them that "when death is imminent, you really focus on the quality of life," Jacobs-Ghaffar says. The sisters also realized that many in Robeson County, where per capital income hovers around $13,000 and illiteracy is prevalent, might be unaware of hospice or other health-care services.

Starting up "was really scary — it became a leap of faith," says Jacobs-Ghaffar, who maxed out her credit cards to launch the home-based business. The sisters enlisted volunteers to spread the word about Native Angels throughout their tight-knit community and soon had 60 patients. Within three months they had moved into an office and hired a small field staff.

The company, which turned a profit in the first year, began expanding its services, offering psychiatric counseling and early-intervention services for children with developmental disabilities. "All of our services grew out of community needs," says Jacobs-Ghaffar, who set up the agency to accept Medicaid (the biggest insurance program for people with limited income), as well as Medicare, military insurance, private insurance and cash.

Jacobs-Ghaffar also attributes the growth to a mix of strategies: writing out a detailed business plan, using accounting software to electronically manage the company's finances (including payroll and billing), and hiring "outrageously great" managers and staff. Native Angels now employs registered nurses, social workers, counselors, child-care specialists, physical therapists and even chaplains. "I tell my staff: means, methods and morals," she says. "You should operate with the highest levels of integrity with everything you do."

In the past year, the company took on debt for the first time in its history, taking out an SBA loan to finance a new $7.2 million headquarters. The 36,000-square-foot facility is scheduled to be completed in April 2008. Then comes the next big project: expanding into new markets.

With baby boomers getting older and medical advances making it possible to live longer, Jacobs-Ghaffar sees a growing need for the services her company provides. She is looking at expanding into Virginia, Florida, Georgia and South Carolina, and has sought advice from management consultants and lawyers familiar with the regulatory issues that affect the health-care business. And her latest challenge — albeit, a nice one to have — is dealing with all the offers the company is getting from private-equity firms and other suitors. "You have all these different influences," says Jacobs-Ghaffar. "It's important to remember who you are, and stay true to what your original mission was."

While she's eyeing other markets, her heart will always be in her native Robeson County. "A lot of the stats [say] it's low-income and impoverished, but I see it in the eyes of visionary," she says. "It is a beautiful place."

Sweet Medicine

Your name: Bobbie Jacobs-Ghaffar (pictured with co-founder Lesa Ann Jacobs)
Name of business: Native Angels Homecare & Hospice
Year founded: 2000
Business type (industry): Nursing Care
Location: Lumberton, N.C.
No. of employees: 322
Web address: www.nativeangels.biz

Where do you look for business advice? (Mentors? Industry or trade groups? Family and friends?)
I am an avid reader of many mediums, including books, trade magazines, newspapers and regulatory agency information at the local, state and national level. I also draw from numerous experiences from previous jobs, including growing up on a farm. I have worked in the nonprofit sector doing consulting and grant-writing from an advocacy perspective. I have trusted advisors, including my banker, business colleagues, lawyer and my accountant. My husband is a voice of reason, and I bounce everything off him. I read many business articles on the Internet and conduct research on patient trends and potential changes in the health-care industry.

What do you know now that you wish you'd known when you started?
Although human resources are your most valuable assets, they are hard to manage.

What's the smartest move you've made so far?
Diversifying into hospice, home health and mental health. Multiple pay sources and multiple streams of income assist with providing needed services, and assist in achieving financial stability.

What is the best business book you've read?
"Maximize the Moment," by T.D. Jakes.

What keeps you up at night?
Payroll, taxes, managing risk and reducing liability.

In brief, how did you fund the business initially, and what are your (projected) annual revenues?
I maxed out my two credit cards. I wouldn't advise anyone to do this unless they are really sure about what they are doing and have a specific plan on when and where they will be reimbursed.

And extra credit, please answer: when/where was your last vacation?
Easter, at Disney World.