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34 48 • No disclosures related to medical malpractice would be included in the financial statements. The discussion of the business contained in the Form 10-K filed by GoodDocs would probably contain a statement similar to the following: “The provision of medical services by the physician group with which GoodDocs contracts entails an inherent risk of professional liability claims. GoodDocs does not control the practice of medicine by physicians or the compliance with certain regulatory and other requirements directly applicable to physicians and physician groups.” Exhibit 34.1 Continued. Note C. Contingencies In addition to the general liability and malpractice insurance carried by the individual physicians, GoodDocs is insured with respect to general liability and medical malpractice risks on a claims-made basis. Management is not aware of any claims against the company. In addition, GoodDocs has not accrued a loss for unreported incidents or for losses in excess of insurance coverage, as the amount, if any, cannot be reasonably estimated and the probability of an adverse outcome cannot be determined at this time. It is the opinion of management that the ultimate resolution of any unasserted claims will not have a material adverse effect on GoodDocs’ financial position or results of operations. FORMAT B—UNCONSOLIDATED (STANDALONE ) PRESENTATION Note C. Contingencies FORMAT A— CONSOLIDATED PRESENTATION 34.4 SPECIAL ACCOUNTING PROBLEMS OF SPECIFIC TYPES OF PROVIDERS 34 49 • recently consummated, a significant management agreement generally are not required in an IPO filing if the PPM does not consolidate the practice and does not guarantee any minimum practice income, extend unusual credit terms, or fund operating losses. However, if the PPM is expected to have a material dependence on the PC, separate financial information about the practice would be material to investors. For example, if the management fee from the practice is expected to generate more than 20% of the PPM’s revenues in the next 12 months, the SEC has requested audited financial statements of the practice. However, the SEC has accepted only unaudited summary financial information about the practice for the three most recent fiscal years if audited financial statements are not readily available and its owners are not promoters of the offering being registered. Historical information about the practice for any period before its ownership by the current owners would not be requested unless the PPM is of the view that a change in an owner does not fundamentally change the underlying business. If the owners of a practice generating 20% or more of the PPM’s revenues own 10% or more of the PPM at the time of its IPO or are promoters of the offering, audited financial statements of that practice for at least its most recent fiscal year ordinarily would be required, unless effects of providing the management services to the practice have been included in the PPM’s audited financial statements for at least nine months. If financial information of a managed practice is presented, care should be taken to avoid the impression that an investor is obtaining an interest in the practice or that the historical results are indicative of future results under the altered incentive structure and management affiliates established with the PPM. Disclosure Issues. The SEC staff expects PPM registrants to clearly and accurately describe their business and contractual relationships. Financial statement disclosures should address the following: WHAT IS THE NATURE OF THE PPM’S BUSINESS? • • • Describe the contractual relationship among the PPM and the medical practices. Describe the PPM’s rights and limitations under the contracts. Disclose how the PPM’s fees are determined. If the fees are based on a percentage of certain items, what are those percentages, or what is the range of the percentages? What items affect the calculation? Even if the PPM combines the operations of the medical practice group for financial statement purposes or has consolidated subsidiaries that provide the medical services, the PPM must clearly distinguish the services it provides from the practice of medicine. WHAT IS THE PPM’S RELATIONSHIP WITH MANAGED CARE PROVIDERS? • • • Disclose whether the PPM (or an assignee) enters into direct contracts with managed care companies or whether the physician groups contract directly with the managed care companies. Identify the party who assumes the risk under managed care contracts (i.e., the PPM or the physician group). If the PPM assumes the contracts, are there any issues relating to medical licensing? Who assumes the risk associated with capitated payment contracts? If the PPM assumes the risk, does this subject it to regulation as an insurance company? IS THE PPM SUBJECT TO ANY STATE OR FEDERAL REGULATIONS? • • • Describe any state prohibitions on the corporate practice of medicine, and discuss the impact upon the PPM. Is the PPM subject to regulation as an insurer? What is the effect of federal antikickback and self-referral restrictions? 34 50 • PROVIDERS OF HEALTH CARE SERVICES 34.5 FINANCIAL REPORTING PRACTICES (a) USERS OF FINANCIAL STATEMENTS. The primary users of health care companies’ general purpose financial statements are providers of capital who make rating and investment decisions in competitive capital markets (including investors in tax-exempt debt securities); suppliers of goods and services to the industry with whom health care companies maintain credit relationships; stockholders and other owners; the Securities and Exchange Commission; and regulators such as state Departments of Insurance and other oversight groups. (b) BASIC FINANCIAL STATEMENTS. Investor-owned and not-for-profit health care providers generally prepare four financial statements: 1. 2. 3. 4. Balance sheet Income statement/statement of operations Statement of changes in stockholders’ equity/statement of changes in net assets Statement of cash flows Not-for-profit health care entities are required to follow the financial reporting requirements contained in FAS No. 117, Financial Statements of Not-for-Profit Organizations, as modified by certain requirements contained in Health Care Organizations. Generally speaking, FAS No. 117 provides broad standards of financial reporting with which all not-for-profit organizations (including not-forprofit health care organizations) must comply. However, the FASB permitted the AICPA to provide industry-specific implementing guidance for FAS No. 117 through its audit and accounting guides. Although technically the guidance in Health Care Organizations stands lower in the GAAP hierarchy than does the FASB guidance, the FASB expects not-for-profit health care organizations to apply the requirements of FAS No. 117 in the manner specified by the Audit Guide. Generally speaking, those modifications are intended to keep the financial statements of not-for-profit providers comparable to those of investor-owned providers. Governmental health care entities are required to follow the financial reporting requirements prescribed by GASB No. 34, “Basic Financial Statements—and Management’s Discussion and Analysis—for State and Local Governments.” (GASB No. 34’s phased-in effective date is discussed at Section 32.11.) For purposes of applying GASB No. 34, the governmental health care organizations included within the scope of the AICPA audit and accounting guide Health Care Organizations are considered “special purpose governments engagement in business-type activities.” Those entities should present financial statements required for enterprise funds, which consist of: • • • • • • Management’s Discussion and Analysis (as RSI) Statement of net assets (balance sheet) Statement of revenues, expenses, and changes in net assets Statement of cash flows Notes to financial statements RSI other than MD&A (if applicable) Although GASB No. 34 establishes eight required elements of MD&A, many of those elements are not applicable to governmental health care entities. Consequently, MD&A discussion should be limited to only the elements that are applicable. Health Care Organizations provides illustrative financial statements for investor-owned, taxexempt, and governmental health care organizations. Those statements illustrate the application of the reporting practices contained in the Guide. Specific types of health care organizations are presented, but only to illustrate a wide diversity of reporting practices. It is not intended that these illustrations represent either the only types of disclosure nor the only statement formats that would be appropriate. More or less detail should appear in the financial statements or notes, depending on the circumstances. 34.5 FINANCIAL REPORTING PRACTICES 34 51 • (c) BALANCE SHEET. All health care organizations must prepare classified balance sheets which segregate assets and liabilities between current and noncurrent categories.22 Special considerations related to balance sheet reporting of not-for-profit and governmental providers are discussed below. (i) Not-for-Profit Providers. Restricted assets and liabilities should not be carved out and presented separately in the balance sheet. Because donor restrictions generally relate to limitations on the use of net assets rather than specific assets (i.e., the provider normally is not required to physically maintain restricted resources separately from unrestricted resources), “cash is cash” regardless of whether it was received as a specific-purpose gift or generated through operations. As a result, the provider’s obligation to use unexpended donor-restricted contributions in accordance with the donor’s wishes is reflected by structuring the equity section of the balance sheet into three broad classes: unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets. If the amount of unexpended donor-restricted contributions is material, the nature of restrictions should be disclosed in the notes to the financial statements. The accounting and reporting requirements for donor-restricted contributions is discussed at Subsection 34.3. Limitations on the use of assets arising from sources other than donor restrictions are highlighted by using the balance sheet caption “assets whose use is limited.” These are discussed at Subsection 34.3(b)(i). (ii) Governmental Providers. A governmental provider’s balance sheet may be prepared using either the traditional balance sheet format or a net assets format (assets less liabilities equal net assets). The equity section of the balance sheet is structured into three broad classes of net assets: unrestricted; invested in capital assets, net of related debt (i.e., capital assets reduced by accumulated depreciation and by any outstanding debt incurred to acquire, construct or improve those assets); and restricted (differentiated between expendable and nonexpendable). The provider’s obligations to use certain resources for specific purposes is reflected in the balance sheet by (1) presenting those assets separately and (2) reporting any difference between those assets and their related liabilities as “restricted net assets.” The word “restricted” is not required to be used in labeling the assets themselves; however, the descriptions used on the face of the balance sheet should make it clear that such assets cannot be used to satisfy the organization’s current liabilities (other than any current liabilities that are intended to be satisfied with the restricted assets). Under GASB No. 34, assets are reported as restricted when limitations on their use is externally imposed (e.g., by creditors, grantors, contributors, or the laws or regulations of other governments). Restricted assets should be presented separately in the balance sheet. Internally imposed limitations (such as specific-purpose designations imposed management or the board) are included in unrestricted net assets. (d) OPERATING STATEMENT. Appendix A of the Guide provides illustrative income statements for investor-owned, not-for-profit, and governmental health care organizations. These statements are not intended to establish standards but merely to illustrate the reporting conventions discussed in the Guide. Although income statement reporting requirements differ significantly based on whether a provider is investor owned, not-for-profit, or governmental, all allow flexibility in the amount of detail that is provided. Some providers choose to present a great deal of detail; others present statements that are highly condensed with details, if any, provided in the notes. The Guide allows each provider to determine the level of detail that provides the most meaningful disclosure within the broad parameters established by GAAP. 22 For not-for-profit providers, this is a modification of the guidance provided in FAS No. 117, which requires information about liquidity of assets and liabilities be provided in “some fashion” (e.g., by sequential ranking) within the balance sheet. 34 52 • PROVIDERS OF HEALTH CARE SERVICES Significant differences exist in the presentation of extraordinary items, discontinued operations, and cumulative effect of changes in accounting principles depending on whether a provider is investor owned, not-for-profit, or governmental, as follows. Presentation of Type of Provider Extraordinary Items Discontinued Operations Cumulative Effect Investor-owned Just before net income Just before net income Just before net income Not-for-profit Just before change in unrestricted net assets, with subtotal Just before change in unrestricted net assets, with subtotal Just before change in unrestricted net assets, with subtotal Governmental Below nonoperating revenue See discussion Adjustment of beginning fund balance GASB No. 34 is silent on how discontinued operations should be reported. Based on informal discussions with GASB staff, the author believes that reporting of discontinued operations would be part of the detail required by GASB No. 34 for the “Operating revenue” and “Operating expense” sections of the statement of changes in revenues, expenses, and changes in net assets, because both continuing and discontinued operations are part of a health care organizations operating activity. The “Operating revenues” section would contain one or more lines identified as “revenue from discontinued operations,” with a similar presentation of “expenses from discontinued operations” provided in the “Operating expenses” section. Any gain or loss on disposal of an operation would be reflected as nonoperating revenue or expense (similar to the treatment of other types of gains/losses under GASB No. 34). (i) Requirements for Investor-Owned Providers. The income statement reporting requirements for investor-owned health care providers are similar to those for other types of investor-owned service providers. Providers that are SEC registrants sometimes will receive comment letters from the SEC requesting that their income statements display operating expenses at a level of detail “consistent with the AICPA audit guide for health care providers.” As stated previously, the sample financial statements included in the Guide are illustrative and are not intended to establish a practice that would require a certain level of disclosure. (ii) Requirements for Not-for-Profit Providers. The income statement requirements for not-forprofit health care entities were established by FAS No. 117, as modified by certain requirements contained in Health Care Organizations. Those modifications are as follows: FAS No. 117 Requirement Modification provided in Health Care Organizations Presentation of a “statement of activity” that combines the information traditionally presented in an income statement with the information traditionally reported in the statement of changes in net assets. Subdivides “statement of activity” into two required statements: a “statement of operations” (i.e., income statement) and a “statement of changes in net assets.” Reporting of results of operations (i.e., net income) is permitted but not required. Must provide “performance indicator” subtotal23 within the statement of operations. Contributions of property, plant, and equipment (or of funds expended to purchase such assets) are reported as increases in unrestricted net assets in the statement of activities. 23 Such contributions should be reported below the “performance indicator” (i.e., excluded from net income) in the statement of operations. The FASB has objected to use of the term “net income” to refer to the results of operations of not-for-profit health care organizations. Therefore, Health Care Organizations uses the generic term “performance indicator” to describe the operating measure. 34.5 FINANCIAL REPORTING PRACTICES 34 53 • Other requirements imposed on not-for-profit providers that differ from those of investor-owned and governmental providers are as follows: • • • • Net assets released from restrictions (except those related to long-lived assets) are included in net income. All expenses must be reported in the “unrestricted net assets” classification. No expenses may be reported in the statement of changes in net assets for the temporarily or permanently restricted classifications. FAS No. 117 requires reporting of expenses by functional categories such as “program,” “management,” and “fund raising.” Administrative allocations to the functional categories should be based on full cost allocations. Normally, providers report expenses classified along revenue/cost center lines (e.g., nursing services, other professional services, general services) or “natural” lines (e.g., salaries and wages, employee benefits, supplies, purchased services). Health Care Organizations emphasizes the flexibility allowed in FAS No. 117, which allows reporting the functional information in the notes to the financial statements. Similarly, flexibility is allowed in the degree to which details are presented with regard to functional information. Some providers may choose to present only two categories: “health services” and “general and administrative”; others may desire to report more detailed information. APB No. 30 items must be reported below the performance indicator (see Subsection 34.5(d)(iv). The health care Guide does not require not-for-profit providers to distinguish between operating and nonoperating activities. If an “income from operations” subtotal is presented and its use is not apparent from the details provided on the face of the statement, note disclosure should be made regarding the nature of the measure or the types of items excluded from that measure. In June 2002, AcSEC issued an exposure draft of a proposed Statement of Position, “Accounting for Derivative Instruments and Hedging Activities by Not-for-Profit Health Care Organizations, and Clarification of the Performance Indicator.” The proposed standard would amend the AICPA audit and accounting guide Health Care Organizations to clarify that the performance indicator reported by not-for-profit health care organizations is analogous to income from continuing operations of a for-profit enterprise. (The analogy is made to a for-profit enterprise’s income from continuing operations, rather than net income, because FAS No. 117 requires “APB No. 30” type items—extraordinary items, cumulative effect of accounting changes, and discontinued operations—to be reported separately from measures of operations such as the performance indicator. In order for the performance indicator to be comparable to net income, APB No. 30 items would need to be included within the performance indicator. See Subsection 34.5(d)(iv) for information on reporting APB No. 30 items.) This clarification also provides not-for-profit providers with a clearer concept of “other comprehensive income” reporting. (Not-for-profit organizations were excluded from the scope of FAS No. 130, “Reporting Comprehensive Income,” because FAS No. 117 already required them to display the equivalent of total comprehensive income in the Statement of Activities.) Gains and losses that FASB pronouncements classify as elements of other comprehensive income should be excluded from the performance indicator. (iii) Requirements for Governmental Providers. The operating statement prepared by governmental health care organizations is the “Statement of revenues, expenses, and changes in net assets.” The focus of this statement is “all-inclusive”—that is, it presents all changes in net assets, not just those that affect net income. Therefore, it contains all transactions that would be reported in an income statement plus a statement of changes in net assets, including changes in restricted resources. The statement must be prepared using a specifically sequenced format that distinguishes operating and nonoperating revenues and expenses, and provides an intermediate total for operating income or loss. The prescribed sequence is as follows: • Operating revenues (detailed) • Total operating revenues (required subtotal) 34 54 • • • • • • • • • • PROVIDERS OF HEALTH CARE SERVICES Operating expenses (detailed) • Total operating expenses (required subtotal) • Operating income/loss (required subtotal) Nonoperating revenues/expenses (detailed) • Income before other revenues, expenses, gains, losses, and transfers Capital contributions Additions to term and permanent endowments “Special items” Extraordinary items Transfers • Increase (decrease) in net assets Net assets—beginning of period Net assets—end of period Because the focus of this statement is on the change in total net assets, rather than changes in classes of net assets, no reclassifications from restricted to unrestricted funds are reported when when restrictions are released. The use of restricted funds and expiration of time restrictions are financial statement “nonevents” under GASB No. 34. Balance sheet reclassifications from “restricted” to “unrestricted” and vice versa are not reported anywhere in a governmental entity’s financial statements. Revenues should be reported by major source, and entities are required to separately identify revenues that provide security for revenue bonds. GASB No. 34 links the determination of operating/nonoperating classification to the classification of transactions in the statement of cash flows under GASB No. 9. Transactions related to cash flows that are classified as noncapital financing, capital financing, or investing in the statement of cash flows typically are not classified as “operating” in the statement of revenues, expenses, and changes in net assets. Examples of items that are required to be classified as nonoperating using this approach are contributions received (financing activity), interest expense (financing activity), and interest income (investing activity). Under the allinclusive format, restricted contributions (other than capital contributions) and restricted investment income are included in nonoperating revenues together with unrestricted contributions and unrestricted investment income). Each organization must establish a policy that defines operating revenues and expenses based on the above parameters and disclose that policy in the notes to the financial statements. GASB No. 34 established a new category of transaction called “special items.” A special item is a significant transaction or other event that is within the control of management and that meets one (but not both) of the APB No. 30 criteria for classification as an extraordinary item. Similar transactions that are beyond the control of management are not special items. Special items should be reported separately below nonoperating revenues (expenses). Although governmental health care entities generally are required to apply all FASB pronouncements that apply to for-profit enterprises, the all-inclusive reporting format required by GASB No. 34 conflicts with FASB Statement No. 130, “Reporting Comprehensive Income.” Therefore, governmental entities do not have a concept of “other comprehensive income.” Gains and losses that FASB pronouncements classify as elements of other comprehensive income should be reported no differently from other gains and losses in the statement of revenues, expenses, and changes in net assets. (e) STATEMENT OF CHANGES IN NET ASSETS/EQUITY. A Statement of Changes in Net Assets/Equity should report all changes that have occurred during the reporting period in all equity, net asset, and fund balance accounts maintained by a not-for-profit provider. Governmental providers 34.5 FINANCIAL REPORTING PRACTICES 34 55 • do not prepare this statement, due to the “all-inclusive” nature of their operating statement as discussed at Subsection 34.5(d)(iii). (f) STATEMENT OF CASH FLOWS. Standards for cash flow reporting differ among investorowned, not-for-profit, and governmental health care entities, as follows: Type of Provider Investor-owned Not-for-profit Governmental Source(s) of Authoritative Guidance FAS No. 95 FAS No. 117/FAS No. 95 GAS No. 9 “Cash Flows from Operations” Reconciles To Net income Change in net assets Income/loss from operations (i) Considerations for Not-for-Profit Providers. Unique considerations for not-for-profit providers include the following: • • • • • Because FAS No. 117 reconciles cash flows from operations to change in total net assets, the reconciliation will have to accommodate certain equity items that are not dealt with in cash flow statements prepared for investor-owned companies. These items include equity transfers, contributions of long-lived assets, unrealized gains and losses on certain investments, investment returns restricted by donor or law, and restricted contributions. Unrealized gains and losses on investment other than trading securities and contributions of long-lived assets will need to be adjusted out as noncash items. Equity transfers, restricted investment income, and restricted contributions (including contributions restricted for purchase of long-lived assets) will need to be “transferred” to the financing category by adjusting them out of operating cash flows and increasing (or decreasing, as appropriate) the financing category by that same amount. Purchases, sales, and maturities of trading securities should be classified as cash flows from operating activities; cash flows from purchases, sales, and maturities of other than trading securities should be classified as cash flows from investing activities. Cash and cash equivalents reported as “assets whose use is limited” should be excluded from “cash and cash equivalents” reported in the cash flow statement. (ii) Considerations for Governmental Providers. Governmental providers follow the guidance in GASB Statement No. 9, Reporting Cash Flows of Proprietary and Nonexpendable Trust Funds and Governmental Entities That Use Proprietary Fund Accounting, in preparing their statement of cash flows. That statement’s requirements differ from those of FASB Statement Nos. 95 and 117 in the following ways: • • • • • The direct method of presenting operating cash flows must be used, with a reconciliation provided of operating cash flows to operating income (loss). The GASB cash flow statement has four categories: operating, investing, capital financing, and noncapital financing. The capital financing category is used for acquiring and disposing of capital assets, borrowing money for acquiring capital assets, and repaying the amounts borrowed. All other financing is classified as noncapital. Some items are classified differently by the GASB than they are by the FASB. For example, fixed assets are classified as capital financing activities under GASB Statement No. 9, but are considered to be investing activities under FASB Statement No. 95. GAS No. 9, par. 8 provides that a statement of cash flows should explain the change in all cash and cash equivalents, regardless of any restrictions on their use. The total amount of cash and cash equivalents should be easily traceable to similarly titled line items. If it is not, a reconciliation should be provided. 34 56 • PROVIDERS OF HEALTH CARE SERVICES 34.6 STATUTORY/REGULATORY REPORTING ISSUES (a) STATUTORY FINANCIAL STATEMENTS. Increasingly, HMOs and provider-sponsored networks are coming under regulation by state departments of insurance. Generally speaking, regulated insurers are required by their state of domicile to submit annually a set of audited financial statements that are prepared using that state’s prescribed regulatory accounting principles (“statutory financial statements”). In 1999, the NAIC completed a process to codify statutory accounting practices (SAP) for managed care organizations, resulting in a revised Accounting Practices and Procedures Manual. Nine of the Statements of Statutory Accounting Principles (SSAPs) included in the Manual have been specifically modified or written to address issues related to managed care. These include SSAP No. 25, “Accounting for and Disclosures about Transactions with Affiliates and Other Related Parties,” No. 35, “Guaranty Fund and Other Assessments,” No. 47, “Uninsured Plans,” No. 50, “Classifications and Definitions of Insurance or Managed Care Contracts in Force,” No. 54, “Individual and Group Accident and Health Contracts,” No. 55, “Unpaid Claims, Losses and Loss Adjustment Expenses,” No. 66, “Retrospectively Rated Insurance Contracts,” No. 73, “Health Care Delivery Assets—Supplies, Pharmaceuticals and Surgical Supplies, Durable Medical Equipment, Furniture, Medical Equipment and Fixtures, and Leasehold Improvements in Health Care Facilities,” and No. 84, “Health Care Receivables.” All other SSAPs should be considered that are applicable to the particular managed care entity. The Manual is updated annually to reflect revisions or additions to SAP. It is expected that most states will require insurers to comply with most, if not all, provisions of the Manual. States may adopt the Manual in whole, or in part, as an element of prescribed SAP in those states. If, however, the requirements of state laws, regulations, and administrative rules differ from guidance provided in the Manual, those state laws, regulations, and administrative rules preempt the guidance in the Manual. (b) RISK-BASED CAPITAL FOR MANAGED CARE ORGANIZATIONS. State laws generally require insurers to maintain minimum levels of capital or surplus. The NAIC has implemented a “risk-based capital” (RBC) formula for managed care organizations under which affected managed care organizations must calculate and report to regulators its capital requirement and total adjusted capital. There are five principal elements to the RBC formula: affiliated investment risk, asset risk, underwriting risk, credit risk, and general business risk. Four action levels (in order of increasingly stringent level of regulatory response) are: company action level, regulatory action level, authorized control level, and mandatory control level. At a minimum, the company action-level event requires the filing of an RBC plan that details conditions leading to the event and proposals of corrective action with the state insurance commissioner. (c) OMB CIRCULAR A-133. Health care organizations that receive financial assistance from a governmental agency may be subject to audit requirements in accordance with the Single Audit Act of 1996 and Office of Management and Budget (OMB) Circular A-133, Audits of Institutions of Higher Education and Other Nonprofit Organizations. Financial assistance may take the form of grants, contracts, loans, loan guarantees, property, cooperative agreements, interest subsidies, and insurance or direct appropriations. 34.7 SOURCES AND SUGGESTED REFERENCES American Institute of Certified Public Accountants, “Health Care Organizations,” Industry Audit and Accounting Guide. New York, 1996. , “Checklists and Illustrative Financial Statements for Health Care Organizations,” 1996. 34.7 SOURCES AND SUGGESTED REFERENCES 34 57 • , “Providers of Health Care Services (Section 6400).” Technical Practice Aids, 1997. Healthcare Financial Management Association, (P&P Board Statements and Issue Analyses are available from HFMA at 1-800-252-4362, ext. 420.) “Accounting and Reporting for Agency Relationships,” Principles and Practices Board Statement No. 5. Westchester, IL, 1983. , “Accounting and Reporting by Institutional Health Care Providers for Risk Contracts,” Principles and Practices Board Statement No. 11, 1989. , “Valuation and Financial Statement Presentation of Charity Service and Bad Debts by Institutional Health Care Providers.” Principles and Practices Board Statement No. 15, 1993. , “Classifying, Valuing, and Analyzing Accounts Receivable Related to Patient Services.” Principles and Practices Board Statement No. 16, 1993. , “Assessments and Arrangements Similar to Taxes on Tax-Exempt Institutional Health Care Providers,” Principles and Practices Board Statement No. 17, 1994. , “Public Disclosure of Financial and Operating Information by Health Care Providers,” Principles and Practices Board Statement No. 18, 1994. , “Transactions Among Affiliated Entities Comprising an Integrated Delivery System,” Principles and Practices Board Statement No. 19, 1995. , “Healthcare Mergers, Acquisitions, and Collaborations,” Principles and Practices Board Statement No. 20, 1997. , “Acquisitions of Physician Practices,” Principles and Practices Board Issue Analysis No. 95-1, 1995. , “Assessing Managed Care Contracting Risk,” Principles and Practices Board Issue Analysis No. 971, 1997. Financial Accounting Standards Board, “Application of FASB Statement No. 94, Consolidation of All MajorityOwned Subsidiaries, and APB Opinion No. 16, Business Combinations, to Physician Practice Management Entities and Certain Other Entities with Contractual Management Arrangements,” EITF Issue No. 97-2. Norwalk, CT, 1997. , “Accounting for Contributions Received and Contributions Made,” Statement of Financial Accounting Standards No. 116, 1993. , “Financial Statements of Not-for-Profit Organizations,” Statement of Financial Accounting Standards No. 117, 1993. , “Accounting for Certain Investments Held by Not-for-Profit Organizations,” Statement of Financial Accounting Standards No. 124, 1995.