Running Head: FINANCIAL AND OPERATIONAL RISK 5
Financial and Operational Risk
Rasmussen College
Amanda McCauley
Author Note
This paper is being submitted on January 22, 2017 for William Tipton’s ACG3205 Risk Management for Accountants course.
Module 3 Course Project
Risk Area
Level of Risk
Strategy (Assume, Mitigate, or Transfer)
Medical Errors
High
Medical errors includes wrong dosage, deaths of patients due to poor handling or treatment as well as using wrong method of treating patients that lead to another medical conditions (Highland Risk Services, 2014). The medical errors cannot be mitigated by ensuring that error made by personnel is reduced. It entail employing competent personnel in the healthcare facilities.
Board Composition
Low
The composition of the Board matters since they help to over the operations of the organizations. Therefore, the composition should have personnel from other related industries to help make multi-disciplinary decisions (Sullivan, 2013). Therefore, the risk can be transferred by selecting a competent and qualified board.
Transportation- shortage of ambulances and other emergency vehicles
High
Transportation is cornerstone of the healthcare facilities as it can be a life saver. Therefore, the risks of shortage of emergency vehicles like ambulance should be mitigated as soon as possible to avoid deaths of patients caused by lack of transportations (Sullivan, 2013). Therefore, the strategy would be to mitigate it by buying or leasing enough vehicles for any emergency purposes.
High Inflation Rate
High
Health care facilities are expected to deliver health services regardless of the cost. The norm makes health care services to have high expenses that might outweigh the revenue (Highland Risk Services, 2014). The risk can be transferred by ensuring that there is sufficient revenue from patients, services, grants and donors.
References
Highland Risk Services. (2014). Risk Management for Healthcare Clinics. Retrieved from Highland Risk Services: http://www.highlandrisk.com/index.php?option=com_content&view=article&id=74:risk-management-for-healthcare-clinics&catid=7&Itemid=223
Sullivan, M. (2013). The Top Five Challenges Facing Today’s Hospitals. Retrieved from http://blog.schneider-electric.com/building-management/2013/10/17/top-five-challenges-facing-todays-hospitals/
Running Head: FINANCE
FINANCE 3
Financial Crisis
Walter Frazier
FIN 100
Professor Fatma Ahmad
January 22, 2017
Unfortunately, due to rapidly rising housing prices during the decade prior to 2006, many home buyers needed increasingly larger loans to make their real property purchases. For example, a $200,000 fixed-rate mortgage loan would result in a much higher monthly payment compared to a $100,000 loan. Rework the above financial calculator spread sheet solutions using a PV of – 200000. The resulting doubling of the monthly payment to $1,199.10 means that fewer potential home buyers could qualify for these ...
Details and Dollars: Using Data and Analytics to Optimize Revenue Cycle Perfo...Health Catalyst
Most hospitals and healthcare systems leave millions of dollars on the table every year because they lack the knowledge, experience, and discipline necessary to register, bill, and collect correctly. These unclaimed earnings have become more critical in the face of COVID-19 as healthcare organizations face unprecedented negative financial impacts and recognize the need to optimize existing revenue streams most efficiently.
Furthermore, the continuously rising cost and demand for healthcare places more pressure on enhancing revenue as a solution to improving financial performance. Financial managers and administrators must rapidly identify opportunities that increase revenue, maximize reimbursement, and decrease write-offs to ensure long-term profitability and improved results.
Marlowe Dazley, Senior Vice President and Managing Director of Financial Advisory Services at Health Catalyst, and Todd Halpin, Senior Vice President of Financial Advisory Services at Health Catalyst, will share the fundamentals of revenue cycle management and how to conduct a data-driven revenue cycle assessment.
During this webinar, attendees learn the following:
- How to conduct a comprehensive, data-driven revenue cycle assessment to rapidly determine the root cause of lost revenue and the erosion of cash collections.
- How to use data and best practices to challenge current processes and effect change.
- How to determine if accounts receivable reserve formulas acknowledge historical managed care discounts, increases in uncompensated care funding, and deterioration of revenue cycle processes.
- How to leverage appropriate staffing models and productivity tools to maximize efficiency.
Marlowe Dazley, Senior Vice President and Managing Director of Financial Advisory Services at Health Catalyst, and Todd Halpin, Senior Vice President of Financial Advisory Services at Health Catalyst, will share the fundamentals of revenue cycle management and how to conduct a data-driven revenue cycle assessment.
During this webinar, attendees will learn the following:
How to conduct a comprehensive, data-driven revenue cycle assessment to rapidly determine the root cause of lost revenue and the erosion of cash collections.
How to use data and best practices to challenge current processes and effect change.
How to determine if accounts receivable reserve formulas acknowledge historical managed care discounts, increases in uncompensated care funding, and deterioration of revenue cycle processes.
How to leverage appropriate staffing models and productivity tools to maximize efficiency.
Statistical Analysis:
FY 2013 FY 2014 FY 2015
FY 20016
Budget
STATISTICAL
SUMMARY LRMC CCH CCH CCH
Admissions 16,583 17,122 17,397 17,745
Adjusted Admissions 22,934 23,101 23,375 23,843
Patient Days 71,109 76,731 78,799 80,375
Adjusted Patient Days 98,330 103,487 105,871 107,988
Average Daily Census 195 210 216 220
Percentage of
Occupancy 63% 68% 70% 71%
Average Length of
Stay 4.3 4.5 4.5 4.5
Emergency Visits 33,586 33,095 36,266 37,354
Urgent Care Visits 11,717 15,734 16,202 16,688
Observation Cases 4,380 5,216 5,496 5,661
Outpatient
Registrations 30,819 30,063 32,313 33,928
Home Health Visits 51,736 43,496 38,532 38,532
Births 1,297 1,328 1,265 1,265
Other Statistics
Employees 2,112 2,350 2,400
Full Time Equivalent Employees 1,690 1,880 1,920
Financial Data:
Balance Sheet
FY 2014 and 2015
Assets 2015 2014
Current assets:
Cash and cash equivalents
Cash and investments held by bond trustee –
required for current liabilities
Accounts receivable, less allowances for
uncollectible
$
53,635,94
4
11,552,85
9
34,328,81
4
12,479,98
5 patient accounts of approximately $40,466,000 and
$38,196,000 in 2010 and 2009, respectively 44,068,697 38,838,787
Estimated third-party settlements, net 1,295,000 1,758,080
Supplies 9,899,409 8,860,081
Prepaid expenses and other current assets 9,066,378 11,867,585
Total current assets 129,518,287 108,133,332
Assets limited as to use:
Current liabilities:
Accounts payable $ 19,860,709 15,744,839
Accrued expenses:
Employee compensation and
benefits
20,467,163 14,712,215
Interest 2,186,356 2,069,202
Other 11,501,375 12,929,155
Current portion of long-term debt 5,000,000 4,715,000
Total current liabilities 59,015,603 50,170,411
Interest rate swaps 7,663,158 5,121,610
Other 12,907,742 8,342,913
Long-term debt, less current portion 154,594,700 162,282,08
4
Total liabilities 234,181,203 225,917,01
8 Net assets:
Unrestricted 181,147,094 175,919,30
4 Temporarily restricted — 129,367
Permanently restricted — 1,101,862
Cash and investments held by bond trustee, less current portion 6,577,710 5,986,813
Other 4,575,567 2,660,774
Total assets limited as to use 11,153,277 8,647,587
Property and equipment, net 176,575,169 184,822,376
Other assets:
Investments
88,036,572
96,245,865
Deferred loan costs, net
1,762,631
—
2,414,097
1,524,290
Due from affiliates 7,388,113 1,280,004
Other assets 894,248 —
Total other assets 98,081,564 101,464,256
Total assets $ 415,328,297 403,067,551
Total net assets 181,147,094 17.
Details and Dollars: Using Data and Analytics to Optimize Revenue Cycle Perfo...Health Catalyst
Most hospitals and healthcare systems leave millions of dollars on the table every year because they lack the knowledge, experience, and discipline necessary to register, bill, and collect correctly. These unclaimed earnings have become more critical in the face of COVID-19 as healthcare organizations face unprecedented negative financial impacts and recognize the need to optimize existing revenue streams most efficiently.
Furthermore, the continuously rising cost and demand for healthcare places more pressure on enhancing revenue as a solution to improving financial performance. Financial managers and administrators must rapidly identify opportunities that increase revenue, maximize reimbursement, and decrease write-offs to ensure long-term profitability and improved results.
Marlowe Dazley, Senior Vice President and Managing Director of Financial Advisory Services at Health Catalyst, and Todd Halpin, Senior Vice President of Financial Advisory Services at Health Catalyst, will share the fundamentals of revenue cycle management and how to conduct a data-driven revenue cycle assessment.
During this webinar, attendees learn the following:
- How to conduct a comprehensive, data-driven revenue cycle assessment to rapidly determine the root cause of lost revenue and the erosion of cash collections.
- How to use data and best practices to challenge current processes and effect change.
- How to determine if accounts receivable reserve formulas acknowledge historical managed care discounts, increases in uncompensated care funding, and deterioration of revenue cycle processes.
- How to leverage appropriate staffing models and productivity tools to maximize efficiency.
Marlowe Dazley, Senior Vice President and Managing Director of Financial Advisory Services at Health Catalyst, and Todd Halpin, Senior Vice President of Financial Advisory Services at Health Catalyst, will share the fundamentals of revenue cycle management and how to conduct a data-driven revenue cycle assessment.
During this webinar, attendees will learn the following:
How to conduct a comprehensive, data-driven revenue cycle assessment to rapidly determine the root cause of lost revenue and the erosion of cash collections.
How to use data and best practices to challenge current processes and effect change.
How to determine if accounts receivable reserve formulas acknowledge historical managed care discounts, increases in uncompensated care funding, and deterioration of revenue cycle processes.
How to leverage appropriate staffing models and productivity tools to maximize efficiency.
Statistical Analysis:
FY 2013 FY 2014 FY 2015
FY 20016
Budget
STATISTICAL
SUMMARY LRMC CCH CCH CCH
Admissions 16,583 17,122 17,397 17,745
Adjusted Admissions 22,934 23,101 23,375 23,843
Patient Days 71,109 76,731 78,799 80,375
Adjusted Patient Days 98,330 103,487 105,871 107,988
Average Daily Census 195 210 216 220
Percentage of
Occupancy 63% 68% 70% 71%
Average Length of
Stay 4.3 4.5 4.5 4.5
Emergency Visits 33,586 33,095 36,266 37,354
Urgent Care Visits 11,717 15,734 16,202 16,688
Observation Cases 4,380 5,216 5,496 5,661
Outpatient
Registrations 30,819 30,063 32,313 33,928
Home Health Visits 51,736 43,496 38,532 38,532
Births 1,297 1,328 1,265 1,265
Other Statistics
Employees 2,112 2,350 2,400
Full Time Equivalent Employees 1,690 1,880 1,920
Financial Data:
Balance Sheet
FY 2014 and 2015
Assets 2015 2014
Current assets:
Cash and cash equivalents
Cash and investments held by bond trustee –
required for current liabilities
Accounts receivable, less allowances for
uncollectible
$
53,635,94
4
11,552,85
9
34,328,81
4
12,479,98
5 patient accounts of approximately $40,466,000 and
$38,196,000 in 2010 and 2009, respectively 44,068,697 38,838,787
Estimated third-party settlements, net 1,295,000 1,758,080
Supplies 9,899,409 8,860,081
Prepaid expenses and other current assets 9,066,378 11,867,585
Total current assets 129,518,287 108,133,332
Assets limited as to use:
Current liabilities:
Accounts payable $ 19,860,709 15,744,839
Accrued expenses:
Employee compensation and
benefits
20,467,163 14,712,215
Interest 2,186,356 2,069,202
Other 11,501,375 12,929,155
Current portion of long-term debt 5,000,000 4,715,000
Total current liabilities 59,015,603 50,170,411
Interest rate swaps 7,663,158 5,121,610
Other 12,907,742 8,342,913
Long-term debt, less current portion 154,594,700 162,282,08
4
Total liabilities 234,181,203 225,917,01
8 Net assets:
Unrestricted 181,147,094 175,919,30
4 Temporarily restricted — 129,367
Permanently restricted — 1,101,862
Cash and investments held by bond trustee, less current portion 6,577,710 5,986,813
Other 4,575,567 2,660,774
Total assets limited as to use 11,153,277 8,647,587
Property and equipment, net 176,575,169 184,822,376
Other assets:
Investments
88,036,572
96,245,865
Deferred loan costs, net
1,762,631
—
2,414,097
1,524,290
Due from affiliates 7,388,113 1,280,004
Other assets 894,248 —
Total other assets 98,081,564 101,464,256
Total assets $ 415,328,297 403,067,551
Total net assets 181,147,094 17.
Financial Analysis In Healthcare Industry PowerPoint Presentation Slides SlideTeam
This PPT deck displays fourtyfour slides with in depth research. Our topic oriented Financial Analysis In Healthcare Industry PowerPoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyse the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics templates, charts and graphs, overviews, analysis templates. Outline all the important aspects without any hassle. It showcases of all kind of editable templates infographs for an inclusive and comprehensive Financial Analysis In Healthcare Industry PowerPoint Presentation Slides presentation. Professionals, managers, individual and team involved in any company organization from any field can use them as per requirement.
WORKING CAPITAL MANAGEMENT PROCEDURE(A Study on ACI Ltd.)Romana Aktar Anyka
A company cannot be fully evaluated only by over viewing the cash, accounts receivables, inventory, short-term security and short-term liabilities management procedures. Other types of financial performance indicators such as profitability ratios, debt ratios, activity ratios and market ratios etc should also be considered when assessing and appraising the performance of a company – and this is also true for ACI Ltd.
Comparisons should also be made:
between companies
between industries
between different time periods for one company
between a single company and its industry average
HealthWaysBudgetTable 1. HealthWays Clinic, Monthly Expense Budget Report, June 2018.ItemJune 2018May 20182018 YTDBudgetActualVarianceActualBudgetActualPhysician FTE1.01.01.01.01.0Nurse PractitionerFTE3.03.03.03.03.0Encounters:Established patients27529128616501671New patients251827150164Total encountersExpenses:Physician Salaries & Benefits$10,500$10,502$10,509$63,000$63,149NP Salaries & Benefits$20,000$20,992$20,191$120,000$122,001Clerical (2 FTE) Salaries & Benefits$6,667$6,771$6,683$40,000$41,978Total personnel expenseMedical supplies$7,500$8,136$7,994$45,000$47,883Office supplies$583$623$508$3,498$3,407Rent$2,917$2,917$2,917$17,502$17,502Depreciation$333$346$346$1,998$2,050Capital Expenses$3,333$3,480$3,480$19,998$20,439Overhead$167$167$167$1,002$1,002Total non-personnel expenseTotal health center expenseInterpretation:Providers:The FTEs have not changed, at least for the first 6 months of 2018.Encounters:The number of encounters, both new and established, is increasing over the year.Personnel expense:Although the FTEs are not changing, the personnel budget is somewhat more than budgeted, particularly the NP and clerical budgets. The management should investigate why this is the case, and better control the personnel budget.Non-personnel expense:Medical supplies are over budget. Office supplies are under budget. Depreciation and capital expenses (new equipment) increased over the budget year. Rent and overhead remain stable, but might be expected to increase next year.Total expenses:The clinic must carefully control expenses as its profitability is very low. Possible strategies might include improving staff productivity, reducing the cost of medical supplies, and postponing further capital purchases.
HealthWaysFinancialsNurse-Run Clinic ScenarioPatient EncountersFY 2018FY 2017Established patients3,3483,204New patients331287Total Encounters3,6793,491 Cash$5,675$12,098Financial Ratios:Expense per Encounter = Total Operating Expenses / Total EncountersTotal Operating Revenue per Encounter = Total Operating Revenue / Total EncountersOperating Margin = Net Income/Total Operating RevenueDays Cash On Hand = (Cash + Cash Equivalents) / (Operating Expenses / Days in Time Period)Table 2. HealthWays Clinic, Income Statement, FY 2018.Table 3. HealthWays Clinic, Balance Sheet, December 31, 2018.FY 2018FY 2017Current AssetsDecember 31, 2018December 31, 2017Current LiabilitiesDecember 31, 2018December 31, 2017Gross Revenue (charges)$558,520$497,221 Cash5,0329,877 Notes Payable27,44950,000Less write-offs & adjustments117,254104,332Short-term Investments40,38934,181 Accounts Payable 78,70269,412Net Patient Revenue (collected)$441,266$392,889 Accounts Receivable63,39259,359 Accrued Expenses:+Other Revenue209,671234,953 Supply Inventories, at Cost16,02914,918 Salaries & Benefits38,26528,274 Prepaid Expenses & Other2,1041,876 Taxes1,4191,398Total Operating Revenue$ 650,937$ 627,842Total Current Assets$ 126,946$ 120 ...
Hospital Sacred Heart of Milot Business PlanHFG Project
The purpose of this business plan of the Hospital Sacred Heart of Milot (Hôpital du Sacré-Coeur de Milot, HSCM) is to define practical and feasible strategies to decrease HSCM’s dependence on external funds and to improve the efficiency and quality of the care offered. The strategies can be implemented immediately, even if some of their results will be realized only in the middle to long term. HSCM had the support of the USAID-funded Health Finance and Governance (HFG) project in developing the business plan; more precisely, the HFG project team did an estimate of the costs of the hospital’s services and then facilitated the drafting of this plan.
Short Thesis on Community Health Systems (CYH)Aaron Tan
Rural hospitals are shutting down across the country. Combined with Community Health System's over-leverage and mismanagement, this will lead to the company testing its debt covenants and eventual bankruptcy - which street analysts are not fully pricing in.
Mark Wilson, Group Chief Executive Officer, said:
“In the first half we have taken a number of steps to deliver our investment thesis of cash flow and growth. These results show satisfactory progress in Aviva’s turnaround.
“We have achieved profit after tax of £776 million, in contrast to the £624 million loss last year. Cash flows to the Group have increased by 30% to £573 million. Our key measure of sales – value of new business – has increased 17%, driven by the UK, France, Poland, Turkey and Asia.
“Although these results continue the positive trends of the first quarter, tackling our legacy issues will take time.
“I am committed to achieving for investors what we set out to do: turning around the company to unlock the considerable value in Aviva.”
Case Study 1 Applying Theory to PracticeSocial scientists hav.docxcowinhelen
Case Study 1: Applying Theory to Practice
Social scientists have proposed a number of theories to explain juvenile delinquency. Each has its own strengths and weaknesses. For this assignment, go to the following Website, located at http://listverse.com/2011/05/14/top-10-young-killers/ and select one of the juvenile case studies.
After reading the case, select one (1) of the psychological theories discussed in Chapter 4 of the text.
Write a two to three (2-3) page paper in which you:
1. Summarize three (3) key aspects of the juvenile case study that you selected.
2. Highlight at least three (3) factors that you believe are important for one to understand the origins of the juvenile’s delinquent behavior.
3. Apply at least two (2) concepts from the theory that you chose from the text that would help explain the juvenile’s behavior.
4. Identify one (1) appropriate strategy geared toward preventing delinquency that is consistent with the theory you chose.
5. Use at least three (3) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.
Discussion-
"The Changing Family System"
Using what you’ve learned this week, respond to the following prompts in your post:
· Explain at least two (2) roles that different parenting styles play in shaping the overall behavior of children. Next, indicate the significant impacts that each role has in contributing to delinquent behavior among juveniles.
· Think about the following question: Should juvenile delinquents be removed from their home and parent(s) and placed in a foster home or group home if the child continues to commit criminal acts after repeated attempts at treatment and confinement? Based on this question, discuss your thoughts on this subject. Provide support for your response.
Discussion-
"Exploring Monopolies and Oligopolies"
Watch this video, Oligopolies and Monopolistic Competition, to help you prepare for this week’s discussion.
Reply to these prompts by using the company for which you currently work, a business with which your familiar, or a dream business you want to start:
· With your selected business in mind, determine if it is competitive, monopolistic competitive, an oligopoly, or pure monopoly. Explain how you drew your conclusion about its market structure.
· How does the business/firm in this industry determine the price it will charge for the products or services it sells?
Discussion-
"Considering Tradeoffs You Make Every Day"
Let's talk about two tradeoffs we face every day: how we spend our time and money.
We can only do two things with income: spend it or save it. Time is the ultimate resource. We can choose to spend time working to earn an income or we can do other things, broadly classified as leisure. Reply to these prompts to start your discussion:
· How does a change in interest rate affect your decision to spend or save? How would a change in the interest rate affect a firm's decision to invest or save?
· How might an increas.
Case Study - Option 3 BarbaraBarbara is a 22 year old woman who h.docxcowinhelen
Case Study - Option 3: Barbara
Barbara is a 22 year old woman who has recently graduated from college with a psychology degree. She is currently working as a waitress at a popular restaurant near campus, and says she has always planned to attend law school. Barbara was born in a New Orleans, Louisiana. Her mother is an African American who is an assistant manager at a grocery store. Her father is Caucasian and works at a department store. Barbara reports that she was a shy, unattractive child, but that in general her early childhood was "pretty happy." Barbara says that during elementary school, she was constantly harassed by classmates about being of mixed race. Still, she says that she felt very close to her family during this period. She now insists that "I am not black or white, I am me."
Barbara is sexually active and engages in sexual activity with different men at least 1 time a week. Barbara indicates that she does not need protection because she is on the pill. She says she is simply too young to settle down. During her junior year of high school, Barbara had her first serious boyfriend, Morris, who was a high school classmate. She describes the relationship as warm and supportive and they became sexually active during her senior year of high school. They broke up soon after the first sexual interaction. In college, Barbara has dated and she acknowledges some bisexual experimentation. Barbara says that she prefers heterosexual relationships, however.
Although Barbara appears to be a natural athlete, she leads a relatively sedentary lifestyle. She does not exercise regularly and indicates that it is just not enjoyable.
Barbara does not like her job at the restaurant, but seems unwilling to look for other employment. She says that she feels "very jittery" whenever she gets ready for work, and she uses any excuse to take days off. She also refuses to associate with fellow employees, and reports getting very anxious when she was given a surprise birthday party. Recently, she has lost interest in cleaning her house and seldom cooks for herself. She also attends less to her personal grooming.
Diagnosis – Social Anxiety Disorder/Minor Depression
DSM-5 – Diagnostic Criteria for Social Anxiety Disorder
1. Fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized.
2. Typically the individual will fear that they will display their anxiety and experience social rejection,
3. Social interaction will consistently provoke distress,
4. Social interactions are either avoided, or painfully and reluctantly endured,
5. The fear and anxiety will be grossly disproportionate to the actual situation,
6. The fear, anxiety or other distress around social situations will persist for six months or longer and
7. Cause personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning,
8. The fear or anxiety cannot be attributed to a medical disorder, s.
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This PPT deck displays fourtyfour slides with in depth research. Our topic oriented Financial Analysis In Healthcare Industry PowerPoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyse the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics templates, charts and graphs, overviews, analysis templates. Outline all the important aspects without any hassle. It showcases of all kind of editable templates infographs for an inclusive and comprehensive Financial Analysis In Healthcare Industry PowerPoint Presentation Slides presentation. Professionals, managers, individual and team involved in any company organization from any field can use them as per requirement.
WORKING CAPITAL MANAGEMENT PROCEDURE(A Study on ACI Ltd.)Romana Aktar Anyka
A company cannot be fully evaluated only by over viewing the cash, accounts receivables, inventory, short-term security and short-term liabilities management procedures. Other types of financial performance indicators such as profitability ratios, debt ratios, activity ratios and market ratios etc should also be considered when assessing and appraising the performance of a company – and this is also true for ACI Ltd.
Comparisons should also be made:
between companies
between industries
between different time periods for one company
between a single company and its industry average
HealthWaysBudgetTable 1. HealthWays Clinic, Monthly Expense Budget Report, June 2018.ItemJune 2018May 20182018 YTDBudgetActualVarianceActualBudgetActualPhysician FTE1.01.01.01.01.0Nurse PractitionerFTE3.03.03.03.03.0Encounters:Established patients27529128616501671New patients251827150164Total encountersExpenses:Physician Salaries & Benefits$10,500$10,502$10,509$63,000$63,149NP Salaries & Benefits$20,000$20,992$20,191$120,000$122,001Clerical (2 FTE) Salaries & Benefits$6,667$6,771$6,683$40,000$41,978Total personnel expenseMedical supplies$7,500$8,136$7,994$45,000$47,883Office supplies$583$623$508$3,498$3,407Rent$2,917$2,917$2,917$17,502$17,502Depreciation$333$346$346$1,998$2,050Capital Expenses$3,333$3,480$3,480$19,998$20,439Overhead$167$167$167$1,002$1,002Total non-personnel expenseTotal health center expenseInterpretation:Providers:The FTEs have not changed, at least for the first 6 months of 2018.Encounters:The number of encounters, both new and established, is increasing over the year.Personnel expense:Although the FTEs are not changing, the personnel budget is somewhat more than budgeted, particularly the NP and clerical budgets. The management should investigate why this is the case, and better control the personnel budget.Non-personnel expense:Medical supplies are over budget. Office supplies are under budget. Depreciation and capital expenses (new equipment) increased over the budget year. Rent and overhead remain stable, but might be expected to increase next year.Total expenses:The clinic must carefully control expenses as its profitability is very low. Possible strategies might include improving staff productivity, reducing the cost of medical supplies, and postponing further capital purchases.
HealthWaysFinancialsNurse-Run Clinic ScenarioPatient EncountersFY 2018FY 2017Established patients3,3483,204New patients331287Total Encounters3,6793,491 Cash$5,675$12,098Financial Ratios:Expense per Encounter = Total Operating Expenses / Total EncountersTotal Operating Revenue per Encounter = Total Operating Revenue / Total EncountersOperating Margin = Net Income/Total Operating RevenueDays Cash On Hand = (Cash + Cash Equivalents) / (Operating Expenses / Days in Time Period)Table 2. HealthWays Clinic, Income Statement, FY 2018.Table 3. HealthWays Clinic, Balance Sheet, December 31, 2018.FY 2018FY 2017Current AssetsDecember 31, 2018December 31, 2017Current LiabilitiesDecember 31, 2018December 31, 2017Gross Revenue (charges)$558,520$497,221 Cash5,0329,877 Notes Payable27,44950,000Less write-offs & adjustments117,254104,332Short-term Investments40,38934,181 Accounts Payable 78,70269,412Net Patient Revenue (collected)$441,266$392,889 Accounts Receivable63,39259,359 Accrued Expenses:+Other Revenue209,671234,953 Supply Inventories, at Cost16,02914,918 Salaries & Benefits38,26528,274 Prepaid Expenses & Other2,1041,876 Taxes1,4191,398Total Operating Revenue$ 650,937$ 627,842Total Current Assets$ 126,946$ 120 ...
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Short Thesis on Community Health Systems (CYH)Aaron Tan
Rural hospitals are shutting down across the country. Combined with Community Health System's over-leverage and mismanagement, this will lead to the company testing its debt covenants and eventual bankruptcy - which street analysts are not fully pricing in.
Mark Wilson, Group Chief Executive Officer, said:
“In the first half we have taken a number of steps to deliver our investment thesis of cash flow and growth. These results show satisfactory progress in Aviva’s turnaround.
“We have achieved profit after tax of £776 million, in contrast to the £624 million loss last year. Cash flows to the Group have increased by 30% to £573 million. Our key measure of sales – value of new business – has increased 17%, driven by the UK, France, Poland, Turkey and Asia.
“Although these results continue the positive trends of the first quarter, tackling our legacy issues will take time.
“I am committed to achieving for investors what we set out to do: turning around the company to unlock the considerable value in Aviva.”
Case Study 1 Applying Theory to PracticeSocial scientists hav.docxcowinhelen
Case Study 1: Applying Theory to Practice
Social scientists have proposed a number of theories to explain juvenile delinquency. Each has its own strengths and weaknesses. For this assignment, go to the following Website, located at http://listverse.com/2011/05/14/top-10-young-killers/ and select one of the juvenile case studies.
After reading the case, select one (1) of the psychological theories discussed in Chapter 4 of the text.
Write a two to three (2-3) page paper in which you:
1. Summarize three (3) key aspects of the juvenile case study that you selected.
2. Highlight at least three (3) factors that you believe are important for one to understand the origins of the juvenile’s delinquent behavior.
3. Apply at least two (2) concepts from the theory that you chose from the text that would help explain the juvenile’s behavior.
4. Identify one (1) appropriate strategy geared toward preventing delinquency that is consistent with the theory you chose.
5. Use at least three (3) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.
Discussion-
"The Changing Family System"
Using what you’ve learned this week, respond to the following prompts in your post:
· Explain at least two (2) roles that different parenting styles play in shaping the overall behavior of children. Next, indicate the significant impacts that each role has in contributing to delinquent behavior among juveniles.
· Think about the following question: Should juvenile delinquents be removed from their home and parent(s) and placed in a foster home or group home if the child continues to commit criminal acts after repeated attempts at treatment and confinement? Based on this question, discuss your thoughts on this subject. Provide support for your response.
Discussion-
"Exploring Monopolies and Oligopolies"
Watch this video, Oligopolies and Monopolistic Competition, to help you prepare for this week’s discussion.
Reply to these prompts by using the company for which you currently work, a business with which your familiar, or a dream business you want to start:
· With your selected business in mind, determine if it is competitive, monopolistic competitive, an oligopoly, or pure monopoly. Explain how you drew your conclusion about its market structure.
· How does the business/firm in this industry determine the price it will charge for the products or services it sells?
Discussion-
"Considering Tradeoffs You Make Every Day"
Let's talk about two tradeoffs we face every day: how we spend our time and money.
We can only do two things with income: spend it or save it. Time is the ultimate resource. We can choose to spend time working to earn an income or we can do other things, broadly classified as leisure. Reply to these prompts to start your discussion:
· How does a change in interest rate affect your decision to spend or save? How would a change in the interest rate affect a firm's decision to invest or save?
· How might an increas.
Case Study - Option 3 BarbaraBarbara is a 22 year old woman who h.docxcowinhelen
Case Study - Option 3: Barbara
Barbara is a 22 year old woman who has recently graduated from college with a psychology degree. She is currently working as a waitress at a popular restaurant near campus, and says she has always planned to attend law school. Barbara was born in a New Orleans, Louisiana. Her mother is an African American who is an assistant manager at a grocery store. Her father is Caucasian and works at a department store. Barbara reports that she was a shy, unattractive child, but that in general her early childhood was "pretty happy." Barbara says that during elementary school, she was constantly harassed by classmates about being of mixed race. Still, she says that she felt very close to her family during this period. She now insists that "I am not black or white, I am me."
Barbara is sexually active and engages in sexual activity with different men at least 1 time a week. Barbara indicates that she does not need protection because she is on the pill. She says she is simply too young to settle down. During her junior year of high school, Barbara had her first serious boyfriend, Morris, who was a high school classmate. She describes the relationship as warm and supportive and they became sexually active during her senior year of high school. They broke up soon after the first sexual interaction. In college, Barbara has dated and she acknowledges some bisexual experimentation. Barbara says that she prefers heterosexual relationships, however.
Although Barbara appears to be a natural athlete, she leads a relatively sedentary lifestyle. She does not exercise regularly and indicates that it is just not enjoyable.
Barbara does not like her job at the restaurant, but seems unwilling to look for other employment. She says that she feels "very jittery" whenever she gets ready for work, and she uses any excuse to take days off. She also refuses to associate with fellow employees, and reports getting very anxious when she was given a surprise birthday party. Recently, she has lost interest in cleaning her house and seldom cooks for herself. She also attends less to her personal grooming.
Diagnosis – Social Anxiety Disorder/Minor Depression
DSM-5 – Diagnostic Criteria for Social Anxiety Disorder
1. Fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized.
2. Typically the individual will fear that they will display their anxiety and experience social rejection,
3. Social interaction will consistently provoke distress,
4. Social interactions are either avoided, or painfully and reluctantly endured,
5. The fear and anxiety will be grossly disproportionate to the actual situation,
6. The fear, anxiety or other distress around social situations will persist for six months or longer and
7. Cause personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning,
8. The fear or anxiety cannot be attributed to a medical disorder, s.
Case Study - Cyberterrorism—A New RealityWhen hackers claiming .docxcowinhelen
Case Study - Cyberterrorism—A New Reality:
When hackers claiming to support the Syrian regime of Bashar Al-Assad attacked and disabled the website of Al Jazeera, the Qatar-based satellite news channel, in September 2012, the act was another act of hacktivism, purporting to promote a specific political agenda over another. Hacktivism has become a very visible form of expressing dissent. Even though there have been numerous incidents reported by the media, the first case of hacktivism was documented in 1989 when a member of the Cult of the Dead Cow hacker collective named Omega coined the term in 1996. However, hacktivism is not the only form of cyber protest and conflict that has everyone from ICT professionals to governments scrambling for solutions. Individuals, enterprises, and governments alike rely in many instances almost completely on network computing technologies, including cloud computing. The international and ever-evolving nature of the Internet along with inadequate law enforcement and the anonymity the global architecture offers creates opportunities for hackers to attack vulnerable nodes for personal, financial, or political gain.
The Internet is also rapidly becoming the political and advocacy platform of choice, bringing with it both positive and negative consequences. Increasingly sophisticated off-the-shelf technologies and easy access to the Internet are significantly increasing incidents of cyberterrorism, netwars, and cyberwarfare. The following are a few examples.
• According to The Israel Electric Company, Israel is attacked 1,000 times a minute by cyberterrorists targeting the country’s infrastructure—water, electricity, communications, and other services.• The New York Times, quoting military officials, said there was a seventeen-fold increase in cyberattacks targeting the US critical infrastructure between 2009 and 2011.• The 2010 Data Breach Investigations Report has data recording more than 900 instances of computer hacking and other data breaches in the past seven years, resulting in some 900 million compromised records. In 2012, the same study listed 855 breaches, resulting in 174 million compromised records in 2011 alone, up from 4 million in 2010.• Another study of 49 breaches in 2011 reported that the average organizational cost of a data breach (including detection, internal response, notification, post notification cost) was $5.5 million. This number was down from $7.2 million in 2010.14 The Telegraph (London) reported that “India blamed a new ‘cyber-jihad’ by Pakistani militant groups for the exodus of thousands of people from India’s north-eastern minorities from its main southern cities in August after text messages warning them to flee went viral.”
There have been recorded instances of nations allegedly engaging in cyberwarfare. The Center for the Study of Technology and Society has identified five methods by which cyberwarfare can be used as a means of military action. These include defacing or di.
Case Study - APA paper with min 4 page content Review the Blai.docxcowinhelen
Case Study - APA paper with min 4 page content
Review the
Blaine
case on the capital structure by understanding the case well enough to help the CEO make informed analysis and decisions on the issues listed in the second paragraph.
I want you to, of course, show me that you understand the situation but then to add the
.
Case Study - Global Mobile Corporation Damn it, .docxcowinhelen
Case Study - Global Mobile Corporation
“Damn it, he's done it again!”
Charlie Newburg had to get up and walk around his office, he was so frustrated. He had been
reviewing the most recent design, parts, and assembly specifications for Global Mobile's latest
smart phone (code named: Nonphixhun) that had been released for production the previous
Thursday. The files had just come back to Charlie's engineering services department with a
caustic note that began, “This one can't be produced, either…” It was the fourth time production
had returned the design.
Newburg, director of engineering for the Global Mobile Corporation, was normally a quiet
person. But the Nonphixhun project was stretching his patience; it was beginning to appear like
several other new products that had hit delays and problems in the transition from design to
production during the eight months Charlie had worked for Global Mobile. These problems were
nothing new at Global Mobile's Asian factory; Charlie's predecessor in the engineering job had
run afoul of them, too, and had finally been fired for protesting too vehemently about the other
departments. But the Nonphixhun phone should have been different. Charlie and the firm's
president, Hannah Hoover, had video-conferenced two months earlier (on July 3, 2006) with the
factory superintendent, Tyson Wang, to smooth the way for the new phone's design. He thought
back to the meeting …
• “Now, we all know there's a tight deadline on the Nonphixhun,” Hannah Hoover said, “and
Charlie's done well to ask us to talk about its introduction. I'm counting on both of you to find
any snags in the system, and to work together to get that first production run out by October
2. Can you do it?” “We can do it in production if we get a clean design two weeks from
now, as scheduled,” answered Tyson Wang, the factory manager. “Charlie and I have already
talked about that, of course. I've spoken with our circuit board and other parts suppliers and
scheduled assembly capacity, and we'll be ready. If the design goes over schedule, though, I'll
have to fill in with other runs, and it will cost us a bundle to break in for the Nonphixhun.
How does it look in engineering, Charlie?” “I've just reviewed the design for the second
time,” Charlie replied. “If Marianne Price can keep the salespeople out of our hair, and avoid
any more last minute changes, we've got a shot. I've pulled my technical support people off of
three other overdue jobs to get this one out. But, Tyson, that means we can't spring engineers
loose to confer with your production people on other manufacturing problems.” “Well
Charlie, most of those problems are caused by the engineers, and we need them to resolve the
difficulties. We've all agreed that production problems come from both of us bowing to sales
pressure, and putting equipment into production before the designs are really ready. That's
just wh.
Case Study #3Apple Suppliers & Labor PracticesWith its h.docxcowinhelen
Case Study #3
Apple Suppliers & Labor Practices
With its highly coveted line of consumer electronics, Apple has a cult following among loyal consumers. During the 2014 holiday season, 74.5 million iPhones were sold. Demand like this meant that Apple was in line to make over $52 billion in profits in 2015, the largest annual profit ever generated from a company’s operations. Despite its consistent financial performance year over year, Apple’s robust profit margin hides a more complicated set of business ethics. Similar to many products sold in the U.S., Apple does not manufacture most its goods domestically. Most of the component sourcing and factory production is done overseas in conditions that critics have argued are dangerous to workers and harmful to the environment.
For example, tin is a major component in Apple’s products and much of it is sourced in Indonesia. Although there are mines that source tin ethically, there are also many that do not. One study found workers—many of them children—working in unsafe conditions, digging tin out by hand in mines prone to landslides that could bury workers alive. About 70% of the tin used in electronic devices such as smartphones and tablets comes from these more dangerous, small-scale mines. An investigation by the BBC revealed how perilous these working conditions can be. In interviews with miners, a 12-yearold working at the bottom of a 70-foot cliff of sand said: “I worry about landslides. The earth slipping from up there to the bottom. It could happen.”
Apple defends its practices by saying it only has so much control over monitoring and regulating its component sources. The company justifies its sourcing practices by saying that it is a complex process, with tens of thousands of miners selling tin, many of them through middle-men. In a statement to the BBC, Apple said “the simplest course of action would be for Apple to unilaterally refuse any tin from Indonesian mines. That would be easy for us to do and would certainly shield us from criticism. But that would also be the lazy and cowardly path, since it would do nothing to improve the situation. We have chosen to stay engaged and attempt to drive changes on the ground.”
In an effort for greater transparency, Apple has released annual reports detailing their work with suppliers and labor practices. While more recent investigations have shown some improvements to suppliers’ working conditions, Apple continues to face criticism as consumer demand for iPhones and other products continues to grow.
Essay directions –
Students will have to identify and analyze the above ethical dilemma. Write a 750 – 1000 word, double-spaced paper, and APA style.
Students are expected to identify the key stakeholders, discussion of the implications of the ethical dilemma, and answer the case study questions. Each paper should have the following sections: • Introduction of the case• The ethical dilemma • Stakeholders • Questions • Conclusions • References .
CASE STUDY (Individual) Scotland In terms of its physical l.docxcowinhelen
CASE STUDY (Individual): Scotland
* In terms of its physical landscape, where is the region that is experiencing a devolutionary process located and what type of climate is prevalent? (use Figure 2.5 and 2.4 of the textbook).
* According to the sources you have consulted, do these physical/natural characteristics have played any role in the historical background for this devolutionary process? How?
* How do the people that inhabit the region you are studying speak about their relationship to the land and the environment? Do they express any ideas on biodiversity conservation?
* Do they say anything about their homeland? If the region you are studying has a website (official or not), what role do maps play on their web site/s?
* Is this region located close to or far from the center of power of the country (the national capital city)?
* Does this condition have any impact on the reasons why they would like to gain at-least more autonomy to make their own decisions?
* According to the source/s you have consulted, what are the main reason/s why this population would like to break-up from the country in which they live in?
Do this/these source/s mention any explanation/s based on cultural or ethnic characteristics? For example, speaking a different language? Which one? Professing a different religion? Which one? Economic disparities
.
Case Study #2 T.D. enjoys caring for the children and young peop.docxcowinhelen
Case Study #2
T.D. enjoys caring for the children and young people in the schools where she works, but sometimes she is faced with tough situations such as suspected child abuse and neglect, teen pregnancy, and alcohol and drug use among teenagers. She works hard to ensure that the children in her schools receive the best care possible.
Question:
Several third graders reports having received no breakfast at home for more than a week. T.D. is exercising Advocacy for the students under her care. What type of actions she might be doing to exercise advocacy for the students?
Discuss this:
Moral distress is a frequent situation where health care providers should face. Please define and discuss a personal experience where you have faced Moral distress in your practice.
Discuss how health promotion relates to morality.
Discuss your insights about your own communication strengths and weaknesses. Identify situations in which it may be difficult for you to establish or terminate a therapeutic relationship.
*
formatted and cited in current APA style with support from at least 2 academic sources.
.
CASE STUDY #2 Chief Complaint I have pain in my belly”.docxcowinhelen
CASE STUDY #2
Chief Complaint:
“I have pain in my belly”
History of Present Illness (HPI):
A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex
PMH:
Patient denies
Drug Hx:
Birth control
Allergies:
NKA
Subjective:
Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination
Objective Data:
PE:
B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10
General:
acute distress and severe pain
HEENT:
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Lungs:
CTA AP&L
Card:
S1S2 without rub or gallop
Abd:
INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
• AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
• PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
• PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area
GU:
• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color
Ext:
no cyanosis, clubbing or edema
Integument:
intact without lesions masses or rashes
Neuro:
No obvious deficits and CN grossly intact II-XII
Then answer the following questions:
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
-
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
.
Case Study #1Jennifer is a 29-year-old administrative assistan.docxcowinhelen
Case Study #1
Jennifer is a 29-year-old administrative assistant married to Antonio, an Italian engineer, whom Jennifer met four years earlier while on a business trip for her marketing company. The couple now lives in Nebraska, where Antonio works for the county's transportation department and Jennifer commutes an hour each way to her marketing office. They have been trying to start a family for over a year. Eight months ago, Jennifer miscarried in her second month of pregnancy. Antonio's parents love Jennifer and often ask her if she is expecting again, hoping to encourage her to focus on her next baby. Jennifer's mother passed away two years ago and her father's health is rapidly deteriorating. Jennifer faces the probability of placing her father in a skilled nursing care facility within the next few months, against his wishes.
At work, Jennifer runs a tight ship. She is organized and prepares lists to assure that everything is done according to schedule. Everyone counts on Jennifer and she takes pride in never letting people down.
Jennifer has visited her physician numerous times in the last six months, complaining of headaches, backaches, and indigestion. Jennifer insists that she is happy and is not feeling stressed, yet she finds herself making more mistakes at work, unable to keep up with housework, and feeling tired and overwhelmed; she has begun to question her effectiveness as an employee, wife, daughter, and potential mother. Her pains seem to be increasing, but her doctor cannot find a physical cause for her discomfort.
Case Study #2
Michael is a 40-year-old airline pilot who has recently begun to experience chest pains. The chest pains began when Michael signed his final divorce papers, ending his 15-year marriage. He fought for joint custody of his two children, ages 12 and 10, but although he wants to be with them more frequently, he only sees them every two weeks. This schedule is, in great part, a result of his employer's announcement that budget constraints would result in layoffs. Michael worries that without his job he will be unable to support his children and lose the new townhouse that he purchased. Michael's chest pains are becoming more frequent and he fears that he may be dying.
Review case studies 1 and 2.
Choose one case study.
Complete the following questions in 150 to 200 words each. Be as detailed as possible and use the information you have learned throughout this course.
• What are the causes of stress in Michael’s or Jennifer’s life? How is stress affecting Michael’s or Jennifer’s health?
• How are these stressors affecting Michael’s or Jennifer’s self-concept and self-esteem?
• How might Michael’s or Jennifer’s situation illustrate adjustment? How might this situation become an opportunity for personal growth?
• What defensive coping methods is Michael or Jennifer using? What active coping methods might be healthier for Michael or Jennifer to use? Explain why you would recom.
Case Study # 2 –Danny’s Unhappy DutyEmployee ProfilesCaro.docxcowinhelen
Case Study # 2 –Danny’s Unhappy Duty
Employee Profiles
:
Carol Brown, Danny Winthrop, Thomas Fletcher
Carol, the Department Secretary for Purchasing and General Stores, has been
working at St. Louis Memorial Hospital for sixteen years, four of which have
been for the present Manager, Dan Winthrop. Carol likes her Boss, who gives
his employees more leeway than most. Carol’s main interests are her work and
her home—traits also typical of the other people who work in the Department.
Carol feels she is part of a close, cooperative group of employees.
Dan, or Danny, as he likes to be called, arrived at St. Louis Memorial four years
ago as a replacement for a Department manager who had been at the Hospital
for a number of years. Danny’s predecessor, Bill Taylor, was very strict in
everything from insisting that employees take exactly one-half hour for lunch
breaks to not having a coffee pot in the Department. When Danny came on
board as a Department Manager, his management style was much less strict.
The result was that Danny’s employees were much happier, and began to meet
and exceed expectations in getting their work done. St. Louis Memorial’s
previous CEO was a good friend and frequently complimented Danny on his
efficient and effective staff. Now a new CEO, Thomas Fletcher, has been hired
by the Hospital’s Board of Directors. Things are about to change.
Thomas Fletcher, new CEO and a recent graduate from a superior school of
hospital management, has always believed in “doing things by the book”.
Thomas originally had wanted to become a doctor, but decided two years into
the process that it was going to take him too long, and that he would be better
off becoming an administrator. He likes the idea of being an administrator,
and wants to be a good one. He has decided to start out his career at St. Louis
Memorial, of the smaller hospitals in the St. Louis area, but hopes to progress to a
a much larger facility in about four years, once he develops a track record at
St. Louis Memorial.
The Challenge: Communication, Criticism and Discipline, Leadership, Motivation,
Rules and Policies
Danny knows his employees quite well. They are generally a happy, cohesive, and cooperative group. They joke around a lot among themselves, but get the work done more than satisfactorily. All of them seem to give a
gr.
Case Study – Multicultural ParadeRead the Case below, and answe.docxcowinhelen
Case Study – Multicultural Parade
Read the Case below, and answer the following questions:
(No references needed, 2 pages double space, label the answer without copying the question in the paper)
1. What images come to mind when you hear the term “costume”? In what ways might it be considered demeaning?
2. Often people conflate “culture,” “ethnicity,” “heritage,” “race,” and “nationality,” or use them interchangeably. How are these concepts different from one another? Is a “Multicultural Day” different than an “International Day”?
3. How is Ms. Morrison’s definition of “cultural clothing” different from her definition of “ethnic heritage”? Did her explanation clarify things for Keisha and Emily?
4. How might activities that require students to share part of their ethnic heritage alienate students or contribute to students’ and teachers’ existing stereotypes and biases?
5. Connect to 3 of the core themes:
(Equity in Education/ Theories of Learning, Culture, and Identity/ Teaching and Learning in a Multicultural Society/ Research and Educational Knowledge )
-------------------------------------------------------------------------------------------------------------------------------
Case Study:
In an effort to celebrate the growing racial and ethnic diversity at Eastern School, the school’s Diversity Committee decided to sponsor Multicultural Day. Numerous performers were hired for assemblies and presentations. During the day’s feature event, the “Culture Parade,” students were asked to showcase cultural clothing as they walked through the hallways. Teachers were encouraged by the committee to discuss clothing from countries outside the United States and to invite students who had such clothing to bring it to school for the parade.
Ms. Morrison was excited about Multicultural Day because many of her students had parents who were immigrants. She imagined the day as an opportunity for those students to teach others about their cultures.
A week before the event, Ms. Morrison brought a kilt to class and explained its significance to the students. “This represents my Scottish heritage,” she said, “and I am proud to show it to you today.” She then asked whether students had “special costumes” at home that represented their cultures. Several students raised their hands, which prompted Ms. Morrison to discuss the events planned for Multicultural Day, including the parade.
During dismissal the day before the parade Ms. Morrison announced, “Don’t forget to bring your costumes to class tomorrow!”
The next day, Ms. Morrison was pleased to see several Hmong and Liberian students came with bags of clothing. She saw that two other students, Emily and Keisha, brought clothing, so she inquired about what was in their bags. Emily, a white student excitedly pulled out her soccer uniform, and Keisha, an African American student, pulled jeans and her favorite sweatshirt out of her bag. Ms. Morrison told the two girls she appreciated the.
Case Study THE INVISIBLE SPONSOR1BackgroundSome execut.docxcowinhelen
Case Study : THE INVISIBLE SPONSOR1
Background
Some executives prefer to micromanage projects whereas other executives
are fearful of making a decision because, if they were to make the wrong
decision, it could impact their career. In this case study, the president of the company assigned one of the vice presidents to act as the project sponsor on a project designed to build tooling for a client. The sponsor, however, was reluctant to make any decisions.
Assigning the VP
Moreland Company was well-respected as a tooling design-and-build
company. Moreland was project-driven because all of its income came
from projects. Moreland was also reasonably mature in project management.
When the previous VP for engineering retired, Moreland hired an executive from a manufacturing company to replace him. The new VP for engineering, Al Zink, had excellent engineering knowledge about tooling but had worked for companies that were not project-driven. Al had very little knowledge about project management and had never functioned as a project sponsor. Because of Al’s lack of experience as a sponsor, the president decided that Al should “get his feet wet” as quickly as possible and assigned him as the project sponsor on a mediumsized project. The project manager on this project was Fred Cutler. Fred was an engineer with more than twenty years of experience in tooling design and manufacturing. Fred reported directly to Al Zink administratively.
Fred's Dilemma
Fred understood the situation; he would have to train Al Zink on how to
function as a project sponsor. This was a new experience for Fred because subordinates usually do not train senior personnel on how to do their job. Would Al Zink be receptive?
Fred explained the role of the sponsor and how there are certain project documents that require the signatures of both the project manager and the project sponsor. Everything seemed to be going well until Fred informed Al that the project sponsor is the person that the president eventually holds accountable for the success or failure of the project. Fred could tell that Al was
quite upset over this statement.
Al realized that the failure of a project where he was the sponsor could damage his reputation and career. Al was now uncomfortable about having to act as a sponsor but knew that he might eventually be assigned as a sponsor on other projects. Al also knew that this project was somewhat of a high risk. If Al could function as an invisible sponsor, he could avoid making any critical decisions.
In the first meeting between Fred and Al where Al was the sponsor, Al asked Fred for a copy of the schedule for the project. Fred responded: I’m working on the schedule right now. I cannot finish the schedule until you tell me whether you want me to lay out the schedule based upon best time, least cost, or least risk.
Al stated that he would think about it and get back to Fred as soon as possible.
During the middle of the next week, Fred and Al m.
CASE STUDY Experiential training encourages changes in work beha.docxcowinhelen
CASE STUDY: Experiential training encourages changes in work behavior and growth in one’s abilities, which is accomplished through a multitude of methods. Experiential training has proven to be cost-effective while motivating employees as well as improving self-awareness, personal accountability, teamwork skills, and communication skills (Ritchie, 2011). Additionally, the training methods provide trainees with direct experience, the opportunity to reflect on that experience, and share models to help trainees to deduce using both present and past experience, while accommodating learning styles and strengths (Ritchie, 2011). Valkanos and Fragoulis identify several reasons why experiential training provides value:
1. Ongoing advances in technology requiring changes in knowledge, skills, and abilities
2. Divergence between theory and practice
3. Mergers and acquisitions of enterprises which tend to bring new jobs, organizational culture, and work content
4. Constant environment of change, from working conditions to processes and procedures relating to organizational issues, quality, and new products or services, and requiring new competencies, duties, or work content (Valkanos & Fragoulis, 2007, p. 22).
Method
Description
On-the-job Training
Receives instructions on the functions of their job in their assigned workplace.
Simulators
Teaches employees on how to operate equipment in a given context
Role Playing
Developing interpersonal and business skills, such as decision-making, communication, conflict resolution, and solving complex problems.
Case Study
Develops critical thinking skills to include analytical, higher-level skills, and exploring and resolving complex problems.
Games
Develops general business and organizational principles addressing application in a variety of situations.
Behavior Modeling
Used when learning goals are a rule and inflexible procedures. Provides skills and practice to modify and model behavior.
In-basket Techniques
A variety of items placed in an envelope that reflects what might be found in an inbox. This activity is used to assist trainees in developing and applying their strategic and operational skills.
(Blanchard & Thacker, 2013, pp. 222-223)
References:
· Blanchard, P. N., & Thacker, J. W. (2013). Effective training: Systems, strategies, and practices (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
· Valkanos, E., & Fragoulis, I. (2007). Experiential learning – its place in in‐house education and training. Development and Learning in Organizations: An International Journal, 21(5), 21-23. doi:10.1108/14777280710779454
Discussion Question--Choose one perspective in which to respond.
Non-HR Perspective: Your department is not meeting performance expectations. What steps do you take to resolve the issue? Is training a possible solution; if so, which of the above training methods would be the most effective in addressing the issue? Would you, at any point, involve HR--if so, at what point and why?.
Case Study Hereditary AngioedemaAll responses must be in your .docxcowinhelen
Case Study: Hereditary Angioedema
All responses must be in your own words. Answers that have been copied and pasted will not receive credit.
1. Translate “angioedema”. [Note: I am not looking for a description of the disorder. Rather, I would like you to translate the medical term itself.]
2. The complement system is described as a ‘cascade system’. How does the system fit into this description of being a cascade? [Suggestion: Google the definition of cascade, then think about the complement system in light of the definition]
3. Is complement involved in the innate, or the adaptive immune system, or both? Please explain you answer.
4. What role does C1INH play in the complement system? Why is it so important?
5. What was the physiologic cause of Richard’s abdominal pain?
6. How can one distinguish the swelling of HAE from the swelling of allergic angioedema?
7. What is bradykinin’s role in HA?
8. Do you think Richard’s infancy colic was related to his HA? No need to research this. Just use your intuition. Explain your thinking.
9. What is typically used to treat attacks of HAE?
10. Swelling in the extremities is not dangerous. What other areas of the body are subject to swelling? What is the most dangerous location for swelling to occur and why is it the most dangerous?
2018
BUS 308 Week 2 Lecture 1
Examining Differences - overview
Expected Outcomes
After reading this lecture, the student should be familiar with:
1. The importance of random sampling.
2. The meaning of statistical significance.
3. The basic approach to determining statistical significance.
4. The meaning of the null and alternate hypothesis statements.
5. The hypothesis testing process.
6. The purpose of the F-test and the T-test.
Overview
Last week we collected clues and evidence to help us answer our case question about
males and females getting equal pay for equal work. As we looked at the clues presented by the
salary and comp-ratio measures of pay, things got a bit confusing with results that did not see to
be consistent. We found, among other things, that the male and female compa-ratios were fairly
close together with the female mean being slightly larger. The salary analysis showed a different
view; here we noticed that the averages were apparently quite different with the males, on
average, earning more. Contradictory findings such as this are not all that uncommon when
examining data in the “real world.”
One issue that we could not fully address last week was how meaningful were the
differences? That is, would a different sample have results that might be completely different, or
can we be fairly sure that the observed differences are real and show up in the population as
well? This issue, often referred to as sampling error, deals with the fact that random samples
taken from a population will generally be a bit different than the actual population parameters,
but will be “close” enough to the actual.
case studieson Gentrification and Displacement in the Sa.docxcowinhelen
case studies
on Gentrification and Displacement
in the San Francisco Bay Area
Authors:
Miriam Zuk and Karen Chapple
Chapter 3: Nicole Montojo
Chapter 4: Sydney Cespedes, Mitchell Crispell, Christina Blackston, Jonathan Plowman, and
Edward Graves
Chapter 5: Logan Rockefeller Harris, Mitchell Crispell, Fern Uennatornwaranggoon, and Hannah Clark
Chapter 6: Nicole Montojo and Beki McElvain
Chapter 7: Celina Chan, Viviana Lopez, Sydney Céspedes, and Nicole Montojo
Chapter 8: Alexander Kowalski, Julia Ehrman, Mitchell Crispell and Fern Uennatornwaranggoon
Chapter 9: Mitchell Crispell
Chapter 10: Logan Rockefeller Harris and Sydney Cespedes
Chapter 11: Mitchell Crispell
Partner Organizations:
Causa Justa :: Just Cause, Chinatown Community Development Center, Marin Grassroots, Monument
Impact, People Organizing to Demand Environmental & Economic Rights (PODER), San Francisco
Organizing Project / Peninsula Interfaith Action , Working Partnerships USA
Acknowledgements:
Research support was provided by Maura Baldiga, Julian Collins, Mitchell Crispell, Julia Ehrman, Alex
Kowalski, Jenn Liu, Beki McElvain, Carlos Recarte, Maira Sanchez, Mar Velez, David Von Stroh, and
Teo Wickland. Report layout and design was done by Somaya Abdelgany.
Additional advisory support was provided by Carlos Romero. This case study was funded in part by
the Regional Prosperity Plan1 of the Metropolitan Transportation Commission as part of the “Regional
Early Warning System for Displacement” project and from the California Air Resources Board2 as part
of the project “Developing a New Methodology for Analyzing Potential Displacement.”
The Center for Community Innovation (CCI) at UC-Berkeley nurtures effective solutions that expand
economic opportunity, diversify housing options, and strengthen connection to place. The Center
builds the capacity of nonprofits and government by convening practitioner leaders, providing techni-
cal assistance and student interns, interpreting academic research, and developing new research out
of practitioner needs.
communityinnovation.berkeley.edu
July 2015
Cover Photographs: Robert Campbell, Ricardo Sanchez, David Monniaux, sanmateorealestateonline.com/Redwood-City, marinretail-
buzz.blogspot.com, trulia.com/homes/California/Oakland , bloomingrock.com, sharks.nhl.com/club/gallery, panoramio.com
1 The work that provided the basis for this publication was supported by funding under an award with the U.S. Department of Hous-
ing and Urban Development. The substance and findings of the work are dedicated to the public. The author and publisher are solely
responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not neces-
sarily reflect the views of the Government.
2 The statements and conclusions in this report are those of the authors and not necessarily those of the California Air Resources
Board. The mention of commercial products, their source, or their u.
Case Studt on KFC Introduction1) Identify the type of .docxcowinhelen
Case Studt on KFC
Introduction
1) Identify the type of business organization and strategies
2) Key players
Body
1. Opportunities
2. Threats
Closing/Conclusion
1. Make recommendations
2. Offer a plan for implementation
.
Case Study Crocs Revolutionizing an Industry’s Supply Chain .docxcowinhelen
Case Study Crocs: Revolutionizing an Industry’s Supply Chain Model for
Competitive Advantage
If the products sell extremely well, we will
build more in season, and will be back on the
shelves in a few weeks. And we’ll build even
more, and even more, and even more, in that
same season. We’re not going to wait with a
hot new product until next year, when hope-
fully the same trend is alive.
—Ronald Snyder, CEO of Crocs, Inc.1
On May 3, 2007, Crocs, Inc. released its results for the
first quarter of the year. The footwear company,
which had sold its first shoes in 2003, reported reve-
nues of $142 million for the quarter, more than three
times its sales for the first quarter of 2006. Net in-
come, at $0.61 per share was more than 17 percent
of sales, nearly four times higher than the previous
year.2 These results far exceeded market expecta-
tions, which had been for earnings of $0.49 per share
on $114 million of revenue.3 As part of the earnings
release, the company announced a two-for-one stock
split. Immediately after the announcement, the stock
price jumped 15 percent.
The growth and profitability of Crocs, which made
funky, brightly colored shoes using an extremely com-
fortable plastic material, had been astounding. Much
of this growth had been made possible by a highly
flexible supply chain which enabled the company to
build additional product to fulfill new orders quickly
within the selling season, allowing it to respond to un-
expectedly high demand—a capability that was previ-
ously unheard of in the footwear industry. This ability
to fulfill the needs of retailers also made the company
a very popular supplier to shoe sellers.
This success also raised questions about how
the company should grow in the future. Should it
vertically integrate or grow through product line
extension? Should it grow organically or through ac-
quisition? Would potential growth paths exploit
Crocs’ core competencies or defocus them?
CROCS, INC.
In 2002, three friends from Boulder, Colorado went
sailing in the Caribbean. One brought a pair of foam
clog shoes that he had bought from a company in
Canada. The clogs were made from a special mate-
rial that did not slip on wet boat decks, was easy
to wash, prevented odor, and was extremely com-
fortable. The three, Lyndon “Duke” Hanson, Scott
Seamans, and George Boedecker, decided to start a
business selling these Canadian shoes to sailing en-
thusiasts out of a leased warehouse in Florida, as
Hanson said, “so we could work when we went on
sailing trips there.”4 The founders wanted to name
the shoes something that captured the amphibious
nature of the product. Since “Alligator” had already
been taken, they chose to name the shoes “Crocs.”
The shoes were an immediate success, and word
of mouth expanded the customer base to a wide
range of people who spent much of their days stand-
ing, such as doctors and gardeners. In October 2003,
as the business began to grow, th.
Case Studies Student must complete 5 case studies as instructed.docxcowinhelen
Case Studies: Student must
complete 5 case studies
as instructed by course
materials. Fill out form below for 5 different people (imaginary is okay).
Master Herbalist Questionnaire
Date: _____________________
Name: _________________________________ Age: ______ Birth date:_____________
Address: ________________________________________________________________
Home Phone: _________________________ Work Phone:________________________
Height: _________ Weight: _________ 1 year ago:__________ 5 years ago:_________
Occupation: _______________________________________ Full Time Part Time
Living situation: Alone Friends Partner Spouse Parents Children Pets
What are your major health concerns and intentions for your visit today?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please list any other health care providers or consultants you are currently working with:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please list any current health conditions diagnosed by a medical doctor:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please use this form
as a source of
reference when
conducting your
Case-Studies.
Treat this part as information only as you are not to treat or prescribe treatment for any specific diseases
It is important to know if the client is receiving treatment from other practitioners and what these entail
Since legally you are not allowed to diagnose disease, it is helpful to get one from an MD
When was your last physical exam?
________________________________________________________________________
Please list all herbs, vitamins, and dietary supplements you are currently taking, includingdosage and frequency:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
List all medication.
Case Studies in Telehealth AdoptionThe mission of The Comm.docxcowinhelen
Case Studies in Telehealth Adoption
The mission of The Commonwealth
Fund is to promote a high performance
health care system. The Fund carries
out this mandate by supporting
independent research on health care
issues and making grants to improve
health care practice and policy. Support
for this research was provided by
The Commonwealth Fund. The views
presented here are those of the author
and not necessarily those of The
Commonwealth Fund or its directors,
officers, or staff.
For more information about this study,
please contact:
Andrew Broderick, M.A., M.B.A.
Codirector, Center for Innovation
and Technology in Public Health
Public Health Institute
[email protected]
The Veterans Health Administration:
Taking Home Telehealth Services to
Scale Nationally
Andrew Broderick
ABSTRACT: Since the 1990s, the Veterans Health Administration (VHA) has used infor-
mation and communications technologies to provide high-quality, coordinated, and com-
prehensive primary and specialist care services to its veteran population. Within the VHA,
the Office of Telehealth Services offers veterans a program called Care Coordination/
Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care man-
agement and case management services to veterans with diabetes, congestive heart fail-
ure, hypertension, post-traumatic stress disorder, and other conditions. The program uses
remote monitoring devices in veterans’ homes to communicate health status and to cap-
ture and transmit biometric data that are monitored remotely by care coordinators. CCHT
has shown promising results: fewer bed days of care, reduced hospital admissions, and
high rates of patient satisfaction. This issue brief highlights factors critical to the VHA’s
success—like the organization’s leadership, culture, and existing information technology
infrastructure—as well as opportunities and challenges.
OVERVIEW
Since the 1990s, information and communications technologies—including tele-
health—have been at the core of the Veterans Health Administration’s (VHA’s)
successful system-level transformation toward providing continuous, coordinated,
and comprehensive primary and specialist care services. The VHA’s leadership
and culture; underlying health information technology infrastructure; and strong
commitment to standardized work processes, policies, and training have all con-
tributed to the home telehealth program’s success in meeting the chronic care
needs of a population of aging veterans and reducing their use of institutional
care and its associated costs. The home teleheath model also encourages patient
activation, self-management, and helps in the early detection of complications.
To learn more about new publications
when they become available, visit the
Fund's website and register to receive
Fund email alerts.
Commonwealth Fund pub. 1657
Vol. 4
January 2013
www.commonwealthfund.org
www.commonwealthfund.org
mailto:[email pro.
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.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
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 Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
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.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Overview on Edible Vaccine: Pros & Cons with Mechanism
Running Head FINANCIAL AND OPERATIONAL RISK5F.docx
1. Running Head: FINANCIAL AND OPERATIONAL RISK
5
Financial and Operational Risk
Rasmussen College
Amanda McCauley
Author Note
This paper is being submitted on January 22, 2017 for
William Tipton’s ACG3205 Risk Management for Accountants
course.
Module 3 Course Project
Risk Area
Level of Risk
Strategy (Assume, Mitigate, or Transfer)
Medical Errors
High
Medical errors includes wrong dosage, deaths of patients due to
poor handling or treatment as well as using wrong method of
treating patients that lead to another medical conditions
(Highland Risk Services, 2014). The medical errors cannot be
2. mitigated by ensuring that error made by personnel is reduced.
It entail employing competent personnel in the healthcare
facilities.
Board Composition
Low
The composition of the Board matters since they help to over
the operations of the organizations. Therefore, the composition
should have personnel from other related industries to help
make multi-disciplinary decisions (Sullivan, 2013). Therefore,
the risk can be transferred by selecting a competent and
qualified board.
Transportation- shortage of ambulances and other emergency
vehicles
High
Transportation is cornerstone of the healthcare facilities as it
can be a life saver. Therefore, the risks of shortage of
emergency vehicles like ambulance should be mitigated as soon
as possible to avoid deaths of patients caused by lack of
transportations (Sullivan, 2013). Therefore, the strategy would
be to mitigate it by buying or leasing enough vehicles for any
emergency purposes.
High Inflation Rate
High
Health care facilities are expected to deliver health services
regardless of the cost. The norm makes health care services to
have high expenses that might outweigh the revenue (Highland
Risk Services, 2014). The risk can be transferred by ensuring
that there is sufficient revenue from patients, services, grants
and donors.
3. References
Highland Risk Services. (2014). Risk Management for
Healthcare Clinics. Retrieved from Highland Risk Services:
http://www.highlandrisk.com/index.php?option=com_content&v
iew=article&id=74:risk-management-for-healthcare-
clinics&catid=7&Itemid=223
Sullivan, M. (2013). The Top Five Challenges Facing Today’s
Hospitals. Retrieved from http://blog.schneider-
electric.com/building-management/2013/10/17/top-five-
challenges-facing-todays-hospitals/
Running Head: FINANCE
FINANCE 3
Financial Crisis
Walter Frazier
FIN 100
Professor Fatma Ahmad
January 22, 2017
Unfortunately, due to rapidly rising housing prices during the
decade prior to 2006, many home buyers needed increasingly
larger loans to make their real property purchases. For example,
a $200,000 fixed-rate mortgage loan would result in a much
higher monthly payment compared to a $100,000 loan. Rework
the above financial calculator spread sheet solutions using a PV
6. Percentage of
Occupancy 63% 68% 70% 71%
Average Length of
Stay 4.3 4.5 4.5 4.5
Emergency Visits 33,586 33,095 36,266 37,354
Urgent Care Visits 11,717 15,734 16,202 16,688
Observation Cases 4,380 5,216 5,496 5,661
Outpatient
Registrations 30,819 30,063 32,313 33,928
Home Health Visits 51,736 43,496 38,532 38,532
Births 1,297 1,328 1,265 1,265
Other Statistics
Employees 2,112 2,350 2,400
Full Time Equivalent Employees 1,690 1,880 1,920
Financial Data:
7. Balance Sheet
FY 2014 and 2015
Assets 2015 2014
Current assets:
Cash and cash equivalents
Cash and investments held by bond trustee –
required for current liabilities
Accounts receivable, less allowances for
uncollectible
$
53,635,94
4
11,552,85
9
34,328,81
4
12,479,98
5 patient accounts of approximately $40,466,000 and
8. $38,196,000 in 2010 and 2009, respectively 44,068,697
38,838,787
Estimated third-party settlements, net 1,295,000 1,758,080
Supplies 9,899,409 8,860,081
Prepaid expenses and other current assets 9,066,378 11,867,585
Total current assets
129,518,287 108,133,332
Assets limited as to use:
Current liabilities:
Accounts payable $ 19,860,709 15,744,839
Accrued expenses:
Employee compensation and
benefits
20,467,163 14,712,215
Interest 2,186,356 2,069,202
Other 11,501,375 12,929,155
Current portion of long-term debt 5,000,000 4,715,000
Total current liabilities 59,015,603 50,170,411
Interest rate swaps 7,663,158 5,121,610
Other 12,907,742 8,342,913
Long-term debt, less current portion 154,594,700 162,282,08
4
Total liabilities 234,181,203 225,917,01
8 Net assets:
9. Unrestricted 181,147,094 175,919,30
4 Temporarily restricted — 129,367
Permanently restricted — 1,101,862
Cash and investments held by bond trustee, less current portion
6,577,710 5,986,813
Other 4,575,567 2,660,774
Total assets limited as to use 11,153,277 8,647,587
Property and equipment, net 176,575,169 184,822,376
Other assets:
Investments
88,036,572
96,245,865
Deferred loan costs, net
1,762,631
—
2,414,097
1,524,290
Due from affiliates 7,388,113 1,280,004
Other assets 894,248 —
Total other assets 98,081,564 101,464,256
10. Total assets $ 415,328,297 403,067,551
Total net assets 181,147,094 177,150,53
3 Total liabilities and net assets $ 415,328,297 403,067,55
1
See accompanying notes to combined financial
statements.
Combined Statements of Operations
and Changes in Net Assets
Years ended 2015 and 2014
2015 2014
Unrestricted revenues:
Net patient service revenue $ 356,970,899
355,503,779
Other revenues 3,972,874 3,265,341
Total revenues 360,943,773 358,769,120
Expenses:
11. Salaries, wages, and benefits 154,185,77
3
156,730,75
4 Supplies and other costs 114,684,53
7
116,721,80
9 Physician and other professional fees 30,825,059
27,166,07
2 Provision for bad debts 26,961,851 27,098,156
Depreciation and amortization 23,307,829 24,265,90
2 Interest 6,255,524 7,237,20
7
Total expenses 356,220,57
3
359,219,90
0 Income (loss) from operations 4,723,200 (450,780)
Nonoperating gains (losses):
Investment loss, net
(3,070,456)
(2,316,910)
Change in net unrealized gains and losses on investments
6,788,945 (7,813,344)
Change in fair value of interest rate swaps (2,541,548)
(4,212,764)
Contributions 202,470 5,196
Change in interest in net assets of Leesburg Regional
12. Medical Center Charitable Foundation, Inc. — (393,832)
Loss on extinguishment of debt (648,158) (5,926,723)
Gain on sale of property and equipment 28,128 3,244
Other 38,270 9,186
Nonoperating gains (losses), net 797,651 (20,645,94
7) Excess (deficiency) of revenue and gains over expenses
before discontinued operations 5,520,851 (21,096,727)
See accompanying notes to combined financial statements.
Combined Statements of Cash Flows Years ended 2015 and
2014
2015 2014
Cash flows from operating activities and nonoperating
gains:
Change in net assets
13. $3,996,561
(15,261,655)
Adjustments to reconcile change in net assets to
net cash
provided by operating activities and nonoperating gains:
Depreciation and amortization 23,307,82
9
24,265,90
2 Provision for bad debts 26,961,85
1
27,098,15
6 Change in fair value of interest rate swaps 2,541,54
8
4,212,76
4 Change in net unrealized gains and losses on
investments
(6,788,94
5)
7,813,34
4 Gain on sale of property and equipment (28,128
)
(3,244
) Change in interest in net assets of Foundation 1,524,29
0
394,672
14. Gain on sale of businesses — (6,380,95
9) Loss on early extinguishment of debt 648,15
8
5,926,72
3 Amortization of premiums and discounts, net (187,38
4)
(189,839
) Changes in operating assets and liabilities:
Accounts receivable (32,191,76
1)
(24,785,38
1) Supplies (1,039,32
8)
719,289
Estimated third-party receivables/payables 463,08
0
(4,170,07
3) Prepaid expenses and other assets 1,906,95
9
(1,397,17
4) Accounts payable 4,115,87
0
1,446,42
9 Accrued expenses 4,444,32
2
15. 2,036,40
3 Other noncurrent liabilities 4,564,829
2,293,03
8 Net cash provided by operating activities and
nonoperating gains 34,239,751
24,018,39
5 Cash flows from investing activities:
Net change in investments 14,998,23
7
(13,286,13
1) Purchases of property and equipment (14,964,88
4)
(10,135,35
4) Proceeds from sale of property and equipment 28,128 3,244
Proceeds from sale of businesses — 5,239,33
1 Net change in assets limited as to use (1,578,564)
2,987,04
8 Net cash used in investing activities (1,517,083)
(15,191,862) Cash flows from financing activities:
Repayment of long-term debt and capital lease
obligations
(44,715,00
0)
(102,517,95
16. 2) Proceeds from issuance of long-term debt 37,500,00
0
97,655,00
0 Change in due from affiliates (6,108,10
9)
(784,088)
Payment of loan costs (92,429)
(2,422,432
) Net cash used in financing activities (13,415,538)
(8,069,472
)
Change in cash and cash equivalents 19,307,13
0
757,061
Cash and cash equivalents, beginning of year 34,328,814
33,571,75
3
Cash and cash equivalents, end of year $ 53,635,944
34,328,81
4
Noncash financing activity:
Notes receivable received in sales of businesses $ —
3,100,00
0
17. Relevant Notes to Financial Statements:
1. Organization and Summary of Significant Accounting
Policies
a. Use of Estimates - The preparation of these combined
financial statements, in
conformity with U.S. generally accepted accounting principles,
requires management to
make estimates and assumptions that affect the reported
amounts of assets and
liabilities and disclosure of contingent assets and liabilities at
the date of the combined
financial statements, and the reported amounts of revenues and
expenses during the
reporting period. Actual results could differ from those
estimates.
b. Cash and Cash Equivalents - CCH considers all highly liquid
investments with a
maturity of three months or less when purchased, excluding
investments classified as
assets limited as to use, to be cash equivalents.
2. Assets Limited as to Use, Investments, and Investment
Income
Investments in equity securities with readily determinable fair
18. values and all investments in
debt securities are measured at fair value in the combined
balance sheets. Investment income
(including realized gains and losses on investments, unrealized
gains and losses on trading
securities, interest and dividends) is included in excess of
revenues and gains over expenses
unless such earnings are subject to donor restrictions.
Investment income that is restricted by
donor stipulations is reported as an increase in temporarily
restricted net assets.
Other assets limited as to use includes $4,575,567 and
$2,660,774 as of 2015 and 2014,
respectively, which has been designated for the State of Florida
workers’ compensation and
medical malpractice requirements.
3. Allowance for Uncollectible Patient Accounts
Additions to the allowance for uncollectible patient accounts
are made by means of the
provision for bad debts. Accounts receivable are written off
after collection efforts have been
followed in accordance with CCH’s policies. Accounts written
off as uncollectible are deducted
from the allowance for uncollectible patient accounts, and
subsequent recoveries are added.
The amount of the provision for bad debts is based upon
management’s assessment of
historical and expected net collections, business and economic
conditions, trends in federal and
19. state government healthcare coverage and other collection
indicators.
4. Interest Rate Swaps
CCH uses interest rate swaps to manage net exposure to interest
rate changes related to its
borrowings and to lower its overall borrowing costs. CCH
recognizes all interest rate swaps as
either assets or liabilities in the combined balance sheets and
measures those instruments at
fair value. The changes in fair value of the derivatives are
recognized as nonoperating gains
(losses).
5. Net Patient Service Revenue
Gross patient service charges are recorded on the accrual basis
in the period in which services
are provided at CCH’s established rates, excluding charges
related to charity care. Contractual
adjustments and other deductions are subtracted from gross
patient service charges to
determine net patient service revenue. Contractual adjustments
under third-party
reimbursement programs and agreements represent the
difference between CCH’s established
rates for services and amounts reimbursed by third-party payors.
20. Payment arrangements
under third-party reimbursement programs and agreements
include prospectively determined
rates per discharge, reimbursed costs, discounted charges and
per diem payments. Other
deductions from revenue include discounts provided to self-pay
patients.
Net patient service revenue is reported at the net realizable
amounts due from patients, third-
party payors and others for services rendered, including
estimated retroactive adjustments
under reimbursement agreements with third-party payors due to
future audits, reviews and
investigations. Retroactive adjustments are accrued on an
estimated basis in the period the
related services are rendered and adjusted in future periods as
final settlements are
determined or as years are no longer subject to such audits,
reviews and investigations.
6. Medicare and Medicaid Programs
The Medicare program CCH for services rendered on a
prospective basis. Payments for
inpatient services are based on each patient’s DRG assignment.
Payments for outpatient
services are based on the Ambulatory Payment Group (APC)
assignment. DRGs and APCs are
based on each patient’s clinical diagnosis and medical
procedures. The Medicare program also
reimburses CCH for capital costs on a prospective basis. CCH
are reimbursed for cost
reimbursable items at a tentative rate with final settlement
21. determined after audit by the fiscal
intermediary. The Medicaid program reimburses CCH on a per
service basis established by
using prior year’s cost, not to exceed the current year’s
allowable cost. Annual provisions for
contractual adjustments are based on management’s
computation of prospective payments
and allowable costs. Final determination of amounts earned
pursuant to the Medicare and
Medicaid programs is subject to review by appropriate
governmental authorities or their
agents. In the opinion of management, adequate provision has
been made for any adjustments
that may result from such reviews.
Final settlements have been determined and received for all
Medicare cost reports through the
year ended 2008. Adjustments to revenue are accrued on an
estimated basis in the period the
related services are rendered and adjusted in future periods as
changes in estimated provisions
and final settlements are determined. Adjustments to revenue
related to prior periods
decreased net patient service revenue by approximately
$220,000 and increased net patient
service revenue by approximately $3,299,000 for the years
ended 2014 and 2014,
respectively.
Approximately 61% and 63% of net patient service revenue was
derived from the Medicare
program for the years ended 2015 and 2014, respectively.
Approximately 4% and 1% of net
patient service revenue was derived from the Medicaid program
22. for the years ended 2015 and
2014, respectively. Laws and regulations governing the
Medicare and Medicaid programs are
extremely complex and subject to interpretation. As a result,
there is at least a reasonable
possibility that recorded estimates will change by a material
amount in the near term.
7. Uncompensated Care
CCH provides uncompensated charity care to patients who meet
certain established criteria.
CCH does not pursue collection of amounts determined to
qualify as charity care; therefore,
these amounts are excluded from net patient service revenues.
Charity care at established
rates was approximately $31,091,000 and $23,949,000 for the
years ended 2015 and 2014,
respectively.
CCH also provides uncompensated care to patients that do not
have health insurance or that
do not meet the established criteria for charity care. CCH
pursues collection of these amounts
net of any discounts; however, certain amounts are eventually
determined to be
uncollectible. These amounts are classified as provision for bad
debts in the accompanying
23. combined statements of operations and changes in net assets and
totaled approximately
$26,962,000 and $27,321,000 for the years ended 2015 and
2014, respectively.
8. Long-Term Debt
In August 2008, CCH entered into another interest rate swap
agreement (the Second Swap
Agreement) to limit the effect of increases in interest rates
related to the 2008A Series Bonds.
The Second Swap Agreement expires in July 2031. The notional
principal amount of the Swap
Agreement is $22,655,000. The effect of the Second Swap
Agreement is to attempt to fix the
effective interest rate at 3.352%. For the years ended, 2015 and
2014, CCH recognized an
increase in interest expense of $702,541 and $458,712,
respectively, in the combined
statements of operations and changes in net assets associated
with payment differentials for
its Second Swap Agreement. The fair value of the Second Swap
Agreement is the estimated
amount LRMC would receive or pay to terminate the Second
Swap Agreement at the reporting
date, taking into account current interest rates and the current
creditworthiness of the parties.
The fair value of the Second Swap Agreement is a liability of
$2,605,703 and $1,730,473 as
of June 30, 2010 and 2009, respectively, and is included as a
separate noncurrent liability in
the accompanying combined balance sheets. The change in the
fair value of the Second Swap
Agreement resulted in a loss of $875,230 and
$1,730,473 for the years ended 2015 and 2014, respectively, and
24. is classified as a
nonoperating loss in the accompanying combined statements of
operations and changes in net
assets.
Due to the uncertainty surrounding monoline bond insurers,
such as AMBAC, MBIA, FSA, and
Radian, during 2009, CCH refunded the 2001 Auction Rate
Bonds insured by AMBAC and the
2006 Bonds insured by Radian.
CCH has a defined contribution retirement plan (the Plan)
covering substantially all employees.
The Plan provides that CCH will match 50% of employee
contributions, up to 3% of the
contributing employee’s compensation. Additional contributions
to the Plan are at the discretion
of the Board of Directors. CCH contributed an additional 1.25%
of employee compensation for
the years ended, 2015 and 2014. Total Plan expense was
approximately
$3,442,000 and $3,246,000 for the years ended 2015 and 2014,
respectively.
CCH has an employee health benefit plan covering substantially
all health costs for eligible
employees and their dependents, including self-insurance
coverage for amounts up to a
specified level. Health plan expense was approximately
$27,508,000 and $25,211,000 for the
years ended 2015 and 2014, respectively.
9. Commitments and Contingencies
25. a. Contingencies
CCH annually purchases commercial malpractice insurance
policies to cover medical
malpractice claims. Such policies have deductible provisions, in
varying amounts, for
which CCH is self-insured.
Losses that are subject to the deductible provisions, including
an estimate of claims
incurred but not reported, total approximately $16,945,000 and
$14,057,000 as of 2015
and 2014, respectively. Such amounts are included in other
accrued expenses, if payment
is expected within one year, or as other long-term liabilities in
the accompanying
combined balance sheets. CCH may be liable for ultimate losses
in excess of amounts
accrued. In the opinion of management, such amounts would not
have a material adverse
effect on CCH’s financial position or results of operations.
From time to time, CCH is involved in other litigation and
claims arising in the normal
course of business. After consultation with legal counsel,
management believes that these
matters will be resolved with no material adverse effect on
CCH’s financial position or
results of operations.
26. 10. Concentrations of Credit Risk
CCH grants credit without collateral to its patients, most of who
are local residents and are
insured under third-party payor agreements. CCH does not
charge interest on accounts
receivable. Net patient accounts receivable included
approximately $24,174,000 or 55%, due
from the Medicare program as of 2015, and $20,126,000 or
50%, due from the Medicare
program as of 2015. The credit risk for other concentrations of
receivables is limited due to the
large number of insurance companies and other payors that
provide payments for services.
Project References:
• Controlling Retained Insurance Costs Through an Allocation
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in.aspx?direct=true&db=bth&AN=103109497&site=ehost-live
• Study Examines Top Priorities of Hospital C-Suite Executives
and Risk Managers
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27. • How to Conduct a Risk Workshop <insert link to
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• Your Hospital’s Strategy for Managing Total Cost of Risk
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961741?
accountid=40836
• Global Association of Risk Professionals <insert link to
www.garp.org>