They want you to analyze the financial feasibility of either building an ambulatory orthopedic center on a parcel of land located 31 miles northeast of the hospital near a large housing development currently under construction or adding a new wing containing 25 beds onto the hospital. The land for the new ambulatory orthopedic center is owned by the county and they have indicated a willingness to lease it to the hospital for $1 per year on a 99-year lease. On the surface, both projects appear to be sound investments but only one can be undertaken. Before deciding, the board and other stakeholders want to understand the financial consequences of the alternatives and expect a recommendation based on the analysis. The Boards Requirements The board is requesting a study covering the first 5 years of the new initiative, including construction time. At a minimum, the board seeks the NPV and IRR for each option. Detail should be calculated and presented at the annual level. Ultimately, the board is looking for your recommendation with a detailed supporting explanation. How you choose to summarize your recommendation has not been specified but the more clearly you present your findings, the better it will be received. The material should be prepared as if it will be given to the Board of Directors for their consideration and decision. Your Approach You assemble a team from your finance and administrative staff and begin by preparing a work plan showing the steps you will follow to meet the objective.

A critical early step will be to estimate cash flows (revenues and expenses) for the first five years of each alternative (including the year for construction). In addition, the team must make and document key assumptions that will be used in the analysis. After working on the problem for 30 days, the team publishes its financial projection data assumptions for comment. Once the discussions with key stakeholders have concluded, these data are finalized, and the analysis commences. The approved data is summarized in the table that follows. Note that if you believe there are assumptions missing you are free to define and use reasonable ones in your work, however they must be specifically identified and justified. Warrington Regional Hospital Financial Assumptions

For both options, assume that:

• Warrington Regional Hospital has sufficient capital to pay for either project without financing
• The discount rate (cost of capital) per year is 5.5%
• Amount billed for an occupied bed or a patient visit will not change during the operation of either alternative
• The construction and equipping phase of both projects would start and end in fiscal year 0 (the year immediately prior to starting operation)

Warrington Regional Hospital Financial Assumptions New Wing Assumptions Cost to construct and equip $11,250,000 Orthopedic Center Assumptions Cost to construct and equip $2,500,000 Months to construct and equip 12 Avg. patient visits per mo. in year 1 300 Revenue per patient per visit in year || $1,900 $69,000 $9,400 Months to construct and equip Avg. occupied beds per mo. in year 1 Revenue per occupied bed per mo. in year 1 Fixed cost per mo. Variable cost per mo. per occupied bed Annual rate of increase for all costs Annual rate of increase in the occupancy rate $46,800 $1,400 Fixed cost per mo. Variable cost per visit per mo. $850 2.5% Annual rate of increase in all costs Annual rate of increase in number of visits 2.5% 2.4% 2.3%