DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health
Resources and Services Administration
BUSINESS
PLAN
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FOR HRSA USE ONLY
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Grantee Name
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Application Tracking Number
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Budget Period Date
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Focus Area: Costs
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Performance Measure:
Total
cost per patient
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Total accrued cost before
donations and after allocation of overhead
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Denominator Description
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Total number of patients
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Costs
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Performance Measure:
Medical
Cost per Medical Visit
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Total accrued medical staff
and medical other cost after allocation of overhead (excludes
lab and x-ray cost)
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Denominator Description
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Non-nursing medical visits
(excludes nursing (RN) and psychiatrist visits)
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Financial
Viability
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Performance Measure
Description: Change
in Net Assets to Expense Ratio
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Ending Net Assets - Beginning
Net Assets
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Denominator Description
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Total Expense
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Financial
Viability
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Performance Measure:
Working
Capital to Monthly Expense Ratio
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Current Assets - Current
Liabilities
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Denominator Description
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Total Expense / Number of
Months in Audit
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Financial
Viability
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Performance Measure:
Long
Term Debt to Equity Ratio
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Long Term Liabilities
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Denominator Description
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Net Assets
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Other
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Performance Measure:
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Denominator Description
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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