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PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
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PPSA is a new act... recently passed in USA.
To monitor the culture between pharma companies and doctors like receiving incentives ,gifts and prescribing those companies drugs
Due to this act , people will be more safer with drugs and healthcare cost burden will reduced...and to know more about act... see the presentration..
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With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
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Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
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The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
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Prepare for additional discussions with key stakeholders regarding RBC assessment and readiness.
Make informed decisions as to next steps while evaluating associated financial risks.
The Physician’s Sunshine Act will impose changes in the way that healthcare meeting planners manage data and reporting. Disclosure of payments for Transfer of Value (TOV) will soon be required and violations for non-compliance can lead to stiff penalties and other ramifications for you and your organization. Find out from meeting experts what they are doing to prepare for the new regulations for transparency and accountability.
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The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
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Topics Include:
- Defining the Sunshine Act as it relates to medical offices
- What is a “transfer of value?”
- Weighing the benefits of rep interactions
- Free apps available to help you keep up to date on recorded information.
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PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
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Presentation Explores Many Contexts of Community BenefitPYA, P.C.
PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
PPSA is a new act... recently passed in USA.
To monitor the culture between pharma companies and doctors like receiving incentives ,gifts and prescribing those companies drugs
Due to this act , people will be more safer with drugs and healthcare cost burden will reduced...and to know more about act... see the presentration..
Addressing Medical Necessity Denials and RecoupmentsPYA, P.C.
With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
Chronic Care Management in Post-Acute/LTC SettingPYA, P.C.
PYA Principal Denise Hall and PYA Manager Lori Baker presented an educational session, “Chronic Care Management in Post-Acute/LTC Setting” to members of The Vision Group during The Society for Post-Acute and Long-Term Care Medicine’s (AMDA) Annual Conference.
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
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The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
Risk-Based Contracting: Background, Assessment, and ImplementationPYA, P.C.
PYA Principal Bob Paskowski presented “Risk-Based Contracting: Assessments and Implementation,” at the National Association of Managed Care Physicians Fall Managed Care Forum, November 10-11, 2016. The presentation allows participants to:
Understand the different types and core elements of risk-based contracting (RBC).
Prepare for additional discussions with key stakeholders regarding RBC assessment and readiness.
Make informed decisions as to next steps while evaluating associated financial risks.
The Physician’s Sunshine Act will impose changes in the way that healthcare meeting planners manage data and reporting. Disclosure of payments for Transfer of Value (TOV) will soon be required and violations for non-compliance can lead to stiff penalties and other ramifications for you and your organization. Find out from meeting experts what they are doing to prepare for the new regulations for transparency and accountability.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
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Topics Include:
- Defining the Sunshine Act as it relates to medical offices
- What is a “transfer of value?”
- Weighing the benefits of rep interactions
- Free apps available to help you keep up to date on recorded information.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
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Read More: https://insightssuccess.com/the-10-most-trusted-insurers-in-the-middle-east-october2023/
Why Revenue Cycle Management Matters For RCM Healthcare Providers.pptMatthew Clark
The healthcare landscape in the United States is undergoing the significant changes, driven by factors such as evolving regulations, increasing patient expectations, and advances in medical technology. In this dynamic environment, healthcare providers are constantly striving to deliver high-quality patient care while maintaining financial stability. One crucial aspect that plays a pivotal role in achieving this delicate balance is revenue cycle management (RCM).
this is assignment 1
Financial Statement Analysis
Student name
University
Professor
October 25, 2016
Financial Statement Analysis
Based on your review of the financial statements, suggest a key insight about the financial health of the company. Speculate on the likely reaction to the financial statements from various stakeholder groups (employee, investors, shareholders). Provide support for your rationale.
Health Management Associates, Inc. (NYSE: HMA) is the operator and owner-general acute care centers in the non-urban communities situated in the US, particularly in the Southwest. The organization was founded in 1977. The hospitals provide services such as oncology, emergency room care, general surgery, internal medicine, radiology, pediatric services, coronary care, and diagnostic care (
www.healthcaremanagement.com
).The company is also providing outpatient services like x-ray, respiratory therapy, one-day surgery, laboratory services, physical therapy as well as cardiology therapy. The mission of the Health Management is to provide America’s best local healthcare. They provide processes, capital finance, expertise, and people that can ensure that the local hospitals can accomplish their mission of delivering compassionate and high-quality healthcare that would substantially improve the lives of patients, the communities they serve, and the physicians providing the care
www.healthcaremanagement.com
)
With regard to the review of the current financial statement, HMA is in a dangerous financial state as a result of the present increasing debts and legal woes. The Office of the Inspector General, Justice Department, and the Department of Health and Human Services served the organization with summons regarding a software program that was used by ED doctors and the records from the emergency department. Some reports suggested that there was pressure from the company’s hospitals management to admit patients from emergency rooms so as to maximize profits. Paul Meyer, former compliance director, claimed that HMA’s fraudulent activities could attract government investigation (Britt, 2012).
The common stock of Health Management Associates was owned by almost 850 shareholders, as per the records of December 31, 2012, with hundreds of institutional investors included. HMA had expanded to include 70 hospitals situated in 15 states, with roughly 10,562 present licensed beds. In 2012, HMA realized about $5.9 billion in net revenue (Britt, 2012).
HMA gets payments for the services it renders from the federal government through the Medicare program, the states in which it functions under each Medicaid program, and commercial insurance, among others; and patients, encompassing deductibles and co-payments. Basically, deductibles and co-payments are part of the bill of patients for the medical services provided, which many government and private payers expect the patient to cater for. The amount of deductibles and co-payments v.
What Makes A Top-Notch Medical Billing Company Stand Out?Matthew Clark
In the complex world of healthcare billing, finding a reliable and efficient medical billing company can make a significant difference in a practice's financial success. However, not all medical billing companies are created equal. The top-notch ones stand out due to their exceptional qualities and services. This blog will explore the key factors distinguishing a top-notch medical billing company from the rest. Understanding these qualities will help healthcare providers decide when selecting a billing partner.
Read the scenario that you will use for the Individual Projects in ea.pdfashokarians
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
1. NEWS RELEASE
FOR IMMEDIATE RELEASE
Contact:
Laci Foster
inVentiv Medical Management
+1 706 855 0830 x2280
laci.foster@inVentivMM.com
inVentiv Medical Management Receives Two More Accreditations in Population
Health Management
iMM Helps Providers Enter New Era of Value-Based Care by Providing
Comprehensive, Quality Services that Improve Outcomes
CHARLOTTE, N.C. – August 1, 2013 – inVentiv Health Medical Management (iMM)
announced today that it has become part of a select group of companies receiving three
accreditations in Population Health Management (PHM) from a national organization setting
quality standards for U.S. healthcare. PHM has become a centerpiece in improving patient
outcomes under the Affordable Care Act.
iMM received the three accreditations from URAC, the nation’s largest accrediting body for
PHM. Under the federal Affordable Care Act providers are rewarded for the value of the care
they deliver to patients rather than the volume of care. Providers must deliver improved
outcomes at lower costs. PHM helps deliver evidence-based, coordinated care across the
healthcare continuum, from promoting wellness to managing complex chronic diseases.
“As providers sprint to meet the federal requirements under the Affordable Care Act, they can
turn to us as their single source for management of population health,” said Marc Palmer,
CEO of iMM. “For employers, human resources professionals and claims administrators, it is
far easier to manage a single provider that they can count on for the highest quality services,
rather than multiple providers.”
iMM now holds accreditation in Health Utilization Management, Case Management and
Disease Management services from URAC:
• Health Utilization Management: The first accreditation from URAC, received in 2012,
was for the independent, clinical evaluation of the appropriateness, medical need and
efficient use of healthcare services according to evidence-based guidelines and
individual health plan benefits.
• Case Management: One of the two most recent accreditations, effective July 1,
recognizes the quality of iMM’s collaborative care process between a consumer, care
providers and clinical case managers toward the goal of promoting cost-effective
outcomes and a return to health.
• Disease Management: The second of the most recent accreditations, this one
recognizes the high quality of iMM’s delivery and coordination of health interventions
over the long term by nurses who help consumers reduce the financial, emotional and
physical burdens of chronic disease.
“By applying for and receiving Case Management and Disease Management accreditation,
inVentiv Medical Management has demonstrated a commitment to quality healthcare,” said
URAC Chief Operating Officer William Vandervennet. “Quality healthcare is crucial to our
nation’s welfare and it is important to have organizations that are willing to measure
2. NEWS RELEASE
themselves against national standards and undergo rigorous evaluation by an independent
accrediting body.”
iMM employs an in-house medical team of physicians and nurses, as well as dieticians and
social workers, to manage care. These experts tap a proprietary database, the inFinitē
Platform, which enables predictive modeling to inform the coordinated care of individual
patients. iMM delivers services appropriate to the individual, while eliminating gaps in care,
promoting cost effectiveness and creating a seamless experience for consumers.
iMM programs that combine the three accredited services have already shown measurable
success in improving outcomes for patients suffering from some of the most complex, costly
diseases, such as cancer, cardiovascular disease and chronic kidney disease.
About URAC
URAC, an independent, nonprofit organization, is a leader in promoting health care quality
through accreditation and certification programs. URAC's standards keep pace with the rapid
changes in the healthcare system, and provide a mark of distinction for healthcare
organizations to demonstrate their commitment to quality and accountability. Through its
broad-based governance structure and an inclusive standards development process, URAC
ensures that all stakeholders are represented in setting meaningful standards for the
healthcare industry. For more information, visit www.urac.org.
About inVentiv Medical Management
inVentiv Medical Management, an inVentiv Health company, is a leading national provider of
physician-directed, nurse-supported, technology-enabled, population health management
solutions to third party administrators, self-funded and fully insured plans, employer groups,
Accountable Care Organizations (ACOs) and health plans. With a mission of improving
healthcare quality, costs and outcomes, enabled by the fully integrated inFinitē Platform
inVentiv Medical Management delivers seamless clinical interventions and cost management
that support consumers, providers and payers. inVentiv Medical Management is
headquartered in Charlotte, North Carolina. Please visit http://www.inVentivMM.com for more
information.
About inVentiv Health
inVentiv Health, Inc. is a leading global provider of best-in-class clinical, commercial and
consulting services to companies seeking to accelerate performance. inVentiv offers
convergent services that deliver extraordinary outcomes to clients whose goal is improving
human life. In 40 countries around the world, inVentiv’s 13,000 employees help clients
rapidly transform promising ideas into commercial reality. inVentiv clients include more than
550 pharmaceutical, biotech and life sciences companies, as well as companies that now
see health as part of their mission. inVentiv Health, Inc. is privately owned by inVentiv Group
Holdings, Inc., an organization sponsored by affiliates of Thomas H. Lee Partners, L.P.,
Liberty Lane Partners and members of the inVentiv management team. For more
information, visit http://www.inVentivHealth.com.
This press release contains forward-looking statements within the meaning of the Private Securities Litigation
Reform Act of 1995. Such forward-looking statements involve known and unknown risks that may cause our
performance to differ materially. These forward-looking statements reflect our current views about future events
and are subject to risks, uncertainties and assumptions. We wish to caution readers that certain important factors
may have affected and could in the future affect our actual results and could cause actual results to differ
significantly from those expressed in any forward-looking statement. Such factors include, without limitation: the
impact of our substantial level of indebtedness on our ability to generate sufficient cash to fulfill our obligations
under our existing debt instruments or our ability to incur additional indebtedness; the impact of customer project
delays and cancellations and our ability to sufficiently increase our revenues and manage expenses and capital
3. NEWS RELEASE
expenditures to permit us to fund our operations; the impact of the consummation of any future acquisitions; the
impact of any change in our ratings and the ratings of our debt securities on our relationships with customers,
vendors and other third parties; the impact of any additional leverage we may incur on our ratings and the ratings
of our debt securities; our ability to continue to comply with the covenants and terms of our senior secured credit
facilities and to access sufficient capital under our credit agreement or from other sources of debt or equity
financing to fund our operations; the impact of any default by any of our credit providers; our ability to accurately
forecast costs to be incurred in providing services under fixed price contracts; our ability to accurately forecast
insurance claims within our self- insured programs; the potential impact of pricing pressures on pharmaceutical
manufacturers from healthcare reform initiatives or from changes in the reimbursement policies of third-party
payers; our ability to grow our existing client relationships, obtain new clients and cross-sell our services; the
potential impact of financial, economic, political and other risks, including interest rate and exchange rate risks,
related to conducting business internationally; our ability to successfully operate new lines of business; our ability
to manage our infrastructure and resources to support our growth; our ability to successfully identify new
businesses to acquire, conclude acquisition negotiations and integrate the acquired businesses into our
operation, and achieve the resulting synergies; the resolution of purchase price adjustment disputes in connection
with our recent acquisitions and related impacts; any disruptions, impairments, or malfunctions affecting software
as well as excessive costs or delays that may adversely impact our continued investment in and development of
software; the potential impact of government regulation on us and on our client base; our ability to comply with all
applicable laws as well as our ability to successfully adapt to any changes in applicable laws on a timely and cost
effective basis; our ability to recruit, motivate and retain qualified personnel, including sales representatives; the
possibility that client agreements will be terminated or not renewed; any potential impairment of goodwill or
intangible assets; consolidation in the pharmaceutical industry; changes in trends in the healthcare and
pharmaceutical industries or in pharmaceutical outsourcing, including initiatives by our clients to perform services
we offer internally; our ability to convert backlog into revenue; the potential liability associated with injury to clinical
trial participants; the actual impact of the adoption of certain accounting standards; and our ability to maintain
technological advantages in a variety of functional areas, including sales force automation, electronic claims
surveillance and patient compliance. Holders of our debt instruments are referred to reports provided to investors
from time to time and the offering memoranda provided in connection with the issuance of our notes for further
discussion of these risks and other factors.
# # #