Description
As healthcare moves away from a fee-for-service payment environment to one that encourages reimbursement for quality and value, chief financial officers face a damning reality: Revenue and income will be strained as hospitals make a push to keep patients out of their four walls when necessary.
The Power of Strong Financial Risk
Management in Healthcare Organizations
A
s healthcare moves away
from a fee-for-service
payment environment to
one that encourages reimburse-
ment for quality and value, chief
fnancial ofcers face a damning
reality: Revenue and income will
be strained as hospitals make a
push to keep patients out of their
four walls when necessary.
Tis type of seismic shif natu-
rally exposes any organization to
increased risks. For hospitals and
health systems, how will they be
able to ofer high-quality care
with fewer dollars? How can they
make investments for the future
with restrained capital? How can
they retain a diligent, hardwork-
ing staf as expenses rise? What
if another economic collapse like
2008 occurs and decimates the
investment portfolio?
Risk management has become
one of the most important issues
of the day for healthcare provid-
ers, and CFOs sit in the hot seat.
In an exclusive roundtable, fve
hospital and health system CFOs
and two healthcare fnance ex-
perts discuss the challenges and
solutions around risk manage-
ment, how trends like consolida-
tion and health IT spending ft in
and how other fnance executives
should manage risks in their bal-
ance sheets and portfolios today.
Te participants included: Joe
Guarracino, Senior Vice Presi-
dent and CFO of Te Brooklyn
(N.Y.) Hospital Center; Mark
Johnson, Senior Vice President
and CFO of UnityPoint Health
in West Des Moines, Iowa;
Ronald Knaus, Senior Vice
President and CFO of Spectrum
Health in Grand Rapids, Mich.;
Dan Moncher, Executive Vice
President and CFO of Firelands
Regional Medical Center in San-
dusky, Ohio; John Orsini, Exec-
utive Vice President and CFO of
Cadence Health
in Winfeld, Ill.;
Kerri Schro-
eder, Senior
Vice President
and Special-
ized Industries
Credit Products Executive at
Bank of America Merrill Lynch;
and Steve Campisi, Director of
Institutional Tought Leadership
at U.S. Trust.
The essence of risk man-
agement in healthcare
When asked what risk manage-
ment meant for their hospitals
and health systems, the CFOs
agreed on several core compo-
nents. Risk management solu-
tions for providers today must
involve an enterprise-wide efort,
not just a priority in the C-suite,
they said. For instance, Mr.
Guarracino said his organization
engages and educates physicians
to create a culture that will lead
to the best possible outcomes.
“We’re trying to engage our clini-
“Our clients are
managing risks that are
multidimensional...”
The Power of Strong Financial Risk
Management in Healthcare Organizations
Kerri Schroeder, Senior Vice President and Specialized Industries
Credit Products Executive at Bank of America Merrill Lynch
Joe Guarracino
Senior Vice President & CFO
The Brooklyn Hospital Center
Mark Johnson
Senior Vice President & CFO
UnityPoint Health
Ronald Knaus
Senior Vice President & CFO
Spectrum Health
Dan Moncher
Senior Vice President & CFO
Firelands Regional Medical
Center
John Orsini
Senior Vice President & CFO
Cadence Health
Kerri Schroeder
Senior Vice President &
Specialized Industries Credit
Products Executive
Bank of America Merrill Lynch
Steve Campisi
Director of Institutional
Thought Leadership
U.S. Trust
The Power of Strong Financial Risk Management in Healthcare Organizations
cians to be partners in this,” he
said.
In addition, risk management
must factor in the organization’s
overarching goals of care quality,
patient safety and patient/em-
ployee satisfaction.
Te term “risk” was also de-
fned in several ways. When it
comes to the balance sheets,
the panelists all agreed several
metrics best encompass risk for
hospitals: days cash on hand,
debt-to-capitalization, debt
service coverage, funded status
of the pension plan, risk-based
capital. On a broader level, risk
also permeates fnancial execu-
tives’ day-to-day tasks.
“Our clients are managing risk
that are multidimensional: Tey
have to manage strategic risk,
which is having the ability to
respond to changes in the ex-
ternal environment, whether
those challenges are regulatory
or competitive, market risks
that might impact the balance
sheet,” Ms. Schroeder of Bank of
America Merrill Lynch said. “It’s
also operational risk, including
the alignment of objectives with
physicians and having internal
processes, people and systems
to manage all of the operational
aspects of the hospital.”
Consolidation: Why inte-
gration is key
Hospital mergers and acquisi-
tions have un-
doubtedly been
on the rise in
healthcare since
2009, and these
transactions
bring their own
sets of risks.
Mr. Orsini, who
is working through a merger
between Cadence and North-
western Memorial HealthCare
in Chicago, said fnancial issues
are generally ironed out during
the evaluation process. But
cultural issues take more time
and nuance to handle. Terefore,
he advised the
leaders of hospi-
tals and health
systems going
through mergers
to ensure their
management
teams share the
same culture
and agree on
strategies and tactics.
“Te biggest risk is more op-
erational and cultural than the
balance sheet,” Mr. Orsini said.
“Te balance sheet is fairly static,
and you know what the balance
sheets are going to look like. You
do your fnancial due diligence
and forward-looking conditions,
so you can model to expect what
the balance sheets are, and what
the synergistic opportunities are.
Te bigger issue in a merger is
how you approach the integra-
tion work.”
Mr. Knaus has also been in-
volved with M&A activity at
Spectrum. Last year, the system
acquired two hospitals — Me-
costa County Medical Center in
Big Rapids, Mich., and Luding-
ton (Mich.) Hospital. Te two
hospitals were very diferent:
MCMC was a county-owned
hospital with a weak balance
sheet, while Ludington had a
more solid fnancial foundation.
As health systems continue to
grow, knowing how the next
hospital will ft into the portfolio
is essential, he said.
“In both cases, it’s a lot of work
to integrate the organizations,”
Mr. Knaus said. “One is an hour
away, and the other is an hour
and a half away. So we just have
to look at the balance sheet that
“The biggest risk is
more operational
and cultural than the
balance sheet...”
“We try to make sure
we look at every project
that comes before the
senior management
team...”
John Orsini, Executive Vice President
and CFO of Cadence Health
Dan Moncher, Executive Vice President and
CFO of Firelands Regional Medical Center
The Power of Strong Financial Risk Management in Healthcare Organizations
is coming in and their fnancial
performance.”
In addition, diferent types of
transactions bring about difer-
ent risks for all parties involved.
“Consolidation in healthcare is
taking place in a variety of mod-
els today, from the more infor-
mal afliations to full-on merg-
ers and the creation integrated
health systems,” Ms. Schroeder
said. “Te complexity and risk of
the transaction increases along
that continuum.”
However, hospital and health
system leaders can advance their
overall goals through transac-
tions, given that they keep their
objectives in mind, Mr. Campisi
said. “It’s a lot of fux, but it’s an
opportunity,” he said. “It’s the
opportunity to see it as an op-
portunity.”
The rise of new capital
spending initiatives
Expansions and new construc-
tion projects are less common
today for hospitals and health
systems, as their strategies shif
away from large inpatient hubs
to more community health facili-
ties. However, health IT — spe-
cifcally electronic health records
— continue to absorb a higher
share of capital dollars, meaning
the appetite for new projects is
still there. Te key to tackling the
risks surrounding today’s capi-
tal spending involves thorough
evaluation, the panelists said.
“We try to make sure we look
at every project that comes
before the senior management
team, especially the signifcant
dollar projects
like IT, capital
renovations
or buildings,”
Mr. Moncher
of Firelands
Regional said.
“We do an ROI:
What’s the long-
term beneft? Do they enhance
patient care? Do they enhance
quality? Do they potentially en-
hance reimbursement? We try to
strategically place capital dollars
where we’re going to get some
longer-term beneft.”
UnityPoint, Spectrum, Cadence
and other multihospital systems
ofen have few problems ac-
cessing the capital markets, but
smaller, independent organiza-
tions have seen
some speed
bumps as of
late.
“It’s a chal-
lenge for us.
Our access to
capital is limited,” said Mr. Guar-
racino of Te Brooklyn Hospital
Center, an independent hospi-
tal that predominantly serves
low-income patients. “I always
joke around: We have to make
our investments like we’re the
Tampa Bay Rays, not like we’re
the New York Yankees. And I’m
a Yankees fan. If you have the
wherewithal, you can take a little
bit more risk for more return.
Unfortunately, we can’t do that.”
Overall, Mr. Guarracino echoed
Mr. Moncher in saying the solu-
tion is to invest wisely and be
thoughtful in selecting vendors.
“We’re trying to make sure we
choose our partners correctly,”
he said.
The nuances of today’s in-
vestments and long-term
assets
In 2008, the fnancial collapse
signifcantly impacted numer-
ous healthcare organizations
across the country. Mr. Moncher
said Firelands Regional realized
some losses because the markets
forced the hospital to be in a
collateral posting position. Mr.
“It’s a challenge for us.
Our access to capital is
limited...”
“By being aware,
getting up, talking to
people in the other
parts of the org ...”
Steve Campisi, Director of Institutional
Thought Leadership at U.S. Trust
Joe Guarracino, Senior Vice President and
CFO of The Brooklyn (N.Y.) Hospital Center
The Power of Strong Financial Risk Management in Healthcare Organizations
Orsini was at San Diego-based
Scripps Health at the time, and
he said the system “had tremen-
dous unrealized losses.”
“Our investment committee got
very nervous,” he said. “It created
bit of a schism. Tere were some
[members] that wanted us to
liquidate the portfolio and put it
in T-bills.”
Investment income has since re-
bounded for most hospitals and
health systems, and many panel-
ists said it was a lesson learned in
terms of portfolio management.
However, as providers man-
age their investment portfolios
today, risks still persist. How
should the portfolio be set up?
How much should be invested in
fxed income versus alternatives
and long-only equities?
“Everybody needs safety in the
short run, but they also need
growth in long run if they’re
going to achieve their long-term
goals, and it’s about balancing
these needs properly,” U.S. Trust’s
Mr. Campisi said. “Afer estab-
lished an adequate position in
liquid bonds, having diversifca-
tion in the growth piece through
balanced exposure to both tradi-
tional equity and alternatives is
important.”
Finding financial sustain-
ability
When asked what healthcare
CFOs and executives could do
to improve their balance sheets
in a meaningful and sustain-
able way, while simultaneously
decreasing risks, the panelists
profered several strategies. For
organizations looking to build
liquidity, low interest rates and
favorable market conditions may
make long term debt issuance a
good strategy if leverage is not
a concern. Sale-leasebacks and
monetization of non-core assets
are also long-
term strategies
that could result
in quick infuxes
of cash.
“Even though
the industry is
rapidly chang-
ing, some of the old tricks for
balance sheet improvements
are still out there,” Mr. John-
son of UnityPoint said. “Tis
can include refnancing higher
interest rate debt or accelerating
accounts receivable manage-
ment. Some healthcare entities
have also considered monetizing
assets, such as medical ofce
buildings or selling underuti-
lized real estate.”
Mr. Campisi said a goal-based
approach to investment is the
key to success for healthcare
fnance executives. He also said
communicating with people in
diferent parts of the organiza-
tion to get a clear understanding
of the practical, everyday issues
they face is important. “Tat
alone would give a diferent per-
spective to the fnance executives
and cause them to do their job in
a more holistic, coordinated and
efective way,” he said.
In the end, fnance executives
must trust their instincts when
it comes to managing risks for
their healthcare organizations.
CFOs usually do not ascend
to their positions by ignoring
prudence and or making rash
decisions.
“It’s important to stay focused.
Don’t get overwhelmed by trying
to tackle everything at once,” Mr.
Moncher said. “Prioritize where
your highest risks are and what’s
going to have the most imme-
diate potential impact on your
organization. Focus on what
needs to be done to mitigate that
risk before moving on.” n
“It’s important to stay
focused...”
Dan Moncher, Executive Vice President and
CFO of Firelands Regional Medical Center
“Bank of America Merrill Lynch” is the marketing name for the global banking and global markets businesses of Bank of America Corporation. Lending, derivatives, and other commercial banking activities
are performed globally by banking affiliates of Bank of America Corporation, including Bank of America, N.A., member FDIC. Securities, strategic advisory, and other investment banking activities are
performed globally by investment banking affiliates of Bank of America Corporation (“Investment Banking Affiliates”), including, in the United States, Merrill Lynch, Pierce, Fenner & Smith Incorporated
and Merrill Lynch Professional Clearing Corp., both of which are registered broker-dealers and members of SIPC, and, in other jurisdictions, by locally registered entities. Merrill Lynch, Pierce, Fenner &
Smith Incorporated and Merrill Lynch Professional Clearing Corp. are registered as futures commission merchants with the CFTC and are members of the NFA. Investment products offered by Investment
Banking Affiliates: Are Not FDIC Insured • May Lose Value • Are Not Bank Guaranteed. THE POWER OF GLOBAL CONNECTIONS is a trademark of Bank of America Corporation, registered in the U.S. Patent
and Trademark Office. ©2014 Bank of America Corporation 01-14-9266
The power of global connections
TM
A dedicated healthcare team delivering better
financial care. It’s how we help hospitals operate
with greater efficiency.
baml.com/healthcare
acute focus
doc_681916044.pdf
As healthcare moves away from a fee-for-service payment environment to one that encourages reimbursement for quality and value, chief financial officers face a damning reality: Revenue and income will be strained as hospitals make a push to keep patients out of their four walls when necessary.
The Power of Strong Financial Risk
Management in Healthcare Organizations
A
s healthcare moves away
from a fee-for-service
payment environment to
one that encourages reimburse-
ment for quality and value, chief
fnancial ofcers face a damning
reality: Revenue and income will
be strained as hospitals make a
push to keep patients out of their
four walls when necessary.
Tis type of seismic shif natu-
rally exposes any organization to
increased risks. For hospitals and
health systems, how will they be
able to ofer high-quality care
with fewer dollars? How can they
make investments for the future
with restrained capital? How can
they retain a diligent, hardwork-
ing staf as expenses rise? What
if another economic collapse like
2008 occurs and decimates the
investment portfolio?
Risk management has become
one of the most important issues
of the day for healthcare provid-
ers, and CFOs sit in the hot seat.
In an exclusive roundtable, fve
hospital and health system CFOs
and two healthcare fnance ex-
perts discuss the challenges and
solutions around risk manage-
ment, how trends like consolida-
tion and health IT spending ft in
and how other fnance executives
should manage risks in their bal-
ance sheets and portfolios today.
Te participants included: Joe
Guarracino, Senior Vice Presi-
dent and CFO of Te Brooklyn
(N.Y.) Hospital Center; Mark
Johnson, Senior Vice President
and CFO of UnityPoint Health
in West Des Moines, Iowa;
Ronald Knaus, Senior Vice
President and CFO of Spectrum
Health in Grand Rapids, Mich.;
Dan Moncher, Executive Vice
President and CFO of Firelands
Regional Medical Center in San-
dusky, Ohio; John Orsini, Exec-
utive Vice President and CFO of
Cadence Health
in Winfeld, Ill.;
Kerri Schro-
eder, Senior
Vice President
and Special-
ized Industries
Credit Products Executive at
Bank of America Merrill Lynch;
and Steve Campisi, Director of
Institutional Tought Leadership
at U.S. Trust.
The essence of risk man-
agement in healthcare
When asked what risk manage-
ment meant for their hospitals
and health systems, the CFOs
agreed on several core compo-
nents. Risk management solu-
tions for providers today must
involve an enterprise-wide efort,
not just a priority in the C-suite,
they said. For instance, Mr.
Guarracino said his organization
engages and educates physicians
to create a culture that will lead
to the best possible outcomes.
“We’re trying to engage our clini-
“Our clients are
managing risks that are
multidimensional...”
The Power of Strong Financial Risk
Management in Healthcare Organizations
Kerri Schroeder, Senior Vice President and Specialized Industries
Credit Products Executive at Bank of America Merrill Lynch
Joe Guarracino
Senior Vice President & CFO
The Brooklyn Hospital Center
Mark Johnson
Senior Vice President & CFO
UnityPoint Health
Ronald Knaus
Senior Vice President & CFO
Spectrum Health
Dan Moncher
Senior Vice President & CFO
Firelands Regional Medical
Center
John Orsini
Senior Vice President & CFO
Cadence Health
Kerri Schroeder
Senior Vice President &
Specialized Industries Credit
Products Executive
Bank of America Merrill Lynch
Steve Campisi
Director of Institutional
Thought Leadership
U.S. Trust
The Power of Strong Financial Risk Management in Healthcare Organizations
cians to be partners in this,” he
said.
In addition, risk management
must factor in the organization’s
overarching goals of care quality,
patient safety and patient/em-
ployee satisfaction.
Te term “risk” was also de-
fned in several ways. When it
comes to the balance sheets,
the panelists all agreed several
metrics best encompass risk for
hospitals: days cash on hand,
debt-to-capitalization, debt
service coverage, funded status
of the pension plan, risk-based
capital. On a broader level, risk
also permeates fnancial execu-
tives’ day-to-day tasks.
“Our clients are managing risk
that are multidimensional: Tey
have to manage strategic risk,
which is having the ability to
respond to changes in the ex-
ternal environment, whether
those challenges are regulatory
or competitive, market risks
that might impact the balance
sheet,” Ms. Schroeder of Bank of
America Merrill Lynch said. “It’s
also operational risk, including
the alignment of objectives with
physicians and having internal
processes, people and systems
to manage all of the operational
aspects of the hospital.”
Consolidation: Why inte-
gration is key
Hospital mergers and acquisi-
tions have un-
doubtedly been
on the rise in
healthcare since
2009, and these
transactions
bring their own
sets of risks.
Mr. Orsini, who
is working through a merger
between Cadence and North-
western Memorial HealthCare
in Chicago, said fnancial issues
are generally ironed out during
the evaluation process. But
cultural issues take more time
and nuance to handle. Terefore,
he advised the
leaders of hospi-
tals and health
systems going
through mergers
to ensure their
management
teams share the
same culture
and agree on
strategies and tactics.
“Te biggest risk is more op-
erational and cultural than the
balance sheet,” Mr. Orsini said.
“Te balance sheet is fairly static,
and you know what the balance
sheets are going to look like. You
do your fnancial due diligence
and forward-looking conditions,
so you can model to expect what
the balance sheets are, and what
the synergistic opportunities are.
Te bigger issue in a merger is
how you approach the integra-
tion work.”
Mr. Knaus has also been in-
volved with M&A activity at
Spectrum. Last year, the system
acquired two hospitals — Me-
costa County Medical Center in
Big Rapids, Mich., and Luding-
ton (Mich.) Hospital. Te two
hospitals were very diferent:
MCMC was a county-owned
hospital with a weak balance
sheet, while Ludington had a
more solid fnancial foundation.
As health systems continue to
grow, knowing how the next
hospital will ft into the portfolio
is essential, he said.
“In both cases, it’s a lot of work
to integrate the organizations,”
Mr. Knaus said. “One is an hour
away, and the other is an hour
and a half away. So we just have
to look at the balance sheet that
“The biggest risk is
more operational
and cultural than the
balance sheet...”
“We try to make sure
we look at every project
that comes before the
senior management
team...”
John Orsini, Executive Vice President
and CFO of Cadence Health
Dan Moncher, Executive Vice President and
CFO of Firelands Regional Medical Center
The Power of Strong Financial Risk Management in Healthcare Organizations
is coming in and their fnancial
performance.”
In addition, diferent types of
transactions bring about difer-
ent risks for all parties involved.
“Consolidation in healthcare is
taking place in a variety of mod-
els today, from the more infor-
mal afliations to full-on merg-
ers and the creation integrated
health systems,” Ms. Schroeder
said. “Te complexity and risk of
the transaction increases along
that continuum.”
However, hospital and health
system leaders can advance their
overall goals through transac-
tions, given that they keep their
objectives in mind, Mr. Campisi
said. “It’s a lot of fux, but it’s an
opportunity,” he said. “It’s the
opportunity to see it as an op-
portunity.”
The rise of new capital
spending initiatives
Expansions and new construc-
tion projects are less common
today for hospitals and health
systems, as their strategies shif
away from large inpatient hubs
to more community health facili-
ties. However, health IT — spe-
cifcally electronic health records
— continue to absorb a higher
share of capital dollars, meaning
the appetite for new projects is
still there. Te key to tackling the
risks surrounding today’s capi-
tal spending involves thorough
evaluation, the panelists said.
“We try to make sure we look
at every project that comes
before the senior management
team, especially the signifcant
dollar projects
like IT, capital
renovations
or buildings,”
Mr. Moncher
of Firelands
Regional said.
“We do an ROI:
What’s the long-
term beneft? Do they enhance
patient care? Do they enhance
quality? Do they potentially en-
hance reimbursement? We try to
strategically place capital dollars
where we’re going to get some
longer-term beneft.”
UnityPoint, Spectrum, Cadence
and other multihospital systems
ofen have few problems ac-
cessing the capital markets, but
smaller, independent organiza-
tions have seen
some speed
bumps as of
late.
“It’s a chal-
lenge for us.
Our access to
capital is limited,” said Mr. Guar-
racino of Te Brooklyn Hospital
Center, an independent hospi-
tal that predominantly serves
low-income patients. “I always
joke around: We have to make
our investments like we’re the
Tampa Bay Rays, not like we’re
the New York Yankees. And I’m
a Yankees fan. If you have the
wherewithal, you can take a little
bit more risk for more return.
Unfortunately, we can’t do that.”
Overall, Mr. Guarracino echoed
Mr. Moncher in saying the solu-
tion is to invest wisely and be
thoughtful in selecting vendors.
“We’re trying to make sure we
choose our partners correctly,”
he said.
The nuances of today’s in-
vestments and long-term
assets
In 2008, the fnancial collapse
signifcantly impacted numer-
ous healthcare organizations
across the country. Mr. Moncher
said Firelands Regional realized
some losses because the markets
forced the hospital to be in a
collateral posting position. Mr.
“It’s a challenge for us.
Our access to capital is
limited...”
“By being aware,
getting up, talking to
people in the other
parts of the org ...”
Steve Campisi, Director of Institutional
Thought Leadership at U.S. Trust
Joe Guarracino, Senior Vice President and
CFO of The Brooklyn (N.Y.) Hospital Center
The Power of Strong Financial Risk Management in Healthcare Organizations
Orsini was at San Diego-based
Scripps Health at the time, and
he said the system “had tremen-
dous unrealized losses.”
“Our investment committee got
very nervous,” he said. “It created
bit of a schism. Tere were some
[members] that wanted us to
liquidate the portfolio and put it
in T-bills.”
Investment income has since re-
bounded for most hospitals and
health systems, and many panel-
ists said it was a lesson learned in
terms of portfolio management.
However, as providers man-
age their investment portfolios
today, risks still persist. How
should the portfolio be set up?
How much should be invested in
fxed income versus alternatives
and long-only equities?
“Everybody needs safety in the
short run, but they also need
growth in long run if they’re
going to achieve their long-term
goals, and it’s about balancing
these needs properly,” U.S. Trust’s
Mr. Campisi said. “Afer estab-
lished an adequate position in
liquid bonds, having diversifca-
tion in the growth piece through
balanced exposure to both tradi-
tional equity and alternatives is
important.”
Finding financial sustain-
ability
When asked what healthcare
CFOs and executives could do
to improve their balance sheets
in a meaningful and sustain-
able way, while simultaneously
decreasing risks, the panelists
profered several strategies. For
organizations looking to build
liquidity, low interest rates and
favorable market conditions may
make long term debt issuance a
good strategy if leverage is not
a concern. Sale-leasebacks and
monetization of non-core assets
are also long-
term strategies
that could result
in quick infuxes
of cash.
“Even though
the industry is
rapidly chang-
ing, some of the old tricks for
balance sheet improvements
are still out there,” Mr. John-
son of UnityPoint said. “Tis
can include refnancing higher
interest rate debt or accelerating
accounts receivable manage-
ment. Some healthcare entities
have also considered monetizing
assets, such as medical ofce
buildings or selling underuti-
lized real estate.”
Mr. Campisi said a goal-based
approach to investment is the
key to success for healthcare
fnance executives. He also said
communicating with people in
diferent parts of the organiza-
tion to get a clear understanding
of the practical, everyday issues
they face is important. “Tat
alone would give a diferent per-
spective to the fnance executives
and cause them to do their job in
a more holistic, coordinated and
efective way,” he said.
In the end, fnance executives
must trust their instincts when
it comes to managing risks for
their healthcare organizations.
CFOs usually do not ascend
to their positions by ignoring
prudence and or making rash
decisions.
“It’s important to stay focused.
Don’t get overwhelmed by trying
to tackle everything at once,” Mr.
Moncher said. “Prioritize where
your highest risks are and what’s
going to have the most imme-
diate potential impact on your
organization. Focus on what
needs to be done to mitigate that
risk before moving on.” n
“It’s important to stay
focused...”
Dan Moncher, Executive Vice President and
CFO of Firelands Regional Medical Center
“Bank of America Merrill Lynch” is the marketing name for the global banking and global markets businesses of Bank of America Corporation. Lending, derivatives, and other commercial banking activities
are performed globally by banking affiliates of Bank of America Corporation, including Bank of America, N.A., member FDIC. Securities, strategic advisory, and other investment banking activities are
performed globally by investment banking affiliates of Bank of America Corporation (“Investment Banking Affiliates”), including, in the United States, Merrill Lynch, Pierce, Fenner & Smith Incorporated
and Merrill Lynch Professional Clearing Corp., both of which are registered broker-dealers and members of SIPC, and, in other jurisdictions, by locally registered entities. Merrill Lynch, Pierce, Fenner &
Smith Incorporated and Merrill Lynch Professional Clearing Corp. are registered as futures commission merchants with the CFTC and are members of the NFA. Investment products offered by Investment
Banking Affiliates: Are Not FDIC Insured • May Lose Value • Are Not Bank Guaranteed. THE POWER OF GLOBAL CONNECTIONS is a trademark of Bank of America Corporation, registered in the U.S. Patent
and Trademark Office. ©2014 Bank of America Corporation 01-14-9266
The power of global connections
TM
A dedicated healthcare team delivering better
financial care. It’s how we help hospitals operate
with greater efficiency.
baml.com/healthcare
acute focus
doc_681916044.pdf