MHC6305 Financial Management of Healthcare OrganizationsMerg.docxannandleola
MHC6305 Financial Management of Healthcare Organizations
Merger Analysis Case Study
Franklin Teaching Hospital
Currently, three hospitals serve the patient base of Palmetto County, Florida, which has a population of about 220,000. The hospitals include the following:
· Franklin Teaching Hospital, a 525-bed, not-for-profit university-related teaching hospital
· Suncoast Regional Medical Center, a 200-bed, for-profit hospital owned by Senate Healthcare, a national chain
· Palmetto General, a 400-bed, not-for-profit, acute care hospital owned by Citrus Healthcare
The service area has a total of 1,125 licensed beds for 200,000 people, or 5.1 beds per 1,000 people, which is higher than the national average of about 3.1 beds per 1,000 people, and much greater than 2 beds per 1,000 people needed under moderately aggressive utilization management. Of course, as a tertiary care facility, Franklin Teaching Hospital receives patients from throughout the state, but the bulk of its patients still come from the local five-county area.
With an excess capacity of hospital beds, the status quo may not survive the changing healthcare environment. Indeed, Palmetto General has had some tough years recently, as evidenced by its number of discharges, which have fallen to 11,412 in 2006 from 12,055 in 2005 and 12,824 in 2004. Additionally, Senate Healthcare has been aggressive in building market share in other areas of Florida through acquisitions. As a result of these factors the local hospital market is likely to witness some consolidation, and the most likely result is the acquisition of Palmetto General by either Franklin Teaching Hospital or Senate Healthcare.
Palmetto General operated as a county hospital for over 50 years and consequently developed a reputation for providing healthcare services to the poor. After many years of operating losses, the county concluded that it could no longer afford to operate the hospital. So, in 1983, the county sold the hospital to Citrus Healthcare, a not-for-profit managed care organization and provider, which by 2006 had become the state's largest integrated healthcare company.
Citrus Healthcare's major business line is managed care. Its numerous plans, including HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point of Service plans), Medicare, and Medicaid, serve over 400,000 members in 31 Florida counties, encompassing all of the major metropolitan areas. In addition to managed care plans, Citrus Healthcare owns nine different providers: two acute care hospitals including Palmetto General, two primary care hospitals, one rehabilitation hospital, one mental health facility, one hospice, one home healthcare provider, and one retirement facility.
Palmetto General is the flagship of Citrus Healthcare's provider network and as such the company has maintained the hospital well in spite of falling inpatient utilization. In fact, in recent years, Palmetto General has built a new, s ...
1IN T R O D U C T I O NThis comprehensive case study ser.docxdrennanmicah
1
IN T R O D U C T I O N
This comprehensive case study serves as a basis for the exercises included throughout the
book.
Coastal Medical Center (CMC) is a licensed, 450-bed regional referral hospital
providing a full range of services. The primary service area is a coastal city and three coun-
ties, with a total population greater than 995,000, located in the Sunbelt. This tricounty
area has had one of the fastest population growth rates in the country for the past five
years. According to the local health planning council, the tricounty population is projected
to increase by 15 percent from 2015 to 2020. Appendix A, at the end of this case study,
provides detailed population statistics for the city and tricounty area.
The population growth rate for households (families) has been 1 to 2 percentage
points higher than the overall population growth. The growth rate of the population under
age 44 shows a young and growing community. Per capita (i.e., per person) income in the
tricounty area is high and increasing. As the population of the tricounty area increases, the
need for healthcare services is anticipated to increase. The area’s economy is largely supported
by manufacturing, with service companies and agriculture accounting for another 35 percent.
Unemployment is typically 6 percent. The overall poverty rate is 12.4 percent. A recent study
revealed that 40,000 city residents are below 125 percent of the established federal poverty level.
HE A LT H C A R E CO S T S
Healthcare costs in the region are high in comparison to healthcare costs in most other
areas in the state. In response to what they feel are excessively high healthcare costs, county
C O A S TA L M E D I C A L C E N T E R
C O M P R E H E N S I V E C A S E
S T U D Y
00_Harrison (2302).indb 1 2/18/16 4:12 PM10/12/2018 - RS0000000000000000000000574903 (Baylee Soper) - Essentials of Strategic Planning
in Healthcare
2 E s s e n t i a l s o f S t r a t e g i c P l a n n i n g i n H e a l t h c a r e
businesses recently formed a business coalition, hired a full-time executive, and publicly
stated their intent to achieve reduction in healthcare costs. The local press has expressed its
concern about the high cost of healthcare in the local community and consistently bashes
the area’s hospitals and physicians. The coalition refused to allow the three major medical
centers in the area to join, despite the fact that each is a major employer.
TH E CO M P E T I T I O N
CMC has two major competitors. Johnson Medical Center (JMC) is the larger of a two-
hospital for-profit healthcare system, and Lutheran Medical Center (LMC) is the larger of
a two-hospital, faith-based not-for-profit healthcare system.
JMC is located less than two miles from CMC and is a 430-bed tertiary care facility.
JMC owns four nursing homes, two assisted living facilities, a durable medical equipment
company, a wellness center, an ambulance service, and an industrial medic.
MHC6305 Financial Management of Healthcare OrganizationsHospit.docxannandleola
MHC6305 Financial Management of Healthcare Organizations
Hospital Performance Assessment Case Study
Eastside Memorial Hospital
Hospitals are accredited by JCAHO (Joint Commission on Accreditation of Healthcare Organizations), which is an independent not-for-profit organization sponsored by a number of professional organizations such as the American Hospital Association (AHA) and the American Medical Association (AMA). (For more information on the Joint Commission, visit their Web site at http://www.jcaho.org.) Although accreditation is optional for hospitals, it is generally required to qualify for governmental (Medicare and Medicaid) reimbursement, and hence the vast majority of hospitals apply for accreditation. Eastside passed its latest Joint Commission accreditation with flying colors, receiving an Accreditation with Full Standards Compliance, the highest of eight accreditation categories.
In recent years, competition among the four hospitals in Eastside's service area has been keen, but friendly. However, a large for-profit chain recently purchased the for-profit hospital, which has resulted in some anxiety among the managers of the other three hospitals because of the chain's reputation for aggressively increasing market share in the markets they serve.
Relevant financial and operating data for Eastside are in Tables 1 through 4, and selected industry data are in Tables 5 and 6. (Note: The industry data given in the case are for illustrative purposes only and do not represent actual data for the years specified. For a better idea of the type of comparative data actually available for hospitals, see the Ingenix Web site at http://www.hospitalbenchmarks.com.) In addition, the following information was extracted from the notes section of Eastside's 2006 Annual Report:
· A significant portion of the hospital's net patient service revenue was generated by patients who are covered either by Medicare, Medicaid, or other government programs as well as by various private plans, including managed care plans, which operate according to hospital contracts that specify discounts from charges. In general, the proportional amount of deductions is similar between inpatients and outpatients. The gross/net revenue breakdown for both inpatient and outpatient services is given below (in millions of dollars):
2002
2003
2004
2005
2006
Gross patient service revenue
Inpatient
25.16
25.275
26.117
29.148
33.216
Outpatient
4.748
5.969
6.535
9.130
11.912
Gross patient revenue
29.908
31.244
32.652
38.278
45.128
Revenue deductions
Contractual allowances
2.489
2.053
1.729
5.196
7.516
Charity care
1.759
1.955
2.127
2.506
3.030
Total deductions
4.248
4.008
3.856
7.702
10.546
Net patient service revenue
25.661
27.236
28.796
30.576
34.582
· Inventories are stated at the lower of cost, determined on a first-in, first-out basis, or market value.
· The breakdown of operating expenses between inpatient and outpatient activities for 2002 through 2006 is as follows ...
The 10 Elements of Art1. Color2. Form3. Line4. Mass5. S.docxtodd801
The 10 Elements of Art:
1. Color
2. Form
3. Line
4. Mass
5. Shape
6. Space
7. Texture
8. Time and Motion
9. Value
10. Volume
The 10 Principles of Art:
1. Balance
2. Contrast
3. Emphasis
4. Focal Point
5. Pattern
6. Proportion
7. Rhythm
8. Scale
9. Unity
10. Variety
1
IN T R O D U C T I O N
This comprehensive case study serves as a basis for the exercises included throughout the
book.
Coastal Medical Center (CMC) is a licensed, 450-bed regional referral hospital
providing a full range of services. The primary service area is a coastal city and three coun-
ties, with a total population greater than 995,000, located in the Sunbelt. This tricounty
area has had one of the fastest population growth rates in the country for the past five
years. According to the local health planning council, the tricounty population is projected
to increase by 15 percent from 2015 to 2020. Appendix A, at the end of this case study,
provides detailed population statistics for the city and tricounty area.
The population growth rate for households (families) has been 1 to 2 percentage
points higher than the overall population growth. The growth rate of the population under
age 44 shows a young and growing community. Per capita (i.e., per person) income in the
tricounty area is high and increasing. As the population of the tricounty area increases, the
need for healthcare services is anticipated to increase. The area’s economy is largely supported
by manufacturing, with service companies and agriculture accounting for another 35 percent.
Unemployment is typically 6 percent. The overall poverty rate is 12.4 percent. A recent study
revealed that 40,000 city residents are below 125 percent of the established federal poverty level.
HE A LT H C A R E CO S T S
Healthcare costs in the region are high in comparison to healthcare costs in most other
areas in the state. In response to what they feel are excessively high healthcare costs, county
C O A S TA L M E D I C A L C E N T E R
C O M P R E H E N S I V E C A S E
S T U D Y
00_Harrison (2302).indb 1 2/18/16 4:12 PM10/12/2018 - RS0000000000000000000000574903 (Baylee Soper) - Essentials of Strategic Planning
in Healthcare
2 E s s e n t i a l s o f S t r a t e g i c P l a n n i n g i n H e a l t h c a r e
businesses recently formed a business coalition, hired a full-time executive, and publicly
stated their intent to achieve reduction in healthcare costs. The local press has expressed its
concern about the high cost of healthcare in the local community and consistently bashes
the area’s hospitals and physicians. The coalition refused to allow the three major medical
centers in the area to join, despite the fact that each is a major employer.
TH E CO M P E T I T I O N
CMC has two major competitors. Johnson Medical Center (JMC) is the larger of a two-
hospital for-profit healthcare system, and Lutheran Medical Center (LMC) is the larger of
a two-hospital, faith-based not-for-pro.
Can you help with the answers for Twin falls community hospital ques.pdfAmansupan
Can you help with the answers for Twin falls community hospital questions?
/ 4
1
Copyright
2013
6/15/12
Case 5
Twin Falls Community Hospital
(Capital Investment Analysis)
Twin Falls Community Hospital is a 250-bed, not-for-profit hospital located
in the city of Twin Falls, the largest city in Idaho’s Magic Valley region
and the seventh largest in the state. The hospital was founded in 1972 and
today is acknowledged to be one of the leading healthcare providers in the
area.
Twin Falls’ management is currently evaluating a proposed ambulatory
(outpatient) surgery center. Over 80 percent of all outpatient surgery is
performed by specialists in gastroenterology, gynecology, ophthalmology,
otolaryngology, orthopedics, plastic surgery, and urology. Ambulatory surgery
requires an average of about one and one-half hours; minor procedures take
about one hour or less, and major procedures take about two or more hours.
About 60 percent of the procedures are performed under general anesthesia, 30
percent under local anesthesia, and 10 percent under regional or spinal
anesthesia. In general, operating rooms are built in pairs so that a patient
can be prepped in one room while the surgeon is completing a procedure in the
other room.
The outpatient surgery market has experienced significant growth since the
first ambulatory surgery center opened in 1970. This growth has been fueled
by three factors. First, rapid advancements in technology have enabled many
procedures that were historically performed in inpatient surgical suites to
be switched to outpatient settings. This shift was caused mainly by advances
in laser, laparoscopic, endoscopic, and arthroscopic technologies. Second,
Medicare has been aggressive in approving new minimally invasive surgery
techniques, so the number of Medicare patients utilizing outpatient surgery
services has grown substantially. Finally, patients prefer outpatient
surgeries because they are more convenient, and third-party payers prefer
them because they are less costly.
These factors have led to a situation in which the number of inpatient
surgeries has grown little (if at all) in recent years while the number of
outpatient procedures has been growing at over 10 percent annually and now
totals about 22 million a year. Rapid growth in the number of outpatient
surgeries has been accompanied by a corresponding growth in the number of
outpatient surgical facilities. The number currently stands at about 5,000
nationwide, so competition in many areas has become intense. Somewhat
surprisingly, there is no outpatient surgery center in the Twin Falls area,
although there have been rumors that local physicians are exploring the
feasibility of a physician-owned facility.
2
The hospital currently owns a parcel of land that is a perfect location for
the surgery center. The land was purchased five years ago for $350,000, and
last year the hospital spent (and expensed for tax purposes) $25,000 to clear
the land and put in sewer and utility .
MHC6305 Financial Management of Healthcare OrganizationsMerg.docxannandleola
MHC6305 Financial Management of Healthcare Organizations
Merger Analysis Case Study
Franklin Teaching Hospital
Currently, three hospitals serve the patient base of Palmetto County, Florida, which has a population of about 220,000. The hospitals include the following:
· Franklin Teaching Hospital, a 525-bed, not-for-profit university-related teaching hospital
· Suncoast Regional Medical Center, a 200-bed, for-profit hospital owned by Senate Healthcare, a national chain
· Palmetto General, a 400-bed, not-for-profit, acute care hospital owned by Citrus Healthcare
The service area has a total of 1,125 licensed beds for 200,000 people, or 5.1 beds per 1,000 people, which is higher than the national average of about 3.1 beds per 1,000 people, and much greater than 2 beds per 1,000 people needed under moderately aggressive utilization management. Of course, as a tertiary care facility, Franklin Teaching Hospital receives patients from throughout the state, but the bulk of its patients still come from the local five-county area.
With an excess capacity of hospital beds, the status quo may not survive the changing healthcare environment. Indeed, Palmetto General has had some tough years recently, as evidenced by its number of discharges, which have fallen to 11,412 in 2006 from 12,055 in 2005 and 12,824 in 2004. Additionally, Senate Healthcare has been aggressive in building market share in other areas of Florida through acquisitions. As a result of these factors the local hospital market is likely to witness some consolidation, and the most likely result is the acquisition of Palmetto General by either Franklin Teaching Hospital or Senate Healthcare.
Palmetto General operated as a county hospital for over 50 years and consequently developed a reputation for providing healthcare services to the poor. After many years of operating losses, the county concluded that it could no longer afford to operate the hospital. So, in 1983, the county sold the hospital to Citrus Healthcare, a not-for-profit managed care organization and provider, which by 2006 had become the state's largest integrated healthcare company.
Citrus Healthcare's major business line is managed care. Its numerous plans, including HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point of Service plans), Medicare, and Medicaid, serve over 400,000 members in 31 Florida counties, encompassing all of the major metropolitan areas. In addition to managed care plans, Citrus Healthcare owns nine different providers: two acute care hospitals including Palmetto General, two primary care hospitals, one rehabilitation hospital, one mental health facility, one hospice, one home healthcare provider, and one retirement facility.
Palmetto General is the flagship of Citrus Healthcare's provider network and as such the company has maintained the hospital well in spite of falling inpatient utilization. In fact, in recent years, Palmetto General has built a new, s ...
1IN T R O D U C T I O NThis comprehensive case study ser.docxdrennanmicah
1
IN T R O D U C T I O N
This comprehensive case study serves as a basis for the exercises included throughout the
book.
Coastal Medical Center (CMC) is a licensed, 450-bed regional referral hospital
providing a full range of services. The primary service area is a coastal city and three coun-
ties, with a total population greater than 995,000, located in the Sunbelt. This tricounty
area has had one of the fastest population growth rates in the country for the past five
years. According to the local health planning council, the tricounty population is projected
to increase by 15 percent from 2015 to 2020. Appendix A, at the end of this case study,
provides detailed population statistics for the city and tricounty area.
The population growth rate for households (families) has been 1 to 2 percentage
points higher than the overall population growth. The growth rate of the population under
age 44 shows a young and growing community. Per capita (i.e., per person) income in the
tricounty area is high and increasing. As the population of the tricounty area increases, the
need for healthcare services is anticipated to increase. The area’s economy is largely supported
by manufacturing, with service companies and agriculture accounting for another 35 percent.
Unemployment is typically 6 percent. The overall poverty rate is 12.4 percent. A recent study
revealed that 40,000 city residents are below 125 percent of the established federal poverty level.
HE A LT H C A R E CO S T S
Healthcare costs in the region are high in comparison to healthcare costs in most other
areas in the state. In response to what they feel are excessively high healthcare costs, county
C O A S TA L M E D I C A L C E N T E R
C O M P R E H E N S I V E C A S E
S T U D Y
00_Harrison (2302).indb 1 2/18/16 4:12 PM10/12/2018 - RS0000000000000000000000574903 (Baylee Soper) - Essentials of Strategic Planning
in Healthcare
2 E s s e n t i a l s o f S t r a t e g i c P l a n n i n g i n H e a l t h c a r e
businesses recently formed a business coalition, hired a full-time executive, and publicly
stated their intent to achieve reduction in healthcare costs. The local press has expressed its
concern about the high cost of healthcare in the local community and consistently bashes
the area’s hospitals and physicians. The coalition refused to allow the three major medical
centers in the area to join, despite the fact that each is a major employer.
TH E CO M P E T I T I O N
CMC has two major competitors. Johnson Medical Center (JMC) is the larger of a two-
hospital for-profit healthcare system, and Lutheran Medical Center (LMC) is the larger of
a two-hospital, faith-based not-for-profit healthcare system.
JMC is located less than two miles from CMC and is a 430-bed tertiary care facility.
JMC owns four nursing homes, two assisted living facilities, a durable medical equipment
company, a wellness center, an ambulance service, and an industrial medic.
MHC6305 Financial Management of Healthcare OrganizationsHospit.docxannandleola
MHC6305 Financial Management of Healthcare Organizations
Hospital Performance Assessment Case Study
Eastside Memorial Hospital
Hospitals are accredited by JCAHO (Joint Commission on Accreditation of Healthcare Organizations), which is an independent not-for-profit organization sponsored by a number of professional organizations such as the American Hospital Association (AHA) and the American Medical Association (AMA). (For more information on the Joint Commission, visit their Web site at http://www.jcaho.org.) Although accreditation is optional for hospitals, it is generally required to qualify for governmental (Medicare and Medicaid) reimbursement, and hence the vast majority of hospitals apply for accreditation. Eastside passed its latest Joint Commission accreditation with flying colors, receiving an Accreditation with Full Standards Compliance, the highest of eight accreditation categories.
In recent years, competition among the four hospitals in Eastside's service area has been keen, but friendly. However, a large for-profit chain recently purchased the for-profit hospital, which has resulted in some anxiety among the managers of the other three hospitals because of the chain's reputation for aggressively increasing market share in the markets they serve.
Relevant financial and operating data for Eastside are in Tables 1 through 4, and selected industry data are in Tables 5 and 6. (Note: The industry data given in the case are for illustrative purposes only and do not represent actual data for the years specified. For a better idea of the type of comparative data actually available for hospitals, see the Ingenix Web site at http://www.hospitalbenchmarks.com.) In addition, the following information was extracted from the notes section of Eastside's 2006 Annual Report:
· A significant portion of the hospital's net patient service revenue was generated by patients who are covered either by Medicare, Medicaid, or other government programs as well as by various private plans, including managed care plans, which operate according to hospital contracts that specify discounts from charges. In general, the proportional amount of deductions is similar between inpatients and outpatients. The gross/net revenue breakdown for both inpatient and outpatient services is given below (in millions of dollars):
2002
2003
2004
2005
2006
Gross patient service revenue
Inpatient
25.16
25.275
26.117
29.148
33.216
Outpatient
4.748
5.969
6.535
9.130
11.912
Gross patient revenue
29.908
31.244
32.652
38.278
45.128
Revenue deductions
Contractual allowances
2.489
2.053
1.729
5.196
7.516
Charity care
1.759
1.955
2.127
2.506
3.030
Total deductions
4.248
4.008
3.856
7.702
10.546
Net patient service revenue
25.661
27.236
28.796
30.576
34.582
· Inventories are stated at the lower of cost, determined on a first-in, first-out basis, or market value.
· The breakdown of operating expenses between inpatient and outpatient activities for 2002 through 2006 is as follows ...
The 10 Elements of Art1. Color2. Form3. Line4. Mass5. S.docxtodd801
The 10 Elements of Art:
1. Color
2. Form
3. Line
4. Mass
5. Shape
6. Space
7. Texture
8. Time and Motion
9. Value
10. Volume
The 10 Principles of Art:
1. Balance
2. Contrast
3. Emphasis
4. Focal Point
5. Pattern
6. Proportion
7. Rhythm
8. Scale
9. Unity
10. Variety
1
IN T R O D U C T I O N
This comprehensive case study serves as a basis for the exercises included throughout the
book.
Coastal Medical Center (CMC) is a licensed, 450-bed regional referral hospital
providing a full range of services. The primary service area is a coastal city and three coun-
ties, with a total population greater than 995,000, located in the Sunbelt. This tricounty
area has had one of the fastest population growth rates in the country for the past five
years. According to the local health planning council, the tricounty population is projected
to increase by 15 percent from 2015 to 2020. Appendix A, at the end of this case study,
provides detailed population statistics for the city and tricounty area.
The population growth rate for households (families) has been 1 to 2 percentage
points higher than the overall population growth. The growth rate of the population under
age 44 shows a young and growing community. Per capita (i.e., per person) income in the
tricounty area is high and increasing. As the population of the tricounty area increases, the
need for healthcare services is anticipated to increase. The area’s economy is largely supported
by manufacturing, with service companies and agriculture accounting for another 35 percent.
Unemployment is typically 6 percent. The overall poverty rate is 12.4 percent. A recent study
revealed that 40,000 city residents are below 125 percent of the established federal poverty level.
HE A LT H C A R E CO S T S
Healthcare costs in the region are high in comparison to healthcare costs in most other
areas in the state. In response to what they feel are excessively high healthcare costs, county
C O A S TA L M E D I C A L C E N T E R
C O M P R E H E N S I V E C A S E
S T U D Y
00_Harrison (2302).indb 1 2/18/16 4:12 PM10/12/2018 - RS0000000000000000000000574903 (Baylee Soper) - Essentials of Strategic Planning
in Healthcare
2 E s s e n t i a l s o f S t r a t e g i c P l a n n i n g i n H e a l t h c a r e
businesses recently formed a business coalition, hired a full-time executive, and publicly
stated their intent to achieve reduction in healthcare costs. The local press has expressed its
concern about the high cost of healthcare in the local community and consistently bashes
the area’s hospitals and physicians. The coalition refused to allow the three major medical
centers in the area to join, despite the fact that each is a major employer.
TH E CO M P E T I T I O N
CMC has two major competitors. Johnson Medical Center (JMC) is the larger of a two-
hospital for-profit healthcare system, and Lutheran Medical Center (LMC) is the larger of
a two-hospital, faith-based not-for-pro.
Can you help with the answers for Twin falls community hospital ques.pdfAmansupan
Can you help with the answers for Twin falls community hospital questions?
/ 4
1
Copyright
2013
6/15/12
Case 5
Twin Falls Community Hospital
(Capital Investment Analysis)
Twin Falls Community Hospital is a 250-bed, not-for-profit hospital located
in the city of Twin Falls, the largest city in Idaho’s Magic Valley region
and the seventh largest in the state. The hospital was founded in 1972 and
today is acknowledged to be one of the leading healthcare providers in the
area.
Twin Falls’ management is currently evaluating a proposed ambulatory
(outpatient) surgery center. Over 80 percent of all outpatient surgery is
performed by specialists in gastroenterology, gynecology, ophthalmology,
otolaryngology, orthopedics, plastic surgery, and urology. Ambulatory surgery
requires an average of about one and one-half hours; minor procedures take
about one hour or less, and major procedures take about two or more hours.
About 60 percent of the procedures are performed under general anesthesia, 30
percent under local anesthesia, and 10 percent under regional or spinal
anesthesia. In general, operating rooms are built in pairs so that a patient
can be prepped in one room while the surgeon is completing a procedure in the
other room.
The outpatient surgery market has experienced significant growth since the
first ambulatory surgery center opened in 1970. This growth has been fueled
by three factors. First, rapid advancements in technology have enabled many
procedures that were historically performed in inpatient surgical suites to
be switched to outpatient settings. This shift was caused mainly by advances
in laser, laparoscopic, endoscopic, and arthroscopic technologies. Second,
Medicare has been aggressive in approving new minimally invasive surgery
techniques, so the number of Medicare patients utilizing outpatient surgery
services has grown substantially. Finally, patients prefer outpatient
surgeries because they are more convenient, and third-party payers prefer
them because they are less costly.
These factors have led to a situation in which the number of inpatient
surgeries has grown little (if at all) in recent years while the number of
outpatient procedures has been growing at over 10 percent annually and now
totals about 22 million a year. Rapid growth in the number of outpatient
surgeries has been accompanied by a corresponding growth in the number of
outpatient surgical facilities. The number currently stands at about 5,000
nationwide, so competition in many areas has become intense. Somewhat
surprisingly, there is no outpatient surgery center in the Twin Falls area,
although there have been rumors that local physicians are exploring the
feasibility of a physician-owned facility.
2
The hospital currently owns a parcel of land that is a perfect location for
the surgery center. The land was purchased five years ago for $350,000, and
last year the hospital spent (and expensed for tax purposes) $25,000 to clear
the land and put in sewer and utility .
Atan M. ZuckermanMetro Mercy Hospital (MMH) has been in a .docxikirkton
Atan M. Zuckerman
Metro Mercy Hospital (MMH) has been in a down-
wardspiral, resulting in losses in tbe past few years
anda tenuous casb position. Altbougb a new CEO
bas recently been biredanda turnaround begun, tbe
board is unclear as to wbetber tbe bospital can and
sbould remain independent now and in tbe future.
Wbat sbould tbe board do?
The Siiiuiatiioini
MMH is a Catholic-sponsored, freestanding,
?oo-bed hospital with annual operating revenues
of $125 million, located in the western end of a
city in a large metropolitan area. The hospital is a
relatively undifferentiated, general acute care
hospital with the typical range of medical, surgi-
cal, ob/gyn, and pédiatrie services. The hospital
does not provide any tertiary or even near tertiary
services. It has a very busy emergency depart-
ment and a network of owned physician practices
in the area it serves; these practices provide
mainly primary care services and constitute a
significant portion of the primary care medical
staff of the hospital.
MMH is located in a rapidly changing community.
The population it has historically served, primarily
second- and third-generation Italian- and
Polish-Americans, has moved to the suburbs
and/or aged. These groups have been replaced
by African-Americans, and more recently
Hispanics, particularly immigrants from
Mexico. Although the service area population
was expected to decrease from 1990 to ?ooo,
Census Bureau data indicate that the population—
especially Hispanic—actually grew. Recent
estimates suggest continued slow growth and
transformation of service area demographics.
MMH faces veiy stiff competition due in part to
the number of competitors in and around its
service area and the general overbeddedness in
the region. Its main competitors include St.
Luke's Hospital, the 600-bed flagship of a veiy
successful multihospital system, located a few
miles west of MMH in an affluent suburban area;
a nationally recognized teaching hospital located
within five miles of MMH; a number of other ter-
tiary teaching hospitals located in and around the
downtown area of the city; and one large for-
profit community hospital and two large system-
affiliated community hospitals all located within
three to five miles of MMH.
MMH has experienced downward trends in uti-
lization and financial performance since 2004.
In 2006, the hospital had an operating loss of
$10.9 million (total loss of $10.6 million) after
an operating loss of $10 million (total loss of
$10.2 million) in 2005. The financial situation
led to the resignation of the previous CEO and an
interim management arrangement for about
12 months until a new CEO was named and began
work early in 2007. The board was also reorgan-
ized and a new lay board chair and other board
members with strong business skills were added
in 2006-07.
The CEO's first priority was to restore the
organization to financial health. By fall 2007,
118 AUGUST 2008 healthcare financial management
METRO MERCY HOSPITA ...
STRATEGY CHALLENGE
Alan M. Zuckerman
What Would You Do?
should this successful integrated system divest one of its business units?
The Problem
Midwest Integrated Health is experiencing intensify-
ing competitive pressures and declining financial per-
formance in its regional pharmacy business. Midwest's
management team has solicited offers to purchase the
business from three vendors and believes a sale is in
the best interest of Midwest Integrated Health. The
board is reviewing management's report and recom-
mendations, including the bids ofthe three vendors.
What should the board do?
The Situation
Midwest Integrated Health is a highly successful,
growing, not-for-profit integrated delivery system
operating in a smaU urban area in mid-America.
The system has had six straight years of outstand-
ing performance, with revenues increasing from
$?25 miUion to $375 miUion and total margins
averaging 1? percent peryear. As a result, the sys-
tem has an exceptional balance sheet, including
$4,00 nullion in reserves and very little debt.
Financial forecasts for the next five years, includ-
ing ahility to fund capital needs, are exceUent.
In addition to its flagship hospital. Midwest has a
foundation and four related business lines:
> Midwest Begional Pharmacy (multi-outlet retail
pharmacy operation)
> Midwest Medical Supply (provider of medical
equipment and supplies to the general public
and hospital patients)
> Midwest Extended Care (operator of a ?3o-bed
nursing home and 175-unit retirement center)
> Midwest Ventures (for-profit company that
operates an ambulance service, a day care cen-
ter, and two ambulatory surgery centers, and
manages 3o physician practices)
The hospital represents about 35 percent of over-
all assets and 75 percent of total revenues, but the
related business lines have been solid performers
and nearly all members ofthe leadership team
agree that good synergy exists among those lines.
Nonetheless, the management team has heen
increasingly concerned about the future viability
of its pharmacy unit. Historically this entity has
been a stellar performer, but its performance is
slipping, and growing competitive pressures are
emerging. Growth in prescriptions filled was up
18 percent in ?ooi-o? but has decreased every
year since, with 2005-06 growth only 1.5 percent.
Market share in the region reached a high of 41
percent in 2005 and decreased for the first time
in 2006. With significant expansion of national
competitors locally in 2006-07, share is expected
to drop dramatically in 2007. The unit is still
profitable, but profitability is projected to decline
beginning in 2007. Management has summarized
the current situation as follows:
> Revenue growth is slowing dramatically.
> Scripts wUl be flat for 2007 at best.
> Some evidence of margin compression exists.
> Walgreens has embarked on a rapid regional
expansion plan.
As a result of growing concerns about this busi-
ness unit, management solicited propos.
Case 3Charitable Contributions and Debt A Comparison of St. Jude .docxtidwellveronique
Case 3Charitable Contributions and Debt: A Comparison of St. Jude Children's Research Hospital/ALSAC and Universal Health Services
Case Topics Outline
1. St. Jude Children's Research Hospital/ALSAC
1. Primary Objective
2. Sources of Capital
3. Reporting Practices
2. Universal Health Services
1. Investor-Owned Hospital
2. Debt Including Leases
3. Comparison
Hospitals are an industry in which both not-for-profits and investor-owned facilities operate. The sources of capital available to the not-for-profits include charitable contributions and debt offerings—unless they are governmental, in which case, higher taxes are also an alternative. Debt availability is always, in part, a function of performance, and just as failures have arisen in both sectors, about one-third of the investor-owned hospitals have been described as losing money. Of interest is how can one effectively evaluate such an industry, with this type of diversity in organizational forms and capital availability? A necessary prerequisite to such an evaluation is to have a firm understanding of how charitable contributions are presented.
St. Jude Children's Research Hospital/ALSAC has the mission of finding cures for children with catastrophic diseases through research and treatment. For the fiscal year 1999, this entity reported total assets of $221,664,232 and income of $177,071,890. A Web site at http://www.stjude.org, as well as Guidestar's listing, references a Form 990 (Return of Organization Exempt from Income Tax) filing, availability of audited financial statements upon request, and information that the hospital has 2,100 employees and 350 volunteers. Founded in 1962, the organization seeks funds from contributions and grants for unrestricted operating expenses, specific projects, buildings, and endowments. More than 4,000 patients are seen annually, with a hospital maintaining 56 beds. The Form 990, Part III states that the hospital provided 15,231 inpatient days of care during the fiscal year and patients made 40,982 clinic visits. ALSAC is the American Lebanese Syrian Associated Charities, Inc., the fund-raising arm of St. Jude Children's Research Hospital. It reported 1999 total assets of $1,007,699,320 and income of $274,123,399. This organization reports the number of employees as 565 and the number of volunteers as 800,000. With its sole focus on the hospital, ALSAC's self-description explains that no child has ever been turned away due to an inability to pay for treatment and explains key accomplishments in the research area achieved by St. Jude's research and treatment of children with catastrophic diseases. What is borne out by the example of St. Jude is the fact that a review of the Form 990 filed for the fiscal year ending 6/30/99 indicates in Part VI the names of related organizations: ALSAC and St. Jude Hospital Foundation, both of which are tax exempt. To gain a sense of capital availability to a not-for-profit entity, affiliated entities must be consider ...
MMLP3.2InstructionsIn LP01.1, LP02.1, and LP03.1 you were aske.docxraju957290
MMLP3.2Instructions
In LP01.1, LP02.1, and LP03.1 you were asked to prepare milestones for a business plan. An executive summary, while written last, is the first part of a business plan. This document is what the executives will read to determine if the business plan has merit and may determine whether or not they will read the entire business plan. The executive summary covers all the key points of the business plan and should be 650-1,000 words. Must use 3 scholarly sources and cite APA.
Here are some helpful sources that discuss what to include in your Executive Summary:
· Chron
· SBA
REFERENCE ONLY: Below is the LP1.1 information
Description of the Business
Wickham Hospital is a rural hospital that provides quality healthcare services to the local community. Our mission is to engage in the promotion of healthier lives by providing quality healthcare services. This is to be executed in a fiscally responsible way that promotes the social, physical, spiritual and psychological wellbeing of the community and patients it serves. Further, the hospital aims at serving all members of the community regardless of their gender, religion, race or age.
Among the services provided by the hospital include outpatient and inpatient services, emergency services, primary care, skilled nursing care, center for rehabilitation medicine, a lung cancer center and surgical services. Our main competitors are some hospitals established within the same community. Among these are Greenview Hospital, Jordan Memorial Hospital and Sloan Hospital. These hospitals offer outpatient and inpatient services as well as other services such as primary stroke services, rehabilitation for pediatric polio patients.
Recommendations to Stand out of the Competition
To stay on top of the competition, Wickham Hospital needs to invest and adapt to the most recent technology to ensure efficient delivery of quality medical services. Further, all healthcare personnel needs to undergo further training through platforms such as seminars and online educational forums. This will promote safe and efficient delivery of services to patients as they promote the quality of life within the community. Besides this, management needs to be keener with the appropriate allocation and deployment of resources to ensure that all areas are sufficiently covered (Enthoven, 2014).
How to Accommodate a Global Business Environment
The hospital currently serves the adjacent community and a few consumers from the outskirts. To broaden into the global business environment, a few strides should be taken. For instance, a website should be created describing the business and services offered. This way, international consumers will seek the business even when they come visiting within the local community. Further, the organization could seek for international investors whose partnership or involvement would attract international healthcare consumers towards the organization (Lunt & Mannion, 2014). The business ...
Create 5- or 6-slide Microsoft® PowerPoint® presentation.docxclayrhr
Create
5- or 6-slide Microsoft
®
PowerPoint
®
presentation with speaker notes illustrating your findings to Case 3, Charitable Contributions and Debt: A Comparison of St. Jude Children’s Research Hospital/ALSAC and Universal Health Services in Ch. 5 of
Mastery of the Financial Accounting Research System (FARS) Through Cases
.
Case 3Charitable Contributions and Debt: A Comparison of St. Jude Children's Research Hospital/ALSAC and Universal Health Services
Case Topics Outline
St. Jude Children's Research Hospital/ALSAC
Primary Objective
Sources of Capital
Reporting Practices
Universal Health Services
Investor-Owned Hospital
Debt Including Leases
Comparison
Hospitals are an industry in which both not-for-profits and investor-owned facilities operate. The sources of capital available to the not-for-profits include charitable contributions and debt offerings—unless they are governmental, in which case, higher taxes are also an alternative. Debt availability is always, in part, a function of performance, and just as failures have arisen in both sectors, about one-third of the investor-owned hospitals have been described as losing money. Of interest is how can one effectively evaluate such an industry, with this type of diversity in organizational forms and capital availability? A necessary prerequisite to such an evaluation is to have a firm understanding of how charitable contributions are presented.
St. Jude Children's Research Hospital/ALSAC has the mission of finding cures for children with catastrophic diseases through research and treatment. For the fiscal year 1999, this entity reported total assets of $221,664,232 and income of $177,071,890. A Web site at
http://www.stjude.org
, as well as Guidestar's listing, references a Form 990 (Return of Organization Exempt from Income Tax) filing, availability of audited financial statements upon request, and information that the hospital has 2,100 employees and 350 volunteers. Founded in 1962, the organization seeks funds from contributions and grants for unrestricted operating expenses, specific projects, buildings, and endowments. More than 4,000 patients are seen annually, with a hospital maintaining 56 beds. The Form 990, Part III states that the hospital provided 15,231 inpatient days of care during the fiscal year and patients made 40,982 clinic visits. ALSAC is the American Lebanese Syrian Associated Charities, Inc., the fund-raising arm of St. Jude Children's Research Hospital. It reported 1999 total assets of $1,007,699,320 and income of $274,123,399. This organization reports the number of employees as 565 and the number of volunteers as 800,000. With its sole focus on the hospital, ALSAC's self-description explains that no child has ever been turned away due to an inability to pay for treatment and explains key accomplishments in the research area achieved by St. Jude's research and treatment of children with catastrophic diseases. What is borne out by the example of St. Jude is t.
STRATEGY CHALLENGE
Alan M. Zuckerman
What Would You Do? '
are freestanding emergency centers
an idea whose time has come?
The Problem
The relatively fragmented, underserved, sparsely
populated but now rapidly growir\g market to the east
of Small City General Hospital has been "discovered"
by providers further east at the periphery of a large
metropolitan area. To secure its position in this newly
emerging battleground, Small City General Hospital
is considering a bold move—developing two freestanding
emergency centers. Does this make sense strategically
and financially?
The Situation
Small City General Hospital is one of the two
large hospitals located in an old. declining,
small industrial city ahout 60 miles from a large
Midwestern city (see map). As the hig city has
grown and expanded, its suhurhan areas have
gradually crept closer to Small City General
Hospital's service area. Right now, a "no-man's
land" huffer of ahout 10 miles exists hetween the
edge of the small city and the big city's suhurhs.
This hucolic. rural area is heginning to he
developed and the projections for the foreseeable
future are for rapid growth (see tahle helow).
Some of the hospitals and health systems on the
eastern end of the emerging hattleground are
contemplating initiatives in this area. Although
nothing is definite yet, rumors ahound. The
potential exists for expansion west into the area
of one or more of the large system-affiliated
medical groups, development of major amhula-
toiy care centers, and possihly, despite certifi-
cate-of-need barriers, a satellite hospital. Small
City General Hospital is concerned ahout this
march west and southwest by formidable com-
petitors. What, if anything, shotdditdo?
Alternative Considerations
Small City General Hospital reviewed a full range
of possible alternative pre-emptive strikes and
responses, including many of the initiatives its
competitors appear to be contemplating. Given
the nature of the competition and the high stakes
SMALL CITY GENERAL HOSPITAL PROPOSED PRIMARY SERVICE AREA POPULATION 2005 TO 2010
Ages
0-17
18-44
45-64
65+
Total
2005
38,200
53,970
43,690
19,490
155,350
SKal
2010
39,930
57,370
51,100
23,660
172,060
% Change
4.5
6.3
17.0
21.4
10.8
Site 2
2005
58,650
78,470
56.950
19,060
213,130
2010
62,840
84.000
71,410
25,220
243,470
% Change
7.1
70
25.4
32.3
142
> Both site 1 and site 2 primary service area populations are projected to increase 11 percent to 14 percent by 2010.
> Largest increases are projected for the 45-64 and 65+ age cohorts.
> The site 2 primary service area is more populous than the site 1 primary service area and is projected to
increase at a faster rate across all age cohorts.
Source: Claritas, 2006.
114 AUGUST 2007 healthcare financial management
PROPOSED SITE 1 A N D SITE 2 SERVICE AREAS
Legend
H Site 1 Primary Service Area
Site 2 Primary Service Area
Competitor Centers
D Medical Center A
B Medicai Center B
O Medical Center.
• •Intensity of service• •Charges for specific procedures.docxanhlodge
• •Intensity of service
• •Charges for specific procedures
(Cleverley 243-254)
Cleverley, William O. Essentials of Health Care Finance, 7th Edition.
Jones & Bartlett Learning, 20101022. VitalBook file.
Chapter 12 Financial Analysis of Alternative
Healthcare Firms
LEARNING OBJECTIVES
After studying this chapter, you should be able to do the following:
• 1.List some of the major nonhospital and nonphysician
sectors of the healthcare industry.
• 2.Discuss the sources of revenue for the nursing home
industry.
Average Case Weight =
36
30
=
1.2
• 3.Discuss the major sources of revenue and expenses of
medical groups.
• 4.List and describe the major organizational types of
physician groups.
• 5.Describe alternative health maintenance organization
arrangements.
REAL-WORLD SCENARIO
Laura Rose has been recently appointed to the Board of ElderCare, a
large, for-profit operator of skilled nursing facilities (SNFs) around the
country. Laura’s first committee assignment is to the Treasury
Committee because of her prior business experience. Although Laura
had extensive experience as a hospital administrator, she had
relatively little familiarity with the SNF industry. Upon reviewing
ElderCare’s recent financial statements, she was concerned about the
dramatically declining financial position. She noticed that revenues
were declining on per facility and per patient bases. Meanwhile, the
company’s debt had been downgraded, and its borrowing costs had
risen substantially.
She is aware that Medicare implemented a SNF prospective payment
system as part of the Balanced Budget Act of 1997. Payment
increases by Medicare and Medicaid have not kept pace with
increases in costs in recent years. She wonders whether this might be
a factor in the company’s financing issues. In general, profitability in
the long-term care industry has declined significantly in recent years,
and several industry leaders had filed for bankruptcy protection.
Although some believe that SNF prospective payment systems were
largely to blame, other factors, such as ill-advised acquisitions,
excessive long-term debt, and poor balance sheets, probably
contributed as well. In essence, she is unsure whether ElderCare’s
financing difficulties are unique to management issues at ElderCare or
whether they reflect more general market conditions and economic
and reimbursement trends.
To understand the issue better, Laura needs to estimate the direct
financial impact of SNF reimbursement. She asked the ElderCare
treasury and controller’s office staff to prepare an analysis of the
financial performance of selected long-term care facilities over the
period 2006 to 2010. In particular, she wants to know how SNF-bond
ratings have been affected by prospective payment systems and what
other factors might have contributed to the industry’s deteriorating
financial performance.
In Chapter 11 we discussed the measures and concepts of financial
analysis in some .
3Running Head Course Project Final SubmissionChanasha Owens.docxgilbertkpeters11344
3
Running Head: Course Project Final Submission
Chanasha Owens
Accounting & Finance for Healthcare Managers B6501
Argosy University-Sarasota
April 13, 2013
NYU Hospital center is an 879 bed not-for-profit (NFP) hospital in a major city. The hospital competes with other hospitals for its patient base. A world-class, patient-centered, integrated, academic medical center is one of the nation’s premier centers for excellence in clinical care, biomedical research and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals: Tisch Hospital, its flagship acute care facility; the Hospital for Joint Diseases, one of only five hospitals in the nation dedicated to orthopedics and rheumatology; Hassenfeld Pediatric Center, a comprehensive pediatric hospital supporting a full array of children’s health services; and the Rusk Institute of Rehabilitation Medicine, the world’s first university-affiliated facility devoted entirely to rehabilitation medicine--plus NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center’s tri-fold mission to serve, teach and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research.
Net Patient revenue non-Medicare$260,183,000.00
Capitation Revenue$36,829,320.00
Patient Revenue - Medicare Medicaid$188,408,800.00
Unrelated business revenue
Capitation Rev
Other rev - sale of asset$5,492,700.00
Rent revenue$450,000.00
dividends$3,800,000.00
Investment Income$1,892,925.00
Other rev - other$5,290,000.00
Contributions$7,722,580.00
Net assets released from restrictions
Ttl Unrestricted Rev$510,069,325.00
The current ratio of NYU ending 2010 was 1.56 and beginning 2011 was 1.49. There was a slight decrease in the ratio which shows that there were resources they may not have been quite controlled and budgeted.
Revenue Source Amount
Net Patient revenue non-Medicare93a Part VII$1,866,400.00
Patient Revenue - Medicare Medicaid93f Part VII160,500,00
Unrelated business revnue93b Part VII$891,284.00
Capitation Rev
Other rev - sale of asset8d Part 1$984,469.00
Rent revenue97 Part VII$169,820.00
Investment Income4 Part 1$1,522,530.00
Other rev - other11 Part 1$1,601,545.00
Contributions13 Part 1$7,200,000.00
Net assets released from restrictions
Ttl Unrestricted Rev$14,236,048.00
HealthSouth is the nation’s largest owner and operator of inpatient rehabilitation hospitals in terms of patients treated and discharged revenues and number of hospitals. Operating in 27 states across the country and in Puerto Rico, HealthSouth serves patients through its network of inpatient rehabilitation hospitals, outpatient rehabilitation satellite clinics and home health agencies. HealthSouth’s hospitals provide a higher level of rehabilitative care to patients who are recovering from conditions such as stroke and .
California's community clinics and health centers are grappling with unprecedented change and huge financial pressures. This primer describes the current funding environment and factors that are shaping the future of California's clinics, including federal and state health care reform. Additionally, key strategies for positioning clinics to thrive during this period of great uncertainty are discussed.
A Case Study forBecky Skinner, RRT, BSSpecialized Care Coo.docxevonnehoggarth79783
A Case Study for
Becky Skinner, RRT, BS
Specialized Care Coordinator
University of Iowa Hospitals and Clinics
May 30, 2013
UIHC Human Capital Strategies to Comply and Thrive Under The Patient Protection Affordable Care Act Regulations
Table of Contents
Mission & Vision 3
History of the University of Iowa Hospitals & Clinics 4
Fiscal Year 2012 Facts 4
Statement of Problem or Challenge 5
Research and Background Data 7
Implications PPACA Has on UIHC Human Capital Management 11
Resolution Proposal 14
Summary and Conclusion 17
Appendix A: SWOT Analysis 19
Appendix B: Corporate Parenting Strategy 27
Appendix C: Portfolio Analysis 35
References 45
History of the University of Iowa Hospitals & ClinicsVision:
World Class People.
· Building on our greatest strength.
World Class Medicine.
· Creating a new standard of excellence in integrated patient care, research and education.
For Iowa and the World.
· Making a difference in quality of life and health for generations.Mission:
Simply stated, our mission is: Changing Medicine. Changing Lives.®
University of Iowa Health Care is changing medicine through Pioneering discovery
· Innovative inter-professional education
· Delivery of superb clinical care
· An extraordinary patient experience in a multi-disciplinary, collaborative, team-based environment
University of Iowa Health Care is changing lives by
· Preventing and curing disease
· Improving health and well-being
· Assuring access to care for people in Iowa and throughout the world
In 1873 The University of Iowa began providing medical services when it reached an agreement with Sisters of Mercy to operate a small hospital in the area. It began with two wards, one for women and the other for men containing four private rooms and a surgical amphitheater. In 1865 this agreement was terminated when the Sisters of Mercy moved across town and opened up Mercy Hospital. Today, the University of Iowa Hospitals and Clinics is a public -teaching hospital affiliated with the University of Iowa and a Level 1 trauma center. It has 711 beds including a 190-bed UI Children’s Hospital (About Us, n.d.). On an average day, there are close to 9,000 individuals providing care to patients, including employees, students and volunteers (About Us, n.d.). Fiscal Year 2012 Facts
There were 32,000 patients admitted to the hospital for in-patient care with 59,000 emergency room visits. In the 200 outpatient clinics of the UIHC, 977,337 clinic visits were counted. In addition to the 1,300 volunteers of UIHC, it employed during FY2012:
· 1,548 physicians, residents, and fellows
· 8,221 non-physician employees of whom 1,845 are professional nurses (About Us, n.d.)
Since U.S. News & World Report began to rank hospitals in 1990, UIHC has made the list as one of the best and has over 271 physicians ranked as “Best Doctors in America”.
Place logo
or logotype here,
otherwise
delete this.
Delete text and place photo here.
June
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CASE 3 Charitable Contributions and Debt A Comparison of St. J.docxwendolynhalbert
CASE 3: Charitable Contributions and Debt: A Comparison of St. Jude Children’s Research Hospital/ALSAC and Universal Health Services
CASE TOPICS OUTLINE
· 1. St. Jude Children’s Research Hospital/ALSAC
· A. Primary Objective
· B. Sources of Capital
· C. Reporting Practices
· 2. Universal Health Services
· A. Investor-Owned Hospital
· B. Debt Including Leases
· 3. Comparison
Hospitals are an industry in which both not-for-profits and investor-owned facilities operate. The sources of capital available to the not-for-profits include charitable contributions and debt offerings—unless they are governmental, in which case, higher taxes are also an alternative. Debt availability is always, in part, a function of performance, and just as failures have arisen in both sectors, about one-third of the investor-owned hospitals have been described as losing money. Of interest is how can one effectively evaluate such an industry, with this type of diversity in organizational forms and capital availability? A necessary prerequisite to such an evaluation is to have a firm understanding of how charitable contributions are presented.
St. Jude Children’s Research Hospital/ALSAC has the mission of finding cures for children with catastrophic diseases through research and treatment. For the fiscal year 1999, this entity reported total assets of $221,664,232 and income of $177,071,890. A Web site at http://www.stjude.org, as well as Guidestar’s listing, references a Form 990 (Return of Organization Exempt from Income Tax) filing, availability of audited financial statements upon request, and information that the hospital has 2,100 employees and 350 volunteers. Founded in 1962, the organization seeks funds from contributions and grants for unrestricted operating expenses, specific projects, buildings, and endowments. More than 4,000 patients are seen annually, with a hospital maintaining 56 beds. The Form 990, Part III states that the hospital provided 15,231 inpatient days of care during the fiscal year and patients made 40,982 clinic visits. ALSAC is the American Lebanese Syrian Associated Charities, Inc., the fund-raising arm of St. Jude Children’s Research Hospital. It reported 1999 total assets of $1,007,699,320 and income of $274,123,399. This organization reports the number of employees as 565 and the number of volunteers as 800,000. With its sole focus on the hospital, ALSAC’s self-description explains that no child has ever been turned away due to an inability to pay for treatment and explains key accomplishments in the research area achieved by St. Jude’s research and treatment of children with catastrophic diseases. What is borne out by the example of St. Jude is the fact that a review of the Form 990 filed for the fiscal year ending 6/30/99 indicates in Part VI the names of related organizations: ALSAC and St. Jude Hospital Foundation, both of which are tax exempt. To gain a sense of capital availability to a not-for-profit entity, affiliated entities mu ...
MGMT 511Location ProblemGeorge Heller was so successful in.docxandreecapon
MGMT 511
Location Problem
George Heller was so successful in his previous assignment that he was promoted to the coveted position of Infrastructure Manager on the Mergers and Acquisitions Team.
Again Agame has recently acquired a competitive company with a plant and a warehouse in a nearby city. Management has decided to keep the additional warehouse. However, they are unsure if they need to keep the additional manufacturing plant. All products can be manufactured in either plant and shipped from either warehouse. Each plant and each warehouse has sufficient capacity to meet the total forecasted demand individually.
Prepare a report for management with your recommendation. Three possible choices exist. 1) Close the Competitor plant and satisfy all demand from the Again Agame plant; 2) Close the Again Agame plant and satisfy all demand from the Competitor plant; 3)Keep both plants open.
Your recommendation should include a solution for each of the five years in question. Include your calculations and spreadsheets in support of your recommendations.
Sales Forecast (cases)
2011
2012
2013
2014
2015
Competitor Warehouse (WH1)
15,000,000
20,000,000
26,000,000
34,000,000
44,000,000
Again Agame Warehouse (WH2)
6,000,000
7,000,000
10,000,000
15,000,000
21,000,000
Fixed Costs
2011
2012
2013
2014
2015
Competitor Plant (P1)
900,000
900,000
900,000
900,000
900,000
Again Agame Plant (P2)
800,000
800,000
800,000
800,000
800,000
Transportation Costs
$1.00 / 1,000 cases / mile
4
Costs -- Both Plant Scenario
20112012201320142015
Transport P1 - WH1
Transport P2 - WH2
Fixed Cost - P1
Fixed Cost - P2
Total
General Info.Infrastructure ExerciseDate: 28/10/97Situation:a) Package -RGBb) Nr. Plants -2c) Nr. WH -2d) Period -5 yearse) Sales Frcst. -DecreasingCapacity MM U/C per Year:Plant 1 -5avg. HK 70 (KS)Plant 2 -3avg. HK 42 (KS)Distance Matrix: (Km)WH1WH2P150600P2600100Diagram:
&A
Page &P
WH2
Franchise 2
Franchise 1
P2
P1
WH1
Sales Frcst.Infrastructure ExerciseDate: 28/10/97Sales Forecast (M U.C)RGB'98'99'00'01'02WH15000.04000.03400.02800.02400.0WH23000.02400.02000.01600.01400.0Obs. Volume is Decreasing 15% per year.
&A
Page &P
CostsInfrastructure ExerciseDate: 28/10/97Transport Costs:0.51,000 cases per KmFixed Costs:900,000P1 = $600,000/year800,000P2 = $500,000/year
&A
Page &P
AnalysisInfrastructure ExerciseDate: 28/10/97Fixed Costs'98'99'00'01'02P1800,000800,000800,000800,000800,000P2700,000700,000700,000700,000700,000Total1,500,0001,500,0001,500,0001,500,0001,500,000Transportation Costs'98'99'00'01'02P1 - WH1125,000100,00085,00070,00060,000P2 - WH2150,000120,000100,00080,00070,000P1 - WH2900,000720,000600,000480,000420,000P2 - WH11,500,0001,200,0001,020,000840,000720,000Total 1275,000220,000185,000150,000130,000(both plants)Total 21,025,000820,000685 ...
MGMT 464From Snowboarders to Lawnmowers Case Study Case An.docxandreecapon
MGMT 464
From Snowboarders to Lawnmowers Case Study
Case Analysis Worksheet #1
Case Analysis Session 1 : Focus on Inspiring a Shared Vision (Principle #2)
Inspiring a shared vision has two main components [1] creating a vision through common purpose, and [2] enlisting or getting people ‘on board’ with the vision.
In your small groups, discuss and document your group’s response to the following questions. Upload your typed document into one of your group member’s D2L dropbox by the assigned due date on your course schedule. Be sure to include on your worksheet all group member names. If present in class, all group members will receive the same grade for this case analysis assignment (maximum 30 pts). Group peer evaluations will be used to determine overall individual group member participation points for both of these case study discussions (maximum 15 pts).
1. In what specific ways did Michael fail and/or succeed in ‘listening deeply’ to his employees?
2. In what specific ways did Michael show that he was not “open to influence?” How would Michael being open to influence have made him more effective, ( i.e., who were the “local experts” and how could he have benefited from them)?
3. When you consider the employees of Bedford Mower as they were before Michael arrived, how would you characterize them in terms of what was personally meaningful to them?
4. When creating his vision for the company, in what specific ways did Michael fail and/or succeed in ‘determining what was meaningful’ to his employees, and what was the impact?
5. What specific mechanisms, or opportunities did Michael have available to him for enlisting others?
6. To what extent did Michael take advantage of these? To what extent were they effective in terms of getting everyone on board with the new vision?
7. In thinking about his attempts to enlist others, in what ways did or didn’t Michael incorporate common ideals into his communication with his employees as it related to the new vision?
8. How successful was Michael in “animating the vision”? How would you characterize him in terms of his use of symbolic language, providing imagery of the future, practicing positive communication, expressing emotion, and speaking from the heart, in his communications to his employees?
9. What would you have done differently with this group of employees in terms of inspiring a shared vision?
Team Leadership Case
From Snowboards to Lawnmowers
Michael Francis, a man in his late 30s, born and raised in Oregon, was an avid snowboarder. He was known among his many friends and associates as a risk-taker, highly intelligent, innovative, a bit of a rebel, but an extremely smart businessman. When he was in his early 20s, he started his own snowboarding company designing and manufacturing what became known as some of the most cutting edge boards available. Having recently married a woman who was raised on the East coast, he decided to sell his company and move to Vermont where h ...
Atan M. ZuckermanMetro Mercy Hospital (MMH) has been in a .docxikirkton
Atan M. Zuckerman
Metro Mercy Hospital (MMH) has been in a down-
wardspiral, resulting in losses in tbe past few years
anda tenuous casb position. Altbougb a new CEO
bas recently been biredanda turnaround begun, tbe
board is unclear as to wbetber tbe bospital can and
sbould remain independent now and in tbe future.
Wbat sbould tbe board do?
The Siiiuiatiioini
MMH is a Catholic-sponsored, freestanding,
?oo-bed hospital with annual operating revenues
of $125 million, located in the western end of a
city in a large metropolitan area. The hospital is a
relatively undifferentiated, general acute care
hospital with the typical range of medical, surgi-
cal, ob/gyn, and pédiatrie services. The hospital
does not provide any tertiary or even near tertiary
services. It has a very busy emergency depart-
ment and a network of owned physician practices
in the area it serves; these practices provide
mainly primary care services and constitute a
significant portion of the primary care medical
staff of the hospital.
MMH is located in a rapidly changing community.
The population it has historically served, primarily
second- and third-generation Italian- and
Polish-Americans, has moved to the suburbs
and/or aged. These groups have been replaced
by African-Americans, and more recently
Hispanics, particularly immigrants from
Mexico. Although the service area population
was expected to decrease from 1990 to ?ooo,
Census Bureau data indicate that the population—
especially Hispanic—actually grew. Recent
estimates suggest continued slow growth and
transformation of service area demographics.
MMH faces veiy stiff competition due in part to
the number of competitors in and around its
service area and the general overbeddedness in
the region. Its main competitors include St.
Luke's Hospital, the 600-bed flagship of a veiy
successful multihospital system, located a few
miles west of MMH in an affluent suburban area;
a nationally recognized teaching hospital located
within five miles of MMH; a number of other ter-
tiary teaching hospitals located in and around the
downtown area of the city; and one large for-
profit community hospital and two large system-
affiliated community hospitals all located within
three to five miles of MMH.
MMH has experienced downward trends in uti-
lization and financial performance since 2004.
In 2006, the hospital had an operating loss of
$10.9 million (total loss of $10.6 million) after
an operating loss of $10 million (total loss of
$10.2 million) in 2005. The financial situation
led to the resignation of the previous CEO and an
interim management arrangement for about
12 months until a new CEO was named and began
work early in 2007. The board was also reorgan-
ized and a new lay board chair and other board
members with strong business skills were added
in 2006-07.
The CEO's first priority was to restore the
organization to financial health. By fall 2007,
118 AUGUST 2008 healthcare financial management
METRO MERCY HOSPITA ...
STRATEGY CHALLENGE
Alan M. Zuckerman
What Would You Do?
should this successful integrated system divest one of its business units?
The Problem
Midwest Integrated Health is experiencing intensify-
ing competitive pressures and declining financial per-
formance in its regional pharmacy business. Midwest's
management team has solicited offers to purchase the
business from three vendors and believes a sale is in
the best interest of Midwest Integrated Health. The
board is reviewing management's report and recom-
mendations, including the bids ofthe three vendors.
What should the board do?
The Situation
Midwest Integrated Health is a highly successful,
growing, not-for-profit integrated delivery system
operating in a smaU urban area in mid-America.
The system has had six straight years of outstand-
ing performance, with revenues increasing from
$?25 miUion to $375 miUion and total margins
averaging 1? percent peryear. As a result, the sys-
tem has an exceptional balance sheet, including
$4,00 nullion in reserves and very little debt.
Financial forecasts for the next five years, includ-
ing ahility to fund capital needs, are exceUent.
In addition to its flagship hospital. Midwest has a
foundation and four related business lines:
> Midwest Begional Pharmacy (multi-outlet retail
pharmacy operation)
> Midwest Medical Supply (provider of medical
equipment and supplies to the general public
and hospital patients)
> Midwest Extended Care (operator of a ?3o-bed
nursing home and 175-unit retirement center)
> Midwest Ventures (for-profit company that
operates an ambulance service, a day care cen-
ter, and two ambulatory surgery centers, and
manages 3o physician practices)
The hospital represents about 35 percent of over-
all assets and 75 percent of total revenues, but the
related business lines have been solid performers
and nearly all members ofthe leadership team
agree that good synergy exists among those lines.
Nonetheless, the management team has heen
increasingly concerned about the future viability
of its pharmacy unit. Historically this entity has
been a stellar performer, but its performance is
slipping, and growing competitive pressures are
emerging. Growth in prescriptions filled was up
18 percent in ?ooi-o? but has decreased every
year since, with 2005-06 growth only 1.5 percent.
Market share in the region reached a high of 41
percent in 2005 and decreased for the first time
in 2006. With significant expansion of national
competitors locally in 2006-07, share is expected
to drop dramatically in 2007. The unit is still
profitable, but profitability is projected to decline
beginning in 2007. Management has summarized
the current situation as follows:
> Revenue growth is slowing dramatically.
> Scripts wUl be flat for 2007 at best.
> Some evidence of margin compression exists.
> Walgreens has embarked on a rapid regional
expansion plan.
As a result of growing concerns about this busi-
ness unit, management solicited propos.
Case 3Charitable Contributions and Debt A Comparison of St. Jude .docxtidwellveronique
Case 3Charitable Contributions and Debt: A Comparison of St. Jude Children's Research Hospital/ALSAC and Universal Health Services
Case Topics Outline
1. St. Jude Children's Research Hospital/ALSAC
1. Primary Objective
2. Sources of Capital
3. Reporting Practices
2. Universal Health Services
1. Investor-Owned Hospital
2. Debt Including Leases
3. Comparison
Hospitals are an industry in which both not-for-profits and investor-owned facilities operate. The sources of capital available to the not-for-profits include charitable contributions and debt offerings—unless they are governmental, in which case, higher taxes are also an alternative. Debt availability is always, in part, a function of performance, and just as failures have arisen in both sectors, about one-third of the investor-owned hospitals have been described as losing money. Of interest is how can one effectively evaluate such an industry, with this type of diversity in organizational forms and capital availability? A necessary prerequisite to such an evaluation is to have a firm understanding of how charitable contributions are presented.
St. Jude Children's Research Hospital/ALSAC has the mission of finding cures for children with catastrophic diseases through research and treatment. For the fiscal year 1999, this entity reported total assets of $221,664,232 and income of $177,071,890. A Web site at http://www.stjude.org, as well as Guidestar's listing, references a Form 990 (Return of Organization Exempt from Income Tax) filing, availability of audited financial statements upon request, and information that the hospital has 2,100 employees and 350 volunteers. Founded in 1962, the organization seeks funds from contributions and grants for unrestricted operating expenses, specific projects, buildings, and endowments. More than 4,000 patients are seen annually, with a hospital maintaining 56 beds. The Form 990, Part III states that the hospital provided 15,231 inpatient days of care during the fiscal year and patients made 40,982 clinic visits. ALSAC is the American Lebanese Syrian Associated Charities, Inc., the fund-raising arm of St. Jude Children's Research Hospital. It reported 1999 total assets of $1,007,699,320 and income of $274,123,399. This organization reports the number of employees as 565 and the number of volunteers as 800,000. With its sole focus on the hospital, ALSAC's self-description explains that no child has ever been turned away due to an inability to pay for treatment and explains key accomplishments in the research area achieved by St. Jude's research and treatment of children with catastrophic diseases. What is borne out by the example of St. Jude is the fact that a review of the Form 990 filed for the fiscal year ending 6/30/99 indicates in Part VI the names of related organizations: ALSAC and St. Jude Hospital Foundation, both of which are tax exempt. To gain a sense of capital availability to a not-for-profit entity, affiliated entities must be consider ...
MMLP3.2InstructionsIn LP01.1, LP02.1, and LP03.1 you were aske.docxraju957290
MMLP3.2Instructions
In LP01.1, LP02.1, and LP03.1 you were asked to prepare milestones for a business plan. An executive summary, while written last, is the first part of a business plan. This document is what the executives will read to determine if the business plan has merit and may determine whether or not they will read the entire business plan. The executive summary covers all the key points of the business plan and should be 650-1,000 words. Must use 3 scholarly sources and cite APA.
Here are some helpful sources that discuss what to include in your Executive Summary:
· Chron
· SBA
REFERENCE ONLY: Below is the LP1.1 information
Description of the Business
Wickham Hospital is a rural hospital that provides quality healthcare services to the local community. Our mission is to engage in the promotion of healthier lives by providing quality healthcare services. This is to be executed in a fiscally responsible way that promotes the social, physical, spiritual and psychological wellbeing of the community and patients it serves. Further, the hospital aims at serving all members of the community regardless of their gender, religion, race or age.
Among the services provided by the hospital include outpatient and inpatient services, emergency services, primary care, skilled nursing care, center for rehabilitation medicine, a lung cancer center and surgical services. Our main competitors are some hospitals established within the same community. Among these are Greenview Hospital, Jordan Memorial Hospital and Sloan Hospital. These hospitals offer outpatient and inpatient services as well as other services such as primary stroke services, rehabilitation for pediatric polio patients.
Recommendations to Stand out of the Competition
To stay on top of the competition, Wickham Hospital needs to invest and adapt to the most recent technology to ensure efficient delivery of quality medical services. Further, all healthcare personnel needs to undergo further training through platforms such as seminars and online educational forums. This will promote safe and efficient delivery of services to patients as they promote the quality of life within the community. Besides this, management needs to be keener with the appropriate allocation and deployment of resources to ensure that all areas are sufficiently covered (Enthoven, 2014).
How to Accommodate a Global Business Environment
The hospital currently serves the adjacent community and a few consumers from the outskirts. To broaden into the global business environment, a few strides should be taken. For instance, a website should be created describing the business and services offered. This way, international consumers will seek the business even when they come visiting within the local community. Further, the organization could seek for international investors whose partnership or involvement would attract international healthcare consumers towards the organization (Lunt & Mannion, 2014). The business ...
Create 5- or 6-slide Microsoft® PowerPoint® presentation.docxclayrhr
Create
5- or 6-slide Microsoft
®
PowerPoint
®
presentation with speaker notes illustrating your findings to Case 3, Charitable Contributions and Debt: A Comparison of St. Jude Children’s Research Hospital/ALSAC and Universal Health Services in Ch. 5 of
Mastery of the Financial Accounting Research System (FARS) Through Cases
.
Case 3Charitable Contributions and Debt: A Comparison of St. Jude Children's Research Hospital/ALSAC and Universal Health Services
Case Topics Outline
St. Jude Children's Research Hospital/ALSAC
Primary Objective
Sources of Capital
Reporting Practices
Universal Health Services
Investor-Owned Hospital
Debt Including Leases
Comparison
Hospitals are an industry in which both not-for-profits and investor-owned facilities operate. The sources of capital available to the not-for-profits include charitable contributions and debt offerings—unless they are governmental, in which case, higher taxes are also an alternative. Debt availability is always, in part, a function of performance, and just as failures have arisen in both sectors, about one-third of the investor-owned hospitals have been described as losing money. Of interest is how can one effectively evaluate such an industry, with this type of diversity in organizational forms and capital availability? A necessary prerequisite to such an evaluation is to have a firm understanding of how charitable contributions are presented.
St. Jude Children's Research Hospital/ALSAC has the mission of finding cures for children with catastrophic diseases through research and treatment. For the fiscal year 1999, this entity reported total assets of $221,664,232 and income of $177,071,890. A Web site at
http://www.stjude.org
, as well as Guidestar's listing, references a Form 990 (Return of Organization Exempt from Income Tax) filing, availability of audited financial statements upon request, and information that the hospital has 2,100 employees and 350 volunteers. Founded in 1962, the organization seeks funds from contributions and grants for unrestricted operating expenses, specific projects, buildings, and endowments. More than 4,000 patients are seen annually, with a hospital maintaining 56 beds. The Form 990, Part III states that the hospital provided 15,231 inpatient days of care during the fiscal year and patients made 40,982 clinic visits. ALSAC is the American Lebanese Syrian Associated Charities, Inc., the fund-raising arm of St. Jude Children's Research Hospital. It reported 1999 total assets of $1,007,699,320 and income of $274,123,399. This organization reports the number of employees as 565 and the number of volunteers as 800,000. With its sole focus on the hospital, ALSAC's self-description explains that no child has ever been turned away due to an inability to pay for treatment and explains key accomplishments in the research area achieved by St. Jude's research and treatment of children with catastrophic diseases. What is borne out by the example of St. Jude is t.
STRATEGY CHALLENGE
Alan M. Zuckerman
What Would You Do? '
are freestanding emergency centers
an idea whose time has come?
The Problem
The relatively fragmented, underserved, sparsely
populated but now rapidly growir\g market to the east
of Small City General Hospital has been "discovered"
by providers further east at the periphery of a large
metropolitan area. To secure its position in this newly
emerging battleground, Small City General Hospital
is considering a bold move—developing two freestanding
emergency centers. Does this make sense strategically
and financially?
The Situation
Small City General Hospital is one of the two
large hospitals located in an old. declining,
small industrial city ahout 60 miles from a large
Midwestern city (see map). As the hig city has
grown and expanded, its suhurhan areas have
gradually crept closer to Small City General
Hospital's service area. Right now, a "no-man's
land" huffer of ahout 10 miles exists hetween the
edge of the small city and the big city's suhurhs.
This hucolic. rural area is heginning to he
developed and the projections for the foreseeable
future are for rapid growth (see tahle helow).
Some of the hospitals and health systems on the
eastern end of the emerging hattleground are
contemplating initiatives in this area. Although
nothing is definite yet, rumors ahound. The
potential exists for expansion west into the area
of one or more of the large system-affiliated
medical groups, development of major amhula-
toiy care centers, and possihly, despite certifi-
cate-of-need barriers, a satellite hospital. Small
City General Hospital is concerned ahout this
march west and southwest by formidable com-
petitors. What, if anything, shotdditdo?
Alternative Considerations
Small City General Hospital reviewed a full range
of possible alternative pre-emptive strikes and
responses, including many of the initiatives its
competitors appear to be contemplating. Given
the nature of the competition and the high stakes
SMALL CITY GENERAL HOSPITAL PROPOSED PRIMARY SERVICE AREA POPULATION 2005 TO 2010
Ages
0-17
18-44
45-64
65+
Total
2005
38,200
53,970
43,690
19,490
155,350
SKal
2010
39,930
57,370
51,100
23,660
172,060
% Change
4.5
6.3
17.0
21.4
10.8
Site 2
2005
58,650
78,470
56.950
19,060
213,130
2010
62,840
84.000
71,410
25,220
243,470
% Change
7.1
70
25.4
32.3
142
> Both site 1 and site 2 primary service area populations are projected to increase 11 percent to 14 percent by 2010.
> Largest increases are projected for the 45-64 and 65+ age cohorts.
> The site 2 primary service area is more populous than the site 1 primary service area and is projected to
increase at a faster rate across all age cohorts.
Source: Claritas, 2006.
114 AUGUST 2007 healthcare financial management
PROPOSED SITE 1 A N D SITE 2 SERVICE AREAS
Legend
H Site 1 Primary Service Area
Site 2 Primary Service Area
Competitor Centers
D Medical Center A
B Medicai Center B
O Medical Center.
• •Intensity of service• •Charges for specific procedures.docxanhlodge
• •Intensity of service
• •Charges for specific procedures
(Cleverley 243-254)
Cleverley, William O. Essentials of Health Care Finance, 7th Edition.
Jones & Bartlett Learning, 20101022. VitalBook file.
Chapter 12 Financial Analysis of Alternative
Healthcare Firms
LEARNING OBJECTIVES
After studying this chapter, you should be able to do the following:
• 1.List some of the major nonhospital and nonphysician
sectors of the healthcare industry.
• 2.Discuss the sources of revenue for the nursing home
industry.
Average Case Weight =
36
30
=
1.2
• 3.Discuss the major sources of revenue and expenses of
medical groups.
• 4.List and describe the major organizational types of
physician groups.
• 5.Describe alternative health maintenance organization
arrangements.
REAL-WORLD SCENARIO
Laura Rose has been recently appointed to the Board of ElderCare, a
large, for-profit operator of skilled nursing facilities (SNFs) around the
country. Laura’s first committee assignment is to the Treasury
Committee because of her prior business experience. Although Laura
had extensive experience as a hospital administrator, she had
relatively little familiarity with the SNF industry. Upon reviewing
ElderCare’s recent financial statements, she was concerned about the
dramatically declining financial position. She noticed that revenues
were declining on per facility and per patient bases. Meanwhile, the
company’s debt had been downgraded, and its borrowing costs had
risen substantially.
She is aware that Medicare implemented a SNF prospective payment
system as part of the Balanced Budget Act of 1997. Payment
increases by Medicare and Medicaid have not kept pace with
increases in costs in recent years. She wonders whether this might be
a factor in the company’s financing issues. In general, profitability in
the long-term care industry has declined significantly in recent years,
and several industry leaders had filed for bankruptcy protection.
Although some believe that SNF prospective payment systems were
largely to blame, other factors, such as ill-advised acquisitions,
excessive long-term debt, and poor balance sheets, probably
contributed as well. In essence, she is unsure whether ElderCare’s
financing difficulties are unique to management issues at ElderCare or
whether they reflect more general market conditions and economic
and reimbursement trends.
To understand the issue better, Laura needs to estimate the direct
financial impact of SNF reimbursement. She asked the ElderCare
treasury and controller’s office staff to prepare an analysis of the
financial performance of selected long-term care facilities over the
period 2006 to 2010. In particular, she wants to know how SNF-bond
ratings have been affected by prospective payment systems and what
other factors might have contributed to the industry’s deteriorating
financial performance.
In Chapter 11 we discussed the measures and concepts of financial
analysis in some .
3Running Head Course Project Final SubmissionChanasha Owens.docxgilbertkpeters11344
3
Running Head: Course Project Final Submission
Chanasha Owens
Accounting & Finance for Healthcare Managers B6501
Argosy University-Sarasota
April 13, 2013
NYU Hospital center is an 879 bed not-for-profit (NFP) hospital in a major city. The hospital competes with other hospitals for its patient base. A world-class, patient-centered, integrated, academic medical center is one of the nation’s premier centers for excellence in clinical care, biomedical research and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals: Tisch Hospital, its flagship acute care facility; the Hospital for Joint Diseases, one of only five hospitals in the nation dedicated to orthopedics and rheumatology; Hassenfeld Pediatric Center, a comprehensive pediatric hospital supporting a full array of children’s health services; and the Rusk Institute of Rehabilitation Medicine, the world’s first university-affiliated facility devoted entirely to rehabilitation medicine--plus NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center’s tri-fold mission to serve, teach and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research.
Net Patient revenue non-Medicare$260,183,000.00
Capitation Revenue$36,829,320.00
Patient Revenue - Medicare Medicaid$188,408,800.00
Unrelated business revenue
Capitation Rev
Other rev - sale of asset$5,492,700.00
Rent revenue$450,000.00
dividends$3,800,000.00
Investment Income$1,892,925.00
Other rev - other$5,290,000.00
Contributions$7,722,580.00
Net assets released from restrictions
Ttl Unrestricted Rev$510,069,325.00
The current ratio of NYU ending 2010 was 1.56 and beginning 2011 was 1.49. There was a slight decrease in the ratio which shows that there were resources they may not have been quite controlled and budgeted.
Revenue Source Amount
Net Patient revenue non-Medicare93a Part VII$1,866,400.00
Patient Revenue - Medicare Medicaid93f Part VII160,500,00
Unrelated business revnue93b Part VII$891,284.00
Capitation Rev
Other rev - sale of asset8d Part 1$984,469.00
Rent revenue97 Part VII$169,820.00
Investment Income4 Part 1$1,522,530.00
Other rev - other11 Part 1$1,601,545.00
Contributions13 Part 1$7,200,000.00
Net assets released from restrictions
Ttl Unrestricted Rev$14,236,048.00
HealthSouth is the nation’s largest owner and operator of inpatient rehabilitation hospitals in terms of patients treated and discharged revenues and number of hospitals. Operating in 27 states across the country and in Puerto Rico, HealthSouth serves patients through its network of inpatient rehabilitation hospitals, outpatient rehabilitation satellite clinics and home health agencies. HealthSouth’s hospitals provide a higher level of rehabilitative care to patients who are recovering from conditions such as stroke and .
California's community clinics and health centers are grappling with unprecedented change and huge financial pressures. This primer describes the current funding environment and factors that are shaping the future of California's clinics, including federal and state health care reform. Additionally, key strategies for positioning clinics to thrive during this period of great uncertainty are discussed.
A Case Study forBecky Skinner, RRT, BSSpecialized Care Coo.docxevonnehoggarth79783
A Case Study for
Becky Skinner, RRT, BS
Specialized Care Coordinator
University of Iowa Hospitals and Clinics
May 30, 2013
UIHC Human Capital Strategies to Comply and Thrive Under The Patient Protection Affordable Care Act Regulations
Table of Contents
Mission & Vision 3
History of the University of Iowa Hospitals & Clinics 4
Fiscal Year 2012 Facts 4
Statement of Problem or Challenge 5
Research and Background Data 7
Implications PPACA Has on UIHC Human Capital Management 11
Resolution Proposal 14
Summary and Conclusion 17
Appendix A: SWOT Analysis 19
Appendix B: Corporate Parenting Strategy 27
Appendix C: Portfolio Analysis 35
References 45
History of the University of Iowa Hospitals & ClinicsVision:
World Class People.
· Building on our greatest strength.
World Class Medicine.
· Creating a new standard of excellence in integrated patient care, research and education.
For Iowa and the World.
· Making a difference in quality of life and health for generations.Mission:
Simply stated, our mission is: Changing Medicine. Changing Lives.®
University of Iowa Health Care is changing medicine through Pioneering discovery
· Innovative inter-professional education
· Delivery of superb clinical care
· An extraordinary patient experience in a multi-disciplinary, collaborative, team-based environment
University of Iowa Health Care is changing lives by
· Preventing and curing disease
· Improving health and well-being
· Assuring access to care for people in Iowa and throughout the world
In 1873 The University of Iowa began providing medical services when it reached an agreement with Sisters of Mercy to operate a small hospital in the area. It began with two wards, one for women and the other for men containing four private rooms and a surgical amphitheater. In 1865 this agreement was terminated when the Sisters of Mercy moved across town and opened up Mercy Hospital. Today, the University of Iowa Hospitals and Clinics is a public -teaching hospital affiliated with the University of Iowa and a Level 1 trauma center. It has 711 beds including a 190-bed UI Children’s Hospital (About Us, n.d.). On an average day, there are close to 9,000 individuals providing care to patients, including employees, students and volunteers (About Us, n.d.). Fiscal Year 2012 Facts
There were 32,000 patients admitted to the hospital for in-patient care with 59,000 emergency room visits. In the 200 outpatient clinics of the UIHC, 977,337 clinic visits were counted. In addition to the 1,300 volunteers of UIHC, it employed during FY2012:
· 1,548 physicians, residents, and fellows
· 8,221 non-physician employees of whom 1,845 are professional nurses (About Us, n.d.)
Since U.S. News & World Report began to rank hospitals in 1990, UIHC has made the list as one of the best and has over 271 physicians ranked as “Best Doctors in America”.
Place logo
or logotype here,
otherwise
delete this.
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CASE 3 Charitable Contributions and Debt A Comparison of St. J.docxwendolynhalbert
CASE 3: Charitable Contributions and Debt: A Comparison of St. Jude Children’s Research Hospital/ALSAC and Universal Health Services
CASE TOPICS OUTLINE
· 1. St. Jude Children’s Research Hospital/ALSAC
· A. Primary Objective
· B. Sources of Capital
· C. Reporting Practices
· 2. Universal Health Services
· A. Investor-Owned Hospital
· B. Debt Including Leases
· 3. Comparison
Hospitals are an industry in which both not-for-profits and investor-owned facilities operate. The sources of capital available to the not-for-profits include charitable contributions and debt offerings—unless they are governmental, in which case, higher taxes are also an alternative. Debt availability is always, in part, a function of performance, and just as failures have arisen in both sectors, about one-third of the investor-owned hospitals have been described as losing money. Of interest is how can one effectively evaluate such an industry, with this type of diversity in organizational forms and capital availability? A necessary prerequisite to such an evaluation is to have a firm understanding of how charitable contributions are presented.
St. Jude Children’s Research Hospital/ALSAC has the mission of finding cures for children with catastrophic diseases through research and treatment. For the fiscal year 1999, this entity reported total assets of $221,664,232 and income of $177,071,890. A Web site at http://www.stjude.org, as well as Guidestar’s listing, references a Form 990 (Return of Organization Exempt from Income Tax) filing, availability of audited financial statements upon request, and information that the hospital has 2,100 employees and 350 volunteers. Founded in 1962, the organization seeks funds from contributions and grants for unrestricted operating expenses, specific projects, buildings, and endowments. More than 4,000 patients are seen annually, with a hospital maintaining 56 beds. The Form 990, Part III states that the hospital provided 15,231 inpatient days of care during the fiscal year and patients made 40,982 clinic visits. ALSAC is the American Lebanese Syrian Associated Charities, Inc., the fund-raising arm of St. Jude Children’s Research Hospital. It reported 1999 total assets of $1,007,699,320 and income of $274,123,399. This organization reports the number of employees as 565 and the number of volunteers as 800,000. With its sole focus on the hospital, ALSAC’s self-description explains that no child has ever been turned away due to an inability to pay for treatment and explains key accomplishments in the research area achieved by St. Jude’s research and treatment of children with catastrophic diseases. What is borne out by the example of St. Jude is the fact that a review of the Form 990 filed for the fiscal year ending 6/30/99 indicates in Part VI the names of related organizations: ALSAC and St. Jude Hospital Foundation, both of which are tax exempt. To gain a sense of capital availability to a not-for-profit entity, affiliated entities mu ...
MGMT 511Location ProblemGeorge Heller was so successful in.docxandreecapon
MGMT 511
Location Problem
George Heller was so successful in his previous assignment that he was promoted to the coveted position of Infrastructure Manager on the Mergers and Acquisitions Team.
Again Agame has recently acquired a competitive company with a plant and a warehouse in a nearby city. Management has decided to keep the additional warehouse. However, they are unsure if they need to keep the additional manufacturing plant. All products can be manufactured in either plant and shipped from either warehouse. Each plant and each warehouse has sufficient capacity to meet the total forecasted demand individually.
Prepare a report for management with your recommendation. Three possible choices exist. 1) Close the Competitor plant and satisfy all demand from the Again Agame plant; 2) Close the Again Agame plant and satisfy all demand from the Competitor plant; 3)Keep both plants open.
Your recommendation should include a solution for each of the five years in question. Include your calculations and spreadsheets in support of your recommendations.
Sales Forecast (cases)
2011
2012
2013
2014
2015
Competitor Warehouse (WH1)
15,000,000
20,000,000
26,000,000
34,000,000
44,000,000
Again Agame Warehouse (WH2)
6,000,000
7,000,000
10,000,000
15,000,000
21,000,000
Fixed Costs
2011
2012
2013
2014
2015
Competitor Plant (P1)
900,000
900,000
900,000
900,000
900,000
Again Agame Plant (P2)
800,000
800,000
800,000
800,000
800,000
Transportation Costs
$1.00 / 1,000 cases / mile
4
Costs -- Both Plant Scenario
20112012201320142015
Transport P1 - WH1
Transport P2 - WH2
Fixed Cost - P1
Fixed Cost - P2
Total
General Info.Infrastructure ExerciseDate: 28/10/97Situation:a) Package -RGBb) Nr. Plants -2c) Nr. WH -2d) Period -5 yearse) Sales Frcst. -DecreasingCapacity MM U/C per Year:Plant 1 -5avg. HK 70 (KS)Plant 2 -3avg. HK 42 (KS)Distance Matrix: (Km)WH1WH2P150600P2600100Diagram:
&A
Page &P
WH2
Franchise 2
Franchise 1
P2
P1
WH1
Sales Frcst.Infrastructure ExerciseDate: 28/10/97Sales Forecast (M U.C)RGB'98'99'00'01'02WH15000.04000.03400.02800.02400.0WH23000.02400.02000.01600.01400.0Obs. Volume is Decreasing 15% per year.
&A
Page &P
CostsInfrastructure ExerciseDate: 28/10/97Transport Costs:0.51,000 cases per KmFixed Costs:900,000P1 = $600,000/year800,000P2 = $500,000/year
&A
Page &P
AnalysisInfrastructure ExerciseDate: 28/10/97Fixed Costs'98'99'00'01'02P1800,000800,000800,000800,000800,000P2700,000700,000700,000700,000700,000Total1,500,0001,500,0001,500,0001,500,0001,500,000Transportation Costs'98'99'00'01'02P1 - WH1125,000100,00085,00070,00060,000P2 - WH2150,000120,000100,00080,00070,000P1 - WH2900,000720,000600,000480,000420,000P2 - WH11,500,0001,200,0001,020,000840,000720,000Total 1275,000220,000185,000150,000130,000(both plants)Total 21,025,000820,000685 ...
MGMT 464From Snowboarders to Lawnmowers Case Study Case An.docxandreecapon
MGMT 464
From Snowboarders to Lawnmowers Case Study
Case Analysis Worksheet #1
Case Analysis Session 1 : Focus on Inspiring a Shared Vision (Principle #2)
Inspiring a shared vision has two main components [1] creating a vision through common purpose, and [2] enlisting or getting people ‘on board’ with the vision.
In your small groups, discuss and document your group’s response to the following questions. Upload your typed document into one of your group member’s D2L dropbox by the assigned due date on your course schedule. Be sure to include on your worksheet all group member names. If present in class, all group members will receive the same grade for this case analysis assignment (maximum 30 pts). Group peer evaluations will be used to determine overall individual group member participation points for both of these case study discussions (maximum 15 pts).
1. In what specific ways did Michael fail and/or succeed in ‘listening deeply’ to his employees?
2. In what specific ways did Michael show that he was not “open to influence?” How would Michael being open to influence have made him more effective, ( i.e., who were the “local experts” and how could he have benefited from them)?
3. When you consider the employees of Bedford Mower as they were before Michael arrived, how would you characterize them in terms of what was personally meaningful to them?
4. When creating his vision for the company, in what specific ways did Michael fail and/or succeed in ‘determining what was meaningful’ to his employees, and what was the impact?
5. What specific mechanisms, or opportunities did Michael have available to him for enlisting others?
6. To what extent did Michael take advantage of these? To what extent were they effective in terms of getting everyone on board with the new vision?
7. In thinking about his attempts to enlist others, in what ways did or didn’t Michael incorporate common ideals into his communication with his employees as it related to the new vision?
8. How successful was Michael in “animating the vision”? How would you characterize him in terms of his use of symbolic language, providing imagery of the future, practicing positive communication, expressing emotion, and speaking from the heart, in his communications to his employees?
9. What would you have done differently with this group of employees in terms of inspiring a shared vision?
Team Leadership Case
From Snowboards to Lawnmowers
Michael Francis, a man in his late 30s, born and raised in Oregon, was an avid snowboarder. He was known among his many friends and associates as a risk-taker, highly intelligent, innovative, a bit of a rebel, but an extremely smart businessman. When he was in his early 20s, he started his own snowboarding company designing and manufacturing what became known as some of the most cutting edge boards available. Having recently married a woman who was raised on the East coast, he decided to sell his company and move to Vermont where h ...
MG345_Lead from Middle.pptLeading from the Middle Exe.docxandreecapon
MG345_Lead from Middle.ppt
Leading from the Middle: Exerting Influence Sideways & Upward
MG345 Organizations & Environment
Tony Buono
Fall 2104
Unfreezing
Changing
Refreezing
Planned
Change
Guided
Changing
Freezing
Rebalancing/
Translating
Unfreezing/
Improvising
Directed
Change
Present
State
Desired
State
Conceptualizing Change Processes
Low
Low
High
High
Business Complexity
Socio-Technical
Uncertainty
Authority
Acceptance
Persuasive Communication
A Question of Rhythm?
Leadership Styles
TASK FOCUS
PEOPLE FOCUS
LEARNING FOCUS
ORGANIZATIONAL EMPHASIS
INDIVIDUAL EMPHASIS
Commanding (Coercive)
Pacesetter
Visionary
(Authoritative)
Affiliative
Democratic
Coaching
EQ Adaptive Ability
Across Styles
Managers as Linking Pins
Middle Management …
“… story of gradual disempowerment in which reasonably healthy, confident and competent people become transformed into anxious, tense, ineffective and self-doubting wrecks.”
Barry Oshry, “Converting Middle Powerlessness to Middle Power,” National Productivity Review
Intervening in the MiddleConceptualizing and Understanding One’s Sphere of InfluenceControllables v. UncontrollablesControlled (Contained) EmpowermentLooking for Opportunities in AmbiguityPursuing “Small Wins”
Source: A.F. Buono & A.J. Nurick, “Intervening in the Middle: Coping Strategies in Mergers and
Acquisitions,” Human Resource Planning, 1992, vol. 15, no. 2.
Lewin’s Force-Field Analysis
Status Quo
Change Drivers
Change Resisters
2-
C
H
A
N
G
I
N
G
1-UNFREEZING
3-REFREEZING
KEY:
Own versus
Induced Forces
Dealing with ResistanceApproachUseAdvantagesDisadvantagesEducation +
CommunicationLack of or inaccurate infoHelps to inform and persuadeTime consuming, especially if many people are involvedParticipation + InvolvementInitiators do not have all info; others have considerable power to resistParticipation leads to commitment; recipient info integrated into change planTime consuming; participators can design inappropriate changeFacilitation + SupportResistance due to adjustment problemsBest way to cope with adjustment issuesCan be time consuming; can still failNegotiationSomeone/group loses out and has power to resistRelatively easy was to avoid problemsCan be expensiveManipulationOther tactics don’t’ workQuick, inexpensiveShort-term utility, can lead to future problemsExplicit + Implicit CoercionSpeed; you have powerSimple, straightforwardShort-term benefits, can be risky; retribution
“Managing” Your Boss
Understand your boss
Goals & Needs Working Style
Strengths & Weaknesses
Understand yourself
Goals & Needs Working Style
Strengths & Weaknesses How you react to your boss?
What do you do to help/hurt your relat ...
MGMT 345
Phase 2 IPBusiness MemoTo:
Warehouse ManagerFrom:[Your Name]Date:February 25, 2015Re:
Effective Supply Chain Design
Enhancing Profitability and Stakeholder Value with Effective Supply Chain Design
Supply Chain Networks
Supply Chain Drivers
Supply Chains and Distribution of Assets and Resources
Supply Chain Visual
Figure 1: The Food Production Chain.(n.d.). Retrieved from http://www.cdc.gov/foodsafety/images/food_production_chain_400px.jpg
References
Do not forget to put your references in alphabetical order (vertically, NOT horizontally) by author’s last name, and use only first initials, not first name. If one of your references begins with the word "The," put the rest of the name first and insert a comma, followed by the word The (example – Associated Press, The.).
Author's Last Name, First Initial. (year). Title of article/Internet page. Retrieved from http://complete URL here Do Not end with a period (EXAMPLE OF AN INTERNET SOURCE – IF NO DATE IS GIVEN ON THE INTERNET PAGE USE: (n.d.). IN PLACE OF THE YEAR.)
Author's Last Name, First Initial. (year). Title of book. City, ST: Publisher. (EXAMPLE OF A BOOK)
Author's Last Name, First Initial. (year, Season). Title of article. Magazine Name, 12(8), 27. (EXAMPLE OF A MAGAZINE ARTICLE - Note – only capitalize the proper nouns in the title of the article; capitalize all the words in the magazine name; the 12 is where the volume number goes, the 8 is where the issue number goes, the 27 is where the page number goes.)
Berube, M. S., ed. (1989). The American heritage dictionary. New York: Dell. (EXAMPLE OF A DICTIONARY)
Bird, I. (1973). A lady's life in the Rocky Mountains (Reprint ed.). New York: Ballantine Books. (EXAMPLE OF A BOOK)
Food Production Chain, The. (n.d.). Retrieved from http://www.cdc.gov/foodsafety/images/food_production_chain_400px.jpg
Grant, A. M. & Berry, J. W. (2011). The necessity of others is the mother of invention: Intrinsic and prosocial motivations, perspective taking, and creativity. Academy of Management Journal.54 (1), 73-96. DOI: 10.5465/AMJ.2011.59215085 (EXAMPLE FROM OUR BONUS LIVE CHAT, PLEASE VIEW THE BONUS LIVE CHAT TO SEE HOW TO FORMAT A REFERENCE WHEN RESEARCHING FROM THE CTU LIBRARY, WHICH IS REQUIRED FOR THIS TASK)
Leonard, S. J., & Noel, T. J. (1990). Denver: Mining camp to metropolis. Niwot, CO: University Press of Colorado. (EXAMPLE OF A BOOK)
Morson, B., & Frazier, D. (2000, December 7). For years, brown cloud fouls Denver image [Electronic version]. Denver (Colorado) Rocky Mountain News. Retrieved October 3, 2002, from http://insidedenver.com/millennium/1207stone.shtml (EXAMPLE OF A NEWSPAPER ARTICLE FROM AN ONLINE VERSION OF THE NEWSPAPER)
National Jewish Medical & Research Center. (2001a, January 5). The 'Brown Cloud,' cold-induced asthma, winter allergies and seasonal affective disorder around the corner as winter approaches. Retrieved October 4, 2002, from http://www.njc.org/news/ winter1.html (EXAMPLE OF AN ORGANIZATION ...
MGMT 3720 – Organizational Behavior EXAM 3
(CH. 9, 10, 11, & 12)
Question 1
1.
While discussing their marketing campaign for a new product, the members of the cross-functional team responsible for Carver Inc. realized that a couple of changes relating to their prior plan would be beneficial. The offer of a franchising that had earlier been brushed off by the company head was discussed thoroughly and it was decided that it would be implemented on a trial basis initially, and on full scale if found to work well. From the information provided, it can be concluded that this cross-functional team has a high degree of ________.
Answer
reflexivity
uncertainty
diversity
conformity
demography
Question 2
1.
Max Hiller was recently hired by Sync, a consumer goods company. During his first meeting with the sales team, Max impressed upon his team that work performance is the only criterion he would use to evaluate them. To help them perform well and meet their targets, he pushed his team to work extra hours. He also gave very clear instructions to each member regarding their job responsibilities and continually verified if they were meeting their targets. Which of the following, if true, would weaken Max's approach?
Answer
Sales figures for the region that Max's team is responsible for have improved in the last quarter.
Max is leading many new employees who have joined his team directly after training.
Max's sales team is comprised of independent and experienced employees who are committed to their jobs.
Max's team functions in a sluggish manner and picks up pace only a week or so before the monthly operations cycle meetings.
Max's team does not display high levels of cohesiveness and members fail to coordinate with each other.
Question 3
1.
Which of the following statements is true regarding the effect of group cohesiveness and performance norms on group productivity?
Answer
When both cohesiveness and performance norms are high, productivity will be high.
The productivity of the group is affected by the performance norms but not by the cohesiveness of the group.
If cohesiveness is high and performance norms are low, productivity will be high.
When cohesiveness is low and performance norms are also low, productivity will be high.
If cohesiveness is low and performance norms are high, productivity will be low.
Question 4
1.
Neutralizers make it impossible for leader behavior to make any difference to follower outcomes.
Answer
True
False
Question 5
1.
Communication includes both the transfer and the understanding of meaning.
Answer
True
False
Question 6
1.
According to the path-goal theory, directive leadership is likely to be welcomed and accepted by employees with high ability or considerable experience.
Answer
True
False
Question 7
1.
Before buying her new phone, Gina listed the various requirements her new phone must meet. As a wedding planner, much of her work revolved around usin ...
Mexico, Page 1 Running Head MEXICO’S CULTURAL, ECONOMI.docxandreecapon
Mexico, Page 1
Running Head: MEXICO’S CULTURAL, ECONOMICAL, AND POLITICAL STATE
Mexico’s Cultural, Economical, and Political State
For
Firms Pursuing Business In or With Mexico
By
Kashmala Khan
For
Athena Miklos, Professor
ECN 2025-102947
Tuesdays and Thursdays, 10:00-11:20 AM
College of Southern Maryland
La Plata, Maryland
November 15, 2012
Mexico, Page 2
Summary
Before a firm does business in Mexico it is imperative to understand the achievements
and pitfalls of its cultural, economic, and political forces. Although Mexico has improved
substantially with its technological development, investment policies, foreign exchange policies,
and tariffs, it still has significant pitfalls when it comes to honoring contracts, legal framework,
and enforcing laws.
The cultural forces of Mexico are largely dependent on social structure. Mexicans respect
authority and look to those above them for guidance and decision-making. This makes it
important to know which person is in charge, and leads to an authoritarian approach to decision-
making and problem solving. Since 92.7% of the total population in Mexico speaks Spanish
only, it will be beneficial to learn Spanish or have a translator at hand at all times. Shared culture
makes it easier to market and sell goods and services.
The economic forces in Mexico offer both favorable and unfavorable qualities. Mexico is
currently the second largest export market for U.S. goods. Some of the greatest achievements of
economic forces include physical infrastructures, telecommunication systems, production
capabilities, and technology. The unfavorable qualities of the economic forces include high
employment rate and unskilled labor.
The political forces in Mexico also play a great role in opportunities and pitfalls. The
opportunities include efficient settlements to disputes and reasonable trade regulations and
standards. The pitfalls include wars and terrorism caused by the drug wars and cartels.
There are numerous opportunities for firms in the Textiles and Clothing industry of
Mexico. A firm should be knowledgeable about the cultural differences in Mexican people in
Mexico, Page 3
order to undergo business successfully. A firm should also be aware of the potential profit
Mexico has to offer, as well as the potential problems. To conclude from this research, U.S.
firms should enter the Textiles and Clothing industry in Mexico because there are a lot of
opportunities and the Mexican economy will further expand in the near future.
Mexico, Page 4
Introduction
This paper will review and relay the most recent information regarding Mexico’s cultural,
economic, and political forces. The objective of this paper is to assist firms who are interested in
entering the Textiles and Clothing industry in Mexico by portraying the opportunities, issues,
and pros and cons of doing business in Mexico. Th ...
MGM316-1401B-01Quesadra D. GoodrumClass Discussion Phase2.docxandreecapon
MGM316-1401B-01
Quesadra D. Goodrum
Class Discussion Phase2
Colorado Technical University
Professor: Edmund Winters
4/07/2014
In an ever-changing world, intercultural business communication is one of the most vital aspects of carrying out business in foreign countries. We are set up to fail if we enter into foreign business agreements blindly. In the absence of proper communication skills, cultural awareness comes into play knowing the culture in which we are dealing. All of your concepts you may have grown up with and ideas that you have formed beforehand need to be thrown away and cast to the side. Your concepts and ideas in these business meetings will only be as effective as your communication skills. If your communications skills are weak so will be your presentation of your projected business plan. If I was going to develop a training program on the same, my lesson plan would look as illustrated below:
I. Class Objectives: The goals or objectives for class include understanding how language affects intercultural business communications and learning about different cultures and how they communicate when conducting business activities.
II. Connection to Course Goals: The class’s daily objectives will connect to the overall course goals by dealing with one topic at a time.
III. Anticipatory Set: What is usually involved in intercultural business communication and how should one behave if relocated to foreign countries such as United Arab Emirates, Mexico, China and Israel?
IV. Cultural Awareness
V. High vs. Low Context Cultures
VI. Language: Verbal vs. Non-Verbal
VII. Conversational Taboos
VIII. Interaction: Ethical/Unethical awareness
IX. Conclusion: connecting the objectives
My developed training program will help my students target and grasp the importance of the concepts listed and how they connect to one another. You will need to know a number of things regarding Cultural Awareness, High vs. Low Context Cultures, and Verbal vs. Non-Verbal, Conversational Taboos, and Interaction Ethical/Unethical awareness, and connecting the objectives. “Low context language is where things are fully spelled out or made explicit where there is also considerable dependence on what is actually being said or written (Gibson, 2002).” Western cultures tend to be inclined more toward low context language while Eastern and
Southern cultures are more inclined to use high context language (LeBaron, 2003).“High context language is whereby communicators assume a great deal of commonality of opinions and knowledge so that not much is made explicit (Novinger, 2001).” In other words, communication is in indirect ways. It is of crucial importance for business individuals venturing overseas to learn more about the business culture and etiquette present in countries such as Mexico, China, United Arab Emirates and Israel as they are not the same as the American business culture.
International Business Communication
Understanding other cultures tend to greatly enh ...
METROPOLITAN PLANNING ANDENVIRONMENTAL ISSUESn May 2008, the N.docxandreecapon
METROPOLITAN PLANNING AND
ENVIRONMENTAL ISSUES
n May 2008, the Nobel Prize–winning economist Paul Krugman was in Berlin, and
he wrote an Op-Ed piece for the New York Times that began, “I have seen the future,
and it works.” He went on to extol “this marvelous urban environment” with its pitchperfect
public transportation servicing medium height high-rise buildings embedded
in a larger urban-scape of commercial service establishments and green areas. He then
commented: “It’s the kind of neighborhood in which people don’t have to drive a lot,
but it’s also a kind of neighborhood that barely exists in America, even in big metropolitan
areas. Greater Atlanta has roughly the same population as greater Berlin—but
Berlin is a city of trains, buses and bikes, while Atlanta is a city of cars, cars and cars.”
The Nobel Prize winner is speaking here not as an objective scientist, but as another
tourist from America, and one who subscribes to the subjective bias against suburban
sprawl. As any other observant visitor to Berlin can attest, he leaves out other aspects of
the experience: the mixed groups of drug addicts loitering around select public places
including open-air heroin users and speed freaks; Nazi skinheads roaming the very
community transportation corridors Krugman lauds; sectors of the city that could be
called slums in the American style, except that the housing is better maintained and
the streets are cleaner; and, despite the popularity of Berlin, an increasing and denser
development of the region outside the city for the kind of single-family homes that are
most characteristic of the United States and that he seems to dislike despite the fact
that he probably lives in one back in Princeton, N.J., where he is a professor.
To be sure, Krugman has an excellent point and his comparison between Berlin
and Atlanta is well taken. However, any tourist comparing American and European
urban development patterns for public consumption, such as this Op-Ed columnist,
must be held responsible for pointing out the single most important reason for the
contrast. Simply put, European cities have fought sprawl and have a more “rational”
public mode of living that includes clustered high-rises and efficient public transportation
precisely because in Europe planners have political power and leverage over
land use built by profit seekers. America has nothing comparable because Americans
321
I
dislike public housing and government planning and are generally opposed to government
regulation and intervention. The fundamental ideological divide between these
societies could not be more different. Witness the frustrating and irrational response
average U.S. citizens have made in opposition to government-sponsored health insurance
during the summer of 2009. European countries adopted universal health care,
in contrast, scores of years ago. At about the same time, in the post–World War II era,
they also sanctioned local and national planning schemes for housing and ...
Methods of Moral Decision Making REL 330 Christian Moralit.docxandreecapon
Methods of Moral Decision Making
REL 330 Christian Morality
Acquisition of Christian Based Ethical Truth comes from:
1. Written Revelation – the Bible
2. Natural Law
· Human reason is capable of divine ethical truth.
· Human kind made in the image of God is therefore capable of understanding ethical standards revealed in nature.
· Natural tendency for self-preservation, avoidance of pain, defense of children.
3. The Church - A. Narrative component : Stories and images,
B. Normative component: Rules/guidelines
C. Church functions to assist with character development by teaching,
through community, and imagination (raises to new acute awareness &
understanding)
How we decide is a matter of style:
Rule-Based or Deontological Theories of Ethics (Rule or duty based)
A. Divine Command/Absolutism –
Our behavior, actions and moral decisions are based on God’s will.
How do we determine the will of God?
Based on our experience of God and our understanding of the nature of
God.
God is good. We need an understanding of what the Good is.
Do we follow God’s command out of fear or out of love?
Which is more important the rule or the intention?
The problem with moral decision making arises when in a particular situation one needs to choose between protecting one’s own life and the life of another. Complex situations in our nuclear age make it difficult to determine the greater good or the lesser of two evils in many cases.
B. Immanuel Kant’s “Categorical Imperative” - another of the deontological or rule based theories of ethics that may help in ethical reasoning-
His theory states “Act only according to that maxim by which you can at the same time will that it should become a universal law.” Also persons are not to be a means to an end. (Immanuel Kant, Groundwork of the Metaphysics of Morals, 1785; cited in Rachels, 115)
C. Social Contract Theories- a belief that moral judgments are simply conventions determined by a particular society. How this works is evident in the “Peace Child.”
D. Critical Realism- is a method thatasserts that our knowledge of the world refers to the-way-things-really-are, but in a partial fashion which will necessarily be revised as that knowledge develops. Critical Realism attempts to find the real good through dialogue and reason between the ideal rule or norm and the reality of the present world.
Teleological or goal-based theories of Ethical Reasoning- (Also known as consequentialism)
A. Ethical Egoism- a moral act is what benefits me.
B. Utilitarianism- a moral act is what causes the greatest amount of happiness for the most people concerned, i.e.,
· Right actions are those with best consequences.
· In assessing “best consequences” the amount of happiness or unhappiness caused is the only relevant consideration.
· Each person’s welfare is equally important
C. Emotivism- moral judgments ar ...
METHODS TO STOP DIFFERENT CYBER CRIMES .docxandreecapon
METHODS TO STOP DIFFERENT CYBER CRIMES 1
Methods to Stop Different Cyber Crimes
People must be well-informed regarding internet scams and certain vulnerabilities, which permit them to occur sooner or later. With education, they will be in a situation to help in prevention of such scams successfully (Hynson, 2012). It is imperative for people to be familiar with attempts of cybercrimes and to comprehend correct solutions in internet practices and solutions. People will learn with education how to put into practice proper security protocols. When they develop into social media savvy people and when they learn how to safe guard their computer devices, cybercriminals will encounter multiple layers of security, which will limit their illegal activities substantially.
Firewalls have the capability to protect users and their network devices against cyber criminals in the first instance of a attempted breach (Lehto,2013). A firewall monitors the interchange between a local network or the internet and a user’s computer. The firewall should be enabled through the security software or a router. Cybercriminals will be unable to use the interchange traffic to install malware, which is intended to compromise the user’s network and computer. If more people would use firewalls, hackers would be at a chief disadvantage due to being unable to navigate deeper into a system to obtain sensitive information and eventually, cybercrime would be lessened for a time.
Users need to analyze their operating and online systems continually so they can resolve vulnerabilities (Hynson, 2012). Internal accounting information or protocols, which lead to financial information or bank statements, should be checked on a regular basis in order to recognize the risks and mitigate them accordingly. It is very difficult for people to curb the flow of cybercrimes if they are ignorant of the risks in which they face or the weaknesses, which exist within their systems.
One successful way of slowing the actions of cyber criminals is by acting like them. This requires law enforcement agencies such as the Federal Bureau of Investigation (FBI) to assign special undercover agents to gain access to clubs or groups of cyber criminals so they can investigate their steps (Hynson, 2012). The investigation method will become more effective by identifying the source of the problem and in developing a stronger strategy to cripple the efforts of the criminals.
Cyber criminals can hack into systems without difficulty when they encounter uncomplicated passwords. Users should use passwords with at least 10 or more characters so they can amplify the complexity of logging into the computer system (Lehto, 2013). It also helps top add in capital letters and special characters to increase the complexity of a password. In addition, different accounts should have dissimilar ID’s or password combinations to avoid giving hackers ac ...
Mexico The Third War Security Weekly Wednesday, February 18.docxandreecapon
Mexico: The Third War
Security Weekly Wednesday, February 18, 2009 - 13:23 Print Text Size
By Fred Burton and Scott Stewart
Mexico has pretty much always been a rough-and
-tumble place. In recent years, however, the
security environment has deteriorated rapidly, and
parts of the country have become incredibly
violent. It is now common to see military
weaponry such as fragmentation grenades and
assault rifles used almost daily in attacks.
In fact, just last week we noted two separate
strings of grenade attacks directed against police
in Durango and Michoacan states. In the
Michoacan incident, police in Uruapan and Lazaro Cardenas were targeted by three grenade attacks during a 12-hour period.
Then on Feb. 17, a major firefight occurred just across the border from the United States in Reynosa, when Mexican
authorities attempted to apprehend several armed men seen riding in a vehicle. The men fled to a nearby residence and
engaged the pursuing police with gunfire, hand grenades and rocket-propelled grenades (RPGs). After the incident, in which
five cartel gunmen were killed and several gunmen, cops, soldiers and civilians were wounded, authorities recovered a 60 mm
mortar, five RPG rounds and two fragmentation grenades.
Make no mistake, considering the military weapons now being used in Mexico and the number of deaths involved, the country
is in the middle of a war. In fact, there are actually three concurrent wars being waged in Mexico involving the Mexican drug
cartels. The first is the battle being waged among the various Mexican drug cartels seeking control over lucrative smuggling
corridors, called plazas. One such battleground is Ciudad Juarez, which provides access to the Interstate 10, Interstate 20 and
Interstate 25 corridors inside the United States. The second battle is being fought between the various cartels and the Mexican
government forces who are seeking to interrupt smuggling operations, curb violence and bring the cartel members to justice.
Then there is a third war being waged in Mexico, though because of its nature it is a bit more subdued. It does not get the
same degree of international media attention generated by the running gun battles and grenade and RPG attacks. However, it
is no less real, and in many ways it is more dangerous to innocent civilians (as well as foreign tourists and business travelers)
than the pitched battles between the cartels and the Mexican government. This third war is the war being waged on the
Mexican population by criminals who may or may not be involved with the cartels. Unlike the other battles, where cartel
members or government forces are the primary targets and civilians are only killed as collateral damage, on this battlefront,
civilians are squarely in the crosshairs.
The Criminal Front
There are many different shapes and sizes of criminal gangs in Mexico. While many of them are in some way related to the
drug cartels, others have various types of c ...
Mercy College Principles of Management
Professor Tormey
Shadow-A-Company Term Project
The EXACT POWERPOINT sequence or order for your report should be as follows:
1. The Company’s Name
2. The Company’s Logo
3. The Company’s Mission Statement
4. Is the company living up to its stated objectives
5. What additional businesses should this company possibly explore entering?
6. The Company’s three (3) main competitors
7. A picture of, and the name of, the following: the Chairman, the President, the CEO and the CFO
8. The Stock Symbol and Exchange that it is traded on
9. The company’s recent stock price
10. The number of company employees worldwide
11. The location of the company’s corporate headquarters (city/state only)
12. The company’s yearly sales for 2012 in billions of dollars
13. The company’s yearly profit for 2012 in millions/billions of dollars
14. The company’s…STRENGTHS
15. The company’s…WEAKNESSES
16. The company’s…OPPORTUNITIES
17. The company’s…THREATS
18. Several of the company’s STAR product’s and or division’s
19. Several of the company’s CASH COW product’s and or division’s
20. The company’s QUESTION MARK’S product’s and or division’s
21. The company’s DOG product’s and or division’s
22. IMPORTANTLY… a statement from EACH student of exactly what each of you have learned while completing this research project
Shadow-A-Company Analysis
A process by which a student evaluates the products and businesses making up their assigned company.
Portfolio AnalysisPurpose of portfolio analysis:
Resources are directed toward more profitable businesses while weaker ones are phased out or dropped.Standard portfolio analysis evaluates SBUs on two important dimensions:
Attractiveness of SBU’s market or industry.
Strength of SBU’s position within that market or industry.
Figure 2.2:
The BCG Growth-Share Matrix
BCG Growth-Share MatrixStars: High-share of high-growth market.
Strategy: Build into cash cow via investment.Cash cows: High-share of low-growth market.
Strategies: Maintain or harvest for cash to build STARS.Question marks: Low-share of high-growth market.
Strategies: Build into STAR via investment OR reallocate funding and let slip into DOG status.Dogs: Low-share of low-growth market.
Strategies: Maintain or divest.
Figure 2.7:
SWOT Analysis
Mercy College Principles of Management
Professor Tormey
Shadow-A-Company Term Project
Each student will be assigned a specific company to closely monitor and study throughout the duration of the semester.
On our final class meeting date, you will be required to s ...
MGMT 301 EOY Group” Case Study and Power Point Presentation G.docxandreecapon
MGMT 301 EOY “Group” Case Study and Power Point Presentation Grade Sheet-
Group Name: _____________________________ Time of class__________________
Total Paper should be 8-10 pages in length- this includes preliminary or prefatory section
No indentations for paragraphs- single spacing with double spacing in-between paragraphs
APA citations need to be used as your guide for citing reference material!
Preliminary or prefatory section- (this section has different page numbering, ii,iii,etc)
Title Page
Page ii-Table of Contents/ and List of Illustrations/Figures/Tables (10 points) ________
Page iii- Executive Summary- use bullets/ and bold headings (10 points) ________
Body of Paper and Analysis of Case Study and Questions and Answers – (starts w/page 1)
Page 1- Introduction- Starts on Page 1 and is at least ¼ to ½ page (5 points) ________
Page Numbering- After Introduction start your research paper…
Body of paper should be 5-8 pages in length
Research used in your paper
You will need to use at least “Five” different research cites! (50 points)________
You need to include “Five” different areas of analysis
Example: Motivation, Communication, Leadership, etc. (Chapters from your book)
Two Charts or Graphs in body of paper (5 points each) (10 points)________
They both need to be properly cited! (Heading)( Figure 1 or 2)(Source: citation)
Recommendation/Conclusion – (10 points)________
Reference Page- cite all you references on a separate sheet (5 points)________
100 POINTS TOTAL_________________
Points to be deducted in each category:
Poor: Headings, Sub-Heading or lack of Bold Headings (5 points)_________
Poor: Grammar- Sentence Structure - Formatting of Paragraphs (5 points)_________
Poor: Citation of your research material (10 points)_________
WRITTEN PAPERWORTH 100 POINTS TOTAL _______________
Power point Presentation - NOT MORE THAN 10 MINUTES!- Please do voice-over or camera
(Call eCampus or Tech-help or blackboard for assistance with your power point presentation)
Appropriate Business Attire for Presentation--points will be taken off for poor attire
Was there an opening statement? (10 points) ________
Clear - Easy to read - Eye appealing (10 points) ________
Not more than 7 lines per slide and 7 words in a line on a slide
Did you engage your audience?
Voice, clarity, clarity, volume, speed, poise and confidence (10 points) ________
Two graphs in your presentation- must be cited correctly (10 points)________
Was there a conclusion slide and statement? (10 points__________
Points will be taken off if:
Speed of presentation, (too fast or too slow) (up to 5 points) ________
“UHMS” and “H’S” – (1 point for every 10)________
POWER POINTWORTH 50 POINTS TOTAL________
ENTIRE PAPERWORTH 150 POINTS TOTAL__________
CASE
3 Building a Coali ...
MGMT 464New Manager’s Case Study Case Analysis Worksheet #.docxandreecapon
MGMT 464
New Manager’s Case Study
Case Analysis Worksheet #2
Team Case Analysis Session 2: Enable Others To Act (Principle # 4)
Enabling others to act has two main components [1] fostering collaboration, and [2] strengthening others.
In your small groups, discuss and document your group’s response to the following questions. Upload your typed document into one of your group member’s D2L dropbox by the assigned due date on your course schedule. Be sure to include on your worksheet all group member names. If present in class, all group members will receive the same grade for this case analysis assignment (maximum 30 pts). Group peer evaluations will be used to determine overall individual group member participation points for both these case discussions (maximum 15 pts).
1. In what specific ways did Mark create a climate of distrust?
2. In what ways did Mark fail to “set the example” in his work role? What was the impact of his failure to be a good role model for his employees?
3. What type of relevant information and resources did he not share with his employees? What was the impact?
4. In what ways had the former supervisor built his employees’ sense of competence? How did Mark later undermine the employees’ sense of competence?
5. In what ways did the employees demonstrate accountability before Mark took over?
6. What kind of expectations of his employees did Mark communicate, and how did this become a self-fulfilling prophecy (The Pygmalion Effect)?
7. What employee obstacles were apparent in the case that Mark ignored? What actions could he have taken to remove these obstacles?
8. In what sense did the employees have a sense of job meaning and impact before Mark arrived? How did Mark’s actions lead to a decreased sense of job meaning and impact for the employees?
9. What would you have done differently with this group of employees in terms of empowerment and fostering collaboration?
Problems: Answer each question
1. A quality control expert is called in to determine whether a newly installed machine is meeting quality standards in producing a particular cotton cloth according to the specifications set by the manufacturer. The mean warp-breaking strength of this particular cotton cloth has been established to be 66 pounds. A random sample of 36 pieces of cotton cloth is obtained from a production run on this machine. The results of the sample reveal a mean warp-breaking strength of 64.5 pounds and a standard deviation of 5 pounds. Can the quality control expert make the decision that the cotton produced on the new machine meets the warp-breaking specification of the manufacturer at the .05 level of significance?
2. The personnel director of a large insurance company is interested in reducing the turnover rate of data processing clerks in the first year of employment. Past records indicate that 25% of all new hires in this area are no longer employed at the end of one year. Extensive new training approaches are im ...
META-INF/MANIFEST.MF
Manifest-Version: 1.0
.classpath
PriorityQueue.classpublicsynchronizedclass PriorityQueue {
Heap q;
public void PriorityQueue(int, java.util.Comparator);
public Object peek();
public Object remove();
void add(Object);
boolean isEmpty();
public int size();
}
PriorityQueue.javaPriorityQueue.javaimport java.util.Comparator;
publicclassPriorityQueue<E>{
Heap q;
/**
*PriorityQueue initializes the queue.
*
* @param initialCapacity an int that is the heaps initial size.
* @param comparator the priority of various imputs.
*/
publicPriorityQueue(int initialCapacity,Comparator<?super E> comparator){
q=newHeap(initialCapacity,comparator);
}
/**
* Peek, returns the next item in the queue without removing it.
*
* If it is empty then null is returned.
* @return the next item in the queue.
*/
public E peek(){
if(q.size()==0){
returnnull;
}
return(E) q.findMax();
}
/**
* This removes the first item from the queue.
*
* It returns null if the queue is empty.
* @return the first item in the queue.
*/
public E remove(){
if(q.size()==0){
returnnull;
}
return(E) q.removeMax();
}
/**
* This adds item to the queue
* @param item that is added to the queue.
*/
void add(E item){
q.insert(item);
}
/**
* isEmpty returns if the queue is empty or not.
*
* @return boolean if the queue is empty or not.
*/
boolean isEmpty(){
if(q.size()!=0){
returnfalse;
}
returntrue;
}
/**
* size returns the size of the queue.
*
* @return int the size of the queue.
*/
publicint size(){
return q.size();
}
}
ArithmeticExpression.classpublicsynchronizedclass ArithmeticExpression {
BinaryTree t;
java.util.ArrayList list;
String equation;
void ArithmeticExpression(String) throws java.text.ParseException;
public String toString(BinaryTree);
public String toPostfixString(BinaryTree);
void setVariable(String, int) throws java.rmi.NotBoundException;
public int evaluate(BinaryTree);
}
ArithmeticExpression.javaArithmeticExpression.javaimport java.rmi.NotBoundException;
import java.text.ParseException;
import java.util.ArrayList;
import java.util.Stack;
/**
* ArithmeticExpression takes equations in the form of strings creates a binary
* tree, and can return either the regular or postfix equation. It also allows
* them to be calculated.
*
*
* Extra Credit:
* ** it can handle spaces or no spaces in the string inputted. ** it can return
* regular or postfix notation
*
* @author tai-lanhirabayashi
*
*/
publicclassArithmeticExpression{
BinaryTree t;
ArrayList list;
String equation;
/**
* ArithmeticExpression is the construction which takes in a space
* delimitated equation containing "*,/,+,-" symbols and converts it into a
* binary tree.
*
* If the expression is not valid it will throw a ParseException. This is ...
Menu Management Options· · APRN504 - 5886 - HEALTH POLICY .docxandreecapon
Menu Management Options
·
·
APRN504 - 5886 - HEALTH POLICY AND LEADERSHIP - Spring2016
· Home Page
· Announcements
· Syllabus
· Discussions
· Weekly news update
· Assignments
· Sign up Wiki
· Writing Information
· Groups
· Week One
· PowerPoint Week #1
· PowerPoints Week #1
· Week Two: Information
· Week Three
· PowerPoint:Week #3 Policy
· PowerPoint-Communication
· PowerPoint: SS
· Week Four
· PowerPoint: Finances
· PowerPoint-Ethics
· Week Five
· Week Six
· Week Seven
· Week Eight
· PowerPoint: Lobbying
· Week Nine
· PowerPoint:Workplace
· Week Ten
· Week Eleven
· PowerPoint:Centers
· PP: Putting it Together
· Week Twelve
· Week Thirteen
· Week Fourteen
· Week Fifteen
· APA Links
· Help
· Tools
PowerPoint Week #1
Top of Form
Bottom of Form
Content
·
Social Determinants of Health
·
One view of the ACA
·
Another view of ACA
Remember South Carolina did NOT take the Medicaid expansion.
·
South Carolina and Medicaid
·
The IOM and Nursing
· Nursing and Politics
·
Mentoring
·
The Difference in Political Philosophy
·
Policy Process
GRADING RUBRICS:
Journals: The Journals should be a synopsis of ALL your required readings and PowerPoints. These papers are three to six pages long and include a reference page. Tell me what you learned. Failure to cover any aspect of the information will result is loss of points. APA format is required so remember your title page. The required APA textbook has examples from pages 41-59. Spelling and grammar issues will result in loss of points. Late Submissions: Minus 10 points/day.
Forum: Discussion Board
Organize Forum Threads on this page and apply settings to several or all threads. Threads are listed in a tabular format. The Threads can be sorted by clicking the column title or the caret at the top of each column. More Help
Content
Top of Form
This is a 'post-first' discussion forum.
There are currently 18 threads in this forum. Join the conversation by creating a thread!
Create Thread
Forum Description
Introduce yourself. Tell us your background and what track you are currently in. Have you had any experience with politics, leadership or political events? What do you hope to gain from this course? What are your concerns about taking a hybid course? What do you wish other people knew about you? Where do you hope to be five years from now? What has been your experience in a Political Group (ANA, SCNA, ANCC, ACNP, SCMA, Republican Party, Democratic Party, etc) and the role they play in politics? Inform us of what district you live in, who is your current represenative and senator for your district. A meaningful response to two classmates and facilitation of a dialog is an expectation for the discussion board. You can not post "I agree" or "I disagree". A discussion is like a ball being tossed back and forth. If you ask questions of your classmates you facilitate dialog. The discussion Boards are open for two weeks and close on Sundays at 11:59 pm. Do not wait until the last minute to post becaus ...
MGMT 673 Problem Set 51. For each of the following economic cond.docxandreecapon
MGMT 673 Problem Set 5
1. For each of the following economic conditions, place an X in the table to indicate the appropriate range in the Aggregate Supply Curve
Condition
Keynesian
Intermediate
Classical
Unemployment is above the historical average
The nation’s factories are running at capacity
Any increase in GDP will be accompanied by high inflation
The nation is suffering through a severe recession
A mid-point in the business cycle expansion phase
GDP can increase without an increase in the Price Index
2. Many exogenous factors can cause a shift in the Aggregate Supply Curve. For each of the following factors, place an X in the table to indicate how the AS curve would shift.
Factor
AS shift right
(increase in AS)
AS shift left
(decrease in AS)
World oil prices increase substantially
Environmental Protection Agency enacts broad pollution restrictions
Business taxes are reduced
Internal combustion engine fuel efficiencies are greatly increased
Adverse winter weather persists for months more the normal
New restrictions slow immigration
Federal minimum wage is increased by 30%
3. Earlier we learned that Demand, which we now call Aggregate Demand, is comprised of 4 components: Consumption (C), Investment (I), Government spending (G), and Net Exports (NE). Any exogenous factor that increases any of the component(s) will also increase Aggregate Demand. For each of the following, place an X to indicate the component affected and an R (increase) or and L (decrease) to show whether the AD curve shifts Right or Left. Consider only the primary effect.
Factor
C
I
G
NE
R or L
Real interest rate decreases
Consumers and executives become more confident in the economic future
The stock market rises
China’s economic growth slows
Congress increases spending for in the current fiscal year
Tariffs are imposed by many countries to protect domestic employment
The US Import/Export bank eliminates guarantees for loans to foreign airlines to purchase Boeing aircraft
Congress enacts tax incentives for firms purchasing new equipment and facilities
4. For each of the following government economic actions, place an X in the table to indicate whether the action is fiscal or monetary policy.
Action
Monetary
Fiscal
Taxes are increased on the wealthiest 1% of households
The Fed purchases Mortgage-backed securities (MBS)
The US Treasury borrows money to finance increased government spending
The federal government provides a rebate to first time home buyers
The President signs and enacts the Affordable Care Act
The Fed promises to keep interest rates near zero for an extended time
5. For each of the following government actions, insert the original and shifted AD curve. Insert an arrow to show the shift in the AD curve. Here’s an example:
GDP
Price
Index
Real GDP
AS
a. While in a steep recession, the federal government enacts a stimulus program of increased spending and r ...
Mental Illness Stigma and the Fundamental Components ofSuppo.docxandreecapon
Mental Illness Stigma and the Fundamental Components of
Supported Employment
Patrick W. Corrigan, Jonathon E. Larson, and Sachiko A. Kuwabara
Illinois Institute of Psychology
Purpose/Objective: The success of supported employment programs will partly depend on the endorse-
ment of stigma in communities in which the programs operate. In this article, the authors examine 2
models of stigma—responsibility attribution and dangerousness—and their relationships to components
of supported employment—help getting a job and help keeping a job. Research Method/Design: A
stratified and randomly recruited sample (N � 815) completed responses to a vignette about “Chris,” a
person alternately described with mental illness, with drug addiction, or in a wheelchair. Research
participants completed items that represented responsibility and dangerousness models. They also
completed items representing 2 fundamental aspects of supported employment: help getting a job or help
keeping a job. Results: When participants viewed Chris as responsible for his condition (e.g., mental
illness), they reacted to him in an angry manner, which in turn led to lesser endorsement of the 2 aspects
of supported employment. In addition, people who viewed Chris as dangerous feared him and wanted to
stay away from him, even in settings where people with mental illness might work. Conclusions/
Implications: Implications for understanding supported employment are discussed.
Keywords: stigma, supported employment, discrimination
The disabilities of serious mental illness can block people from
obtaining important life goals, including a good job. Several kinds
of vocational rehabilitation programs have emerged to address
work-related disabilities. Some of these approaches are known as
train-place strategies (Corrigan & McCracken, 2005). Through an
education-based strategy, in train-place programs, participants
must learn prevocational and work readiness skills before they are
placed in work settings. These work settings are often sheltered;
that is, the job is “owned” by a rehabilitation agency, which can
protect participants from stressors (Corrigan, 2001). Alternatively,
supported employment is place-train in orientation. People are
placed in real-world work and subsequently provided training and
support to address problems as they emerge, thereby helping a
person to maintain a regular job. The latter group has dominated
recent supported employment models for people with psychiatric
disabilities (Bond et al., 2001; Bond, Becker, Drake, & Vogler, 1997).
Some forms of supported employment recommend rapid placement
of people in work settings of interest to them (Becker & Drake, 2003).
Unlike train-place programs, supported employment does not
try to protect people with disabilities from the work world (Cor-
rigan, 2001; Corrigan & McCracken, 2005). Instead, providers
offer direct support in vivo. This kind of approach is more suc-
cessful in communities where the intent of supported ...
Merck & Co. Inc. MRKCopy and pasteany three Notes to the Fina.docxandreecapon
Merck & Co. Inc. MRK
Copy and pasteany three “Notes to the Financial Statements” (except for the one addressing “Significant Accounting Policies”)
Complete the following tasks and questions:
1. Does your company have a Deferred Tax Asset or Deferred Tax Liability, or both? How much are they?
2. What was the Income Tax Expense for the year?
3. What is the Income Tax Payable or Refundable for the year?
4. How much Taxes was paid for the year?
5. Copy and paste the disclosure note that relates to Taxation. (Note - not the one that appears in Significant Accounting Policies)
6. Does your company have any Uncertain Tax positions? If so, what are they for?
7. What did you find most interesting about the company’s Tax disclosure note?
...
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
2. revenue$72.708$78.205$90.383$99.475$100.236Patient
services
expenses$60.245$73.858$81.525$90.645$89.505Interest
expense3.0453.1473.0933.0022.980Depreciation3.4663.6894.39
54.2586.031Total operating
expense$66.756$80.694$89.013$97.905$98.516Net
income$5.952($2.489)$1.370$1.570$1.720MODEL-
GENERATED DATA:Palmetto General HospitalPro Forma
Income Statements:(Millions of
Dollars)20072008200920102011Inpatient
revenue$110.384$110.384$110.384$110.384$110.384Outpatient
revenue50.81050.81050.81050.81050.810Gross patient
revenue$161.194$161.194$161.194$161.194$161.194Allowance
s and discounts0.0000.0000.0000.0000.000Net patient
revenue$161.194$161.194$161.194$161.194$161.194Other
operating revenue1.0481.0481.0481.0481.048Total operating
revenue$162.242$162.242$162.242$162.242$162.242Patient
services expenses$0.000$0.000$0.000$0.000$0.000Interest
expense0.0000.0000.0000.0000.000Total operating
expense$0.000$0.000$0.000$0.000$0.000Net operating cash
flow$162.242$162.242$162.242$162.242$162.242Cost savings
at University0.0000.0000.0000.0000.000Growth
retentions0.0000.0000.0000.0000.000Terminal value0.000Net
cash flow to
equityholders$162.242$162.242$162.242$162.242$0.000EBITD
A$162.242$162.242$162.242$162.242$0.000Valuation
Results:Average 5-year EBITDA$0.000Value according to DCF
method$0.000Value according to market multiple
method:Applied to 2004 EBITDA$0.000Applied to average
2004-2008 EBITDA$0.000
&A
Page &P
MHC6305 Financial Management of Healthcare Organizations
3. Merger Analysis Case Study
Franklin Teaching Hospital
Currently, three hospitals serve the patient base of Palmetto
County, Florida, which has a population of about 220,000. The
hospitals include the following:
· Franklin Teaching Hospital, a 525-bed, not-for-profit
university-related teaching hospital
· Suncoast Regional Medical Center, a 200-bed, for-profit
hospital owned by Senate Healthcare, a national chain
· Palmetto General, a 400-bed, not-for-profit, acute care
hospital owned by Citrus Healthcare
The service area has a total of 1,125 licensed beds for 200,000
people, or 5.1 beds per 1,000 people, which is higher than the
national average of about 3.1 beds per 1,000 people, and much
greater than 2 beds per 1,000 people needed under moderately
aggressive utilization management. Of course, as a tertiary care
facility, Franklin Teaching Hospital receives patients from
throughout the state, but the bulk of its patients still come from
the local five-county area.
With an excess capacity of hospital beds, the status quo may not
survive the changing healthcare environment. Indeed, Palmetto
General has had some tough years recently, as evidenced by its
number of discharges, which have fallen to 11,412 in 2006 from
12,055 in 2005 and 12,824 in 2004. Additionally, Senate
Healthcare has been aggressive in building market share in
other areas of Florida through acquisitions. As a result of these
factors the local hospital market is likely to witness some
consolidation, and the most likely result is the acquisition of
Palmetto General by either Franklin Teaching Hospital or
4. Senate Healthcare.
Palmetto General operated as a county hospital for over 50
years and consequently developed a reputation for providing
healthcare services to the poor. After many years of operating
losses, the county concluded that it could no longer afford to
operate the hospital. So, in 1983, the county sold the hospital to
Citrus Healthcare, a not-for-profit managed care organization
and provider, which by 2006 had become the state's largest
integrated healthcare company.
Citrus Healthcare's major business line is managed care. Its
numerous plans, including HMO (Health Maintenance
Organization), PPO (Preferred Provider Organization), POS
(Point of Service plans), Medicare, and Medicaid, serve over
400,000 members in 31 Florida counties, encompassing all of
the major metropolitan areas. In addition to managed care plans,
Citrus Healthcare owns nine different providers: two acute care
hospitals including Palmetto General, two primary care
hospitals, one rehabilitation hospital, one mental health facility,
one hospice, one home healthcare provider, and one retirement
facility.
Palmetto General is the flagship of Citrus Healthcare's provider
network and as such the company has maintained the hospital
well in spite of falling inpatient utilization. In fact, in recent
years, Palmetto General has built a new, state-of-the-art Heart
Care Center and a modern Maternity Care Center. Furthermore,
Palmetto General operates a full-service emergency department
and a medical emergency helicopter service.
In response to the current situation, Franklin Teaching Hospital
has formed a special committee to consider the feasibility of
making an offer to Citrus Healthcare to acquire Palmetto
General. The committee's primary goals are as follows:
5. · To place a dollar value on Palmetto General's equity (fund)
capital, assuming that the hospital will be acquired and operated
by Franklin Teaching Hospital
· To develop a financing plan for the acquisition
In addition, the committee has been asked to consider two other
issues related to the potential acquisition.
· What is the best organizational structure for a combined
enterprise? Currently, both Palmetto General and Franklin
Teaching Hospital have separate boards of directors and
management staffs. Of course, the senior members of the board
of Palmetto General currently are Citrus Healthcare officers.
· Should the medical staffs of the two hospitals be integrated,
and, if so, in what way? The medical staff of Palmetto General
consists of local physicians, including many family practice
physicians, while the medical staff at Franklin Teaching
Hospital is almost entirely made up of specialists, and all are
members of Franklin University's College of Medicine with
responsibilities that go well beyond clinical practice. A new
committee will be formed to address the above issues should
Franklin Teaching Hospital's management agree to move
forward with the acquisition offer, but some preliminary
judgments are sought at this time.
As a starting point in the valuation analysis, the committee has
obtained historical income statement and balance sheet data on
both hospitals. Table 1 contains the data for Palmetto General,
while Table 2 provides the data for Franklin Teaching Hospital.
Note that both sets of statements focus on operating data, which
are considered to be most relevant to the analysis. In addition,
some relevant comparative data are presented in Table 3.
Finally, relevant market data are contained in Table 4. (Note
that the data in Tables 3 and 4 reflect late 2006 conditions.)
6. One of the toughest tasks that the committee faces is the
development of Palmetto General's pro forma cash flow
statements, which form the basis of a discounted cash flow
valuation. Two basic questions must be answered before any
numbers can be generated. First, what synergies, if any, can be
realized from the merger and how long will it take for any
synergies to be realized? For example, can duplications be
eliminated? Both hospitals have mercy flight helicopters and
both offer full emergency department services, even though the
two hospitals are less than two miles apart. And, what is the
impact of such operational changes on revenues and costs and
hence on the net cash flows that Palmetto General's assets can
produce? Second, once the consolidation takes place and all
synergies have been realized, what is the long-term growth
prospect for Palmetto General's cash flows? The answers to
these questions, and others, form the basis for the pro forma
cash flow estimates.
Assume that you are the chair of the special committee formed
at Franklin Teaching Hospital to evaluate the potential
acquisition. You must present your findings and
recommendations to the hospital's board of directors. Note that
Tables 1 through 4 contain far less data than normally available
to parties involved in merger analyses, especially when the
potential merger is friendly. In effect, the case discussion and
accompanying data raise many more questions than they answer.
You will be required to make a myriad of difficult assumptions
to complete the analysis. Although you do not know much about
Palmetto General's local market, you do know the current trends
in the health services industry. Use this knowledge to help make
judgments about the case. The quality of many, if not most,
real-world financial analyses depend more on the validity of the
underlying assumptions than on the theoretical correctness of
the analytical techniques.
7. Note: There is no preferred solution to this case, so your case
analysis will be judged as much on the assumptions used in the
analysis as on the analysis itself. Finally, remember that
numerous risk analysis techniques are available that can be used
to give decision makers some feel for the risks involved.
Table 1: Palmetto General Hospital: Historical Financial
Statements (in millions of dollars)
2002
2003
2004
2005
2006
Income Statements
Inpatient revenue
81.624
88.249
99.010
105.332
110.384
Outpatient revenue
22.861
27.067
34.628
43.616
50.810
Gross patient revenue
104.485
115.316
133.638
148.948
161.194
Allowances and discounts
33.699
38.626
16. 401.249
422.450
Table 3: Selected Comparative Data
Palmetto
Franklin Teaching
Average age of plant
6.8 years
8.5 years
Licensed beds
400
525
Occupancy rate
52.7%
64.2%
Average length of stay
5.5 days
6.6 days
Number of discharges
11,412
19,748
Medicare percent
57.2%
29.7%
Medicaid percent
10.3%
13.0%
Medicare case mix index
1.51
2.13
Gross price per discharge
$11,688
$20,204
Net price per discharge
$5,850
$12,757
17. Cost per discharge
$5,703
$12,144
Table 4: U.S. Treasury Yield Curve
Maturity
Interest Rate
6 months
3.0
1 year
3.5
5 years
3.9
10 years
4.5
20 years
5.0
30 years
5.1
Market Risk Premium
Historical risk premium
18. 7.0%
Average current risk premium as forecasted by three investment
banking firms
6.0%
Market Betas, Capitalization, and Tax Rates of Two Publicly
Traded Hospital Companies
Company
Beta
Debt/Asset Ratio
Tax Rate
Provident Healthcare
1.1
50%
40%
National Health Company
1.2
65%
43%
Ratio of Stock Price to EB1TDA per share
Provident Healthcare
6.1
National Health Company
7.9
Ratio of Total Equity Market Value to Number of Discharges