Marketing....4/9

FROM:Charlie Therrien
TO:Staff
SUBJECT:Common questions
March 30, 2009

As I meet with departments and individuals there are a few questions that come up that I thought I would respond to across the hospital.
Will DTO continue?
We will continue to make sure that we maintain the correct level of staff for the fluctuating level ofpatients in both the inpatient and outpatient areas, clinical and non-clinical. I understand that this creates anxiety and financial pressure during difficult times; however we are trying to reduce our expenses and avoid the elimination of positions.
Why spend money on Studer at this time?
The investment in Studer is an investment in the training and development of our people. It is consistent with our educational assistance program, CME, and other training that are all investments in the employees. The measurable outcome from all of these initiatives is to improve employee satisfaction, which drives patient satisfaction, which drives volume growth.
What is the hospital doing to increase business?
National trends indicate that people are putting off elective and non-urgent healthcare services due to the economic issues that we all are facing. In order to offset these trends we are actively pursuing strategies to grow new business. For example, we are actively working on a plan to open an urgent care center in New York, we are in the process of developing a coordinated women's health program, we have hired nurse practitioners and physician assistants to improve access to primary care services, and we continue to actively recruit more physicians to the area.
Please don't hesitate to contact me with any additional questions. Thank you very
much.

Marketing ideas, hmmmmm:

• They've tried suing me, that really helped publicize Essent.
• They've tried putting a happy employee's face on TV, extolling Essent's virtues--while laying off more staff.
• They start the bidding for another hospital, at the same time cutting managers' salaries by 10%
• They give a bonus...and pull matching retirement contributions. (Oh, yeah, that wasn't a bonus, that was retention.)

So rather than pay what they promised, they'll promise to pay.... Looks like Ducky and Charlie have been talking....

Global Internet Fire Walls

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As reported in Foreign Policy, "The List: Look Who's Censoring the Internet Now."

China and Iran have always had strict built-in fire walls for their Internet. But now, the following countries have also made the list:

• France
• India
• Argentina
• South Korea

Find out why here.

Weakening Of Other People's Currency

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The new silver lining is that American travelers, if they have the money to spend, can strike a bargain with other people's currency.

In Iceland, for example, the krona has tumbled as much as 45 percent (refer to graph). A South African safari costs some 30 percent less than it did last year. And in Estonia and the Ukraine, Americans can vacation like kings and queens.

Take a good look here.

Globalization Is Here To Stay

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Globalization is much, much more than international trade and investment. It's about connectedness and global activities.

Quick quote:

Still, the current wave of globalization has many unprecedented characteristics. As Internet access penetrates the most remote corners of the globe, it is transforming the lives of more people, in more places, more cheaply than ever before—and the pace of change is accelerating faster than we can hope to chronicle it.

Read the interesting essay (that includes the above quote) about this notion in Foreign Policy, "Think Again: Globalization."

Federal Inroads....3/28

The new announcement of the additional powers for the treasury are interesting in the extreme. Being able to determine that a business is under-capitalized---and dissolve them if it would be in the public interest. Kind of an eminent domain for business.

Now we've seen over the years how eminent domain has been abused. What makes us feel safe in our own little communities when a large developer wants our land? Never the concept of fairness.

But, let's put another spin on this ball. The Feds want inroads into healthcare. What healthcare organizations are truly financially sound? Could the Feds walk into Columbia and say, "You're insolvent, you belong to US...."? What about Essent?

Those hospitals that Essent owns impact their communities drastically if something occurs...and three hospitals are marginal. This could be a back way into healthcare.

How To Enforce Intellectual Property Rights On a Global Scale

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When it comes to global trade, intellectual property rights is a hot topic that causes great concern because it can slow down development efforts. It boils down to this question: How do we regulate our global knowledge economy?

Read how Carsten Fink thinks we should handle this at the International Centre for Trade and Sustainable Development (ICTSD) under:

The Global Debate on the Enforcement of Intellectual Property Rights and Developing Countries.

Or go straight for the gold by downloading PDF report (1.05 MB) here.

Note: I had a problem attempting to download report ...

On-line IP Tagging....3/30

The neat little trick that Essent used to pick up my IP address is the same one that can bite your butt.



If you go from this site to the Essent site to check your paystub without totally dumping out of your browser, it will show up that you were 'logged to the blog.' And, they'll have your IP along with your employee number.



Can we spell pink-slip?



Also, if you've been cruzin' through their websites looking for neat quotes and stuff, they already have your IP, just matching it to a name is what they want to do.



So, how does one find anonymity? Laptops from a hotspot, check your stub at work, or from the library. There are also ways to shed that nasty IP. More on that, later.



And, if they really push the issue, how secure is your computer? Who has access to it? I'd imagine several people, so it might not have been you at all.

Don't Rule Out Globalization

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What are the implications for global trade during the economic downturn?

The answer from McKinsey digital folks is here.

Thinking Of Taking Your Business Global?

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You've come to the right place! Just finished the LIVE event for the Small Business Online Community (powered by Bank of America). Here are some of the questions I addressed:

• Can you talk about tips related to container shipping? Also, sometimes I do not have enough merchandise to fill one container, how can I find a partner to share costs?

• How do you go about establishing a relationship with an international merchant? I was traveling and came across some innovative products that would do well in the U.S. Also, what legal or tax related issues are there with shipping goods from overseas to the U.S.?

• When do you know if it's right for your business to expand into other countries? What advantages are there?

• I would like to start a small business. What’s your advice?

• How does globalization impact neighborhood businesses? Do small neighborhood businesses like restaurants, barbershops, local retailers, etc. need to be aware of globalization? How does international trade affect those kinds of businesses, and how can an awareness of global issues make them more successful?

• Are there certain countries that are easier to export to? Why?

Find out the answers here.

Facebook Makes the World Smaller

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International growth for Facebook has been organic, especially when users are willing to do the translation. Read more here.

USA Scores High on Entrepreneurship

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The United States of Entrepreneurs still leads the way on entrepreneurship. Read the special report in The Economist.

Small Business Can Be Borderless

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Remember when E.F. Schumacher wrote the classic Small is Beautiful? I think about that all the time now with small businesses going global. One of Schumacher's philosophies was: "Why use the computer if you can make the calculation on the back of an envelope."

If he were to revise his book today, he might offer this: "Why remain local with a business if you can easily go global?"

Apparently Dan Brutto thinks along the same line with his commentary over at Forbes entitled, Small Business, Big World. which is about how international clients can keep a company buoyant in tough times.

Here's one of his comments:

Clearly, entrepreneurs are recognizing the benefits of trade, and we should do what we can to help them harness the power of trade to grow their businesses.

Going Global With Your Small Business

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Please join me tomorrow, March 24, from 1:00-2:00 p.m. CDT for an open, online global small business "live" forum, on Going Global With Your Business.

I will address questions like:

• What is the single biggest stumbling block to taking a business global?
• How do I find the right international partners?
• Why should I go global?
• How do I evaluate the benefits and risks with expanding my business abroad?
• What advice would you offer to those of us considering expanding our business internationally?

My intent is to empower you to take that first dramatic step toward starting your own business and taking it global from the get-go. And we hope to make going global easy.

Register (complimentary) here and post your questions now or "live" during the event.

Hope to connect with you there. Look forward to it!

What Does Essent Want?....3/30

So, Essent is bucking the trend. They're back in a buying mode? They have free capital to invest, or their backers are so enamored with what they've done so far that they're willing to advance more money?



Someone has done some fast talking.



So, what should they look for? A hospital that has just completed major renovation, facility and equipment. One that has a monopoly in an area that has a heavy percentage of insured patients. One that is concentrated in one location (campus) with room to expand. One that is in a right-to-work state. And, last but not least, one whose finances are in the toilet.



They keep trying to buy publicly owned hospitals, but that's because they can off-load the debt to the community. (Look at previous purchases.)



Natchez was probably a less than optimal choice. There were two campuses. (They wanted to buy two hospitals there, two sellers.) Jackson would have been a better area, but neither area is great.



Could it be that the role of Essent was going to be merely that of landlord? The vaunted management skills not put to use? That would be rather telling as well. Maybe the tenant was directing this one.

Feathers....5/29

Heard some dept managers were urging their folks to send Ducks a thank you card "as they didn't have to do this." Did they or didn't they??

Send him a cookie. Being "urged" to send a thank-you card is classless at best. Ooops, I forgot, it's Duckers here.

Show some love to da Duck, lest ye find thy head on the chopping block next time. Kiss the Duck's butt, and never mind the feathers in your mouth.

Waiting For The Fed To Boost Global Small Business

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The Fed's long-awaited program to revive consumer and small business lending, the Term Asset-Backed Securities Loan Facility (TALF), got off to a slow start.

Learn more with the appropriate title of: Global Markets: Dollar rebounds as markets see-saw on the Fed move.

More on small business boosts here.

Share What You Know With The World

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Here at our blog (borderbuster.blogspot.com), we do a lot of sharing about what we know on going global but maybe you need a special place to strut your stuff to get more business worldwide.

Have you tried Moontoast -- where the world comes together to share knowledge, experience and expertise by actually talking to each other?

I haven't tried it yet but the concept sounds interesting. Check it out and let us know what you think.

Global Entrepreneurs Lead The Way

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Can our world problems be solved by global entrepreneurs? I'd like to think "yes." The dean of EMLYON Business School, in Lyon, France explains the importance of entrepreneurial leaders and the 10 pitfalls they must avoid.

Read all about it here.

Full disclosure: The reference to the World Entrepreneurship Forum at EM Lyon is the forum I attended in November where I had the great pleasure to meet Johan Stael von Holstein, founder of the global business incubator, IQUBE.

Twitts To The World

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Live Twitts all over the world: twittearth

Wherever you are, Twitter me here.

Top Of The Morning To Everyone Worldwide

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This is one of my favorite days of the year (my Dad is Irish -- from Ballyhaunis, County Mayo, Ireland -- and my Mom is Dutch/Swedish). The first thing I did this morning was to call my parents and wish my Dad his best day ever (85 years young and he said he was wearing the "Kiss Me I'm Irish" cap I gave him over the weekend; my Mom has her work cut out for her!).

Celebrate your global entrepreneurial and fighting-Irish spirit with the following Irish blessing:

May all the days
of the rest of your life
be the very best
of your life.

Enjoy and Happy St. Patrick's Day!

And Twitter me at http://twitter.com/laureldelaney to let me know how you are celebrating.

Born to Innovate

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Latest findings from Intuit and Emergent Research on Defining Small Business Innovation indicate, among many things, that key characteristics play a role in truly innovative companies:

• Small business owners are born (natural) innovators and their inspiration or motivation is driven by three needs: necessity, opportunity and ingenuity.

• Six innovation enablers that allow small businesses to more readily identify opportunities, quickly react to changing conditions and remain competitive. They include personal passion, customer connection, agility and adaptation, experimentation and improvisation, resource limitations, information sharing and collaboration.

• A small business’ ability to innovate is also amplified by use of technology, access to capital, fostering a culture that values experimentation and building market knowledge. Government regulation can also spur or rein in innovation.

What happens when small businesses innovate? It not only improves the business and lifestyles of small business workers, it can also alter the overall marketplace through two types of outcomes:

1. Market-sustaining -- improvements to existing products or business processes
2. Market-changing -- shift in competitive landscape

Our friends and colleagues over at Emergent Research write these reports with support from Intuit and the research is filled with insightful ideas.

Read the latest Intuit Future of Small Business Report (part of an ongoing series) here. And we can't help but mention in our Global Small Business Trends 2009 report that "disruptive innovation" will be both the coolest and hottest new growth strategy in 2009 because it will transcend all boundaries and transform businesses.

Travel Smart With A Girls' Guide To The World

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Sure, it is called the Girls' Guide to the World (www.girlsguidetotheworld) but that doesn't mean that everyone can't get something out of it.

Girls' Guide to the World is a cool boutique travel site connecting like-minded travelers around the globe that provides unbiased and insightful tips from a travel community with high expectations and a craving for fashionably experiencing the world.

At the same time, they support Women for Women International’s effort to help change the lives of women who are survivors of war, civil strife, and other conflicts.

Get involved. Make a trip. Sign up for their newsletter. Check it out here.

Everyone Is Irish On St. Patrick's Day

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In celebration of St. Patrick's Day Tuesday, Chicago traditionally dyes the Chicago River a bright emerald green (as pictured) which they did this morning.

The annual parade is taking place as I write this (3/14/09 at 1:25 p.m. CDT) and rest assured, with a name like Delaney (from Ballyhaunis, County Mayo, Ireland) ... I am wearing every green item I own.

Promoting Entrepreneurs In Emerging Economies

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Endeavor focuses on High Impact Entrepreneurs (HIE) which are entrepreneurs with the biggest ideas and the most ambitious plans.

The impact could be social, economic or environmental, and Endeavor usually looks for a combination of these in a business they select. HIEs have the potential to create thriving companies that employ hundreds or even thousands of people, and generate millions in wages and revenues.

Learn about who they are currently promoting here. redBus is one company.

Word-of-Mouth Global Marketing

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Getting customers to spread the word about a new product through their global social or professional networks is a hot strategy in the marketing world.

But how do companies find the right individuals to deliver the message? New research by Wharton marketing professors Raghuram Iyengar and Christophe Van den Bulte finds that traditional targets may not be so influential.

The global buzz starts here.

News from Natchez....3/13

From the Natchez Democrat:

Potential buyer backs out of deal to buy Natchez Regional
By Julie Cooper (Contact) The Natchez Democrat

Originally published 11:32 a.m., March 11, 2009
Updated 11:37 p.m., March 11, 2009

NATCHEZ — Natchez Regional Medical Center’s would-be buyer has backed out of the deal, reportedly citing poor economic conditions.

Essent Healthcare of Tennessee has been in negotiations with NRMC since November but told CEO Scott Phillips late Tuesday night that the deal was off.

Phillips said, ultimately, Essent was concerned with the risks of taking on a new property in the current economy.

The company reportedly wanted to purchase Natchez Community Hospital and partner with Oschner Health System of New Orleans to manage both facilities. Essent was unable purchase Community, a factor that also hurt the NRMC deal, Phillips said....

Sweet Deals Are Being Done Globally

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Hershey Co. agreed to buy Barry Callebaut AG's Van Houten consumer chocolate business in Asia (Singapore), an acquisition that would give the U.S. candy maker a greater presence overseas as its seeks to diversify its mainly domestic operations. Barry Callebaut is considered the world's leading manufacturer of high-quality cocoa and chocolate products

The deal with Barry Callebaut may also signal a willingness by Hershey to continue to grow abroad via similar pacts

Read more here. Barry Callebaut news release here.

China to Open Up Role in Trade

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China may soon allow Chinese trading companies to buy and sell merchandise internationally using yuan, a step that would move one of the world's largest trading countries closer to having a fully convertible currency.

Read more here.

In The Black....3/13

Interesting that for the year that they make $3.8M plus, they pull the matching 'discretionary' funds.

PRMC*****************255beds $3,824,649
SWMC******************73beds -$464,815

SWMC is the only other hospital that's been updated, so far, but it's had some significant improvement.

So, it might take some wind out of my sails, but my questions are these:

• What were the results on MVH and NVMC?



• While a profit is important (keeping the doors open is very important), was the pain that the community--patients as well as staff--worth it?



• We noted that several functions were not moving. Are they now? Psych, Wound Care?



• Are the cuts in matching funds now going to be made up?



• Are there going to be more staff cuts when the move happens?



• Are the other upgrades in equipment needed at the North Campus going to be made on a timely basis?

Or is the negotiation for Nachez Community and Natchez Regional going to slow things a bit. Only time will tell.

Peregruzka, er, Perezagruzka

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Secretary of State Hillary Clinton experienced a global gaffe when she presented a gift to Russian Foreign Minister Sergei Lavrov that was intended to display the Russian word for "reset" -- having to do with Vice President Joe Biden's light-hearted comment that the U.S. wants to "reset" relations with Russian.

The gift read "peregruzka." Mrs. Clinton said, "We worked hard to get the right Russian word. Do you think we got it?"

Lavrov answered, "You got it wrong." Peregruzka means "over-charged," he explained. "Reset" is "perezagruzka." Needless to say, the U.S. officials said they would correct the gift.

Now, my advice to all of you who are in the translation business? Contact the White House and get to work!

Read more here.

Natchez on the Essent....3/9

It's been what, three years, since Essent has seriously gone after a hospital? Maybe not quite that long.

Anyway, Natchez Regional Medical Center, Natchez, MS, is in the sights this time. They lost $2M, so the company they keep won't awe them. 179 beds.

And, they might have a not-for-profit management team. Funny how that works out. They might have a better chance of making the black on their financial chart in that case. Or, it could be like Presby here.

It would appear that the after-hours clinic is on the same vein as Dr. Salas.

See, Greg, you jumped ship too soon. Essent might actually get one! Something about a blind squirrel....

The Wisdom of Bloggers on the Economy

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The first-ever Economics Bloggers Forum at the Ewing Marion Kauffman Foundation was held last week. The experts shared perspectives on the business of blogging and the most pressing topic of the day: the economy.

A couple of the questions asked:

• What is your blog's business model?

• What has been the personal impact of your blogging?

• What 1-3 blog posts have you written of which you are particularly proud?

Learn more (immediate download of 40-page PDF file):

Read The Wisdom of Economic Bloggers: Blogger Survey Summary

And here's a good listing of all the people who contributed to the report along with their blog links. Not too much of a global focus but it's a start.

Pay to Stay....3/21

The latest from the 'town meetings':

Well I heard that at the Town Hall Meeting everything is sunshine and roses--so good in fact that Ducky & Co are going to pay out a bonus to employees. (Apparently they 'set aside' some funds from the 2008 budget for this--could it be the matching funds for 401K?) Bonuses are expected to be between $200 and $4000 dollars based on full or part-time status and number of quarters worked. They may have to 'break up' some payments. The first installment is to be doled out on Friday, March 13th (how auspicious!)

Most employees are skeptical. Will it really happen? 4K seems like a lot to dole out to that many full time employees....

And is this bonus because Essent finally cares about its employees or is it an effort to stem the flood of exiting staff?

There must have been some serious doubts in Essent's retention figures, possibly voiced by a comment a bit ago:

I don't know if it even matters anymore...... Several nurses that I have spoken with are just waiting for the temporary, transition-related hiring freeze at Greenville and the other new Baylor facilities to end, then adios!

This makes sense when you put it in the context of what Christus tried, so many years back, but they labeled them retention bonuses. Now, that would be admitting to a problem. Hardly an Essent virtue.

Doing Business in the U.S., Canada or the U.K.

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It's not too early to starting thinking about how to move or store product during the holiday selling season (as noted in picture) -- especially if you decide to sell in the U.S., Canada or the U.K. Here's a success story shared by a reader:

Shipping and warehousing is one area that is essential to accelerating business growth, and simultaneously can be a drain on financial and time resources. The time-suck and hassle of shipping takes away from the other roles that business owners are more adept at—such as marketing, sales or business development. By re-evaluating shipping and logistics processes and leveraging Web-based innovation, businesses can take a hands-off approach, encourage sustainable growth and uncover hidden savings.

Marc Blaiwes, co-owner of car seat cover e-commerce company SeatGlovers, did what many smart entrepreneurs in today's climate should--he found a niche product with an untapped market and focused his energies. However, the sales success that followed was too much to handle. Marc needed to expand his warehouse, but the added costs threatened his profit margins and would have required product price increases. "Large companies play the expansion game all the time by building out storage and inventory and eating the added costs until business catches up," said Blaiwes, "Small businesses just don't have that luxury. That's why we needed Shipwire--to help us manage the double-edged sword of business growth."

"Shipwire is granting us immunity to all the flux in the market," said Blaiwes. "Shipping was a huge hassle for years, and it prevented me from growing my business. Finding Shipwire was as big for my business as selling on eBay and sourcing with Alibaba. We're growing exponentially and I'm realizing the true potential of my business. All of this at a time when many other merchants are just trying to stay afloat. Talk about a competitive advantage"

And Shipwire CEO Damon Schechter believes the way to scale and grow a business internationally is to get the product warehoused closer to local buyers.

More on Shipwire here (they offer a free, no obligation trial). Locations and shipping calculator that demonstrates cost advantages here.

Thanks to UPS, eBay PowerSellers in Hong Kong Get Even More Muscle

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What do UPS and eBay in Hong Kong have in common? More than you realize. They just announced a partnership to offer enhanced shipping solutions to select eBay users in Hong Kong. eBay PowerSellers based in Hong Kong can now use a UPS proprietary online shipping solution (http://go.ebay.com.hk/shipping) that improves business efficiency and enhances their reliability as vendors.

According to a 2008 global survey conducted by The Nielsen Company, over 85 percent of the world’s online population shop online, up 40 percent from 2006. More than half of all Internet users are regular online shoppers who make online purchases at least once a month.

Visit the shipping solution here (available in English and Chinese). Go connect with customers worldwide and transform your desktop into a virtual shipping centre.

Lead Fearlessly Into the Future

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Just posted, "For Advice That's Never Stale, Pick Up a Classic Business Book," over at the OPEN Forum by American Express OPEN.

During a time of such unprecedented economic turmoil and change, lately I find myself visiting my trusty (and dusty, I might add) in-home library of business books, looking for answers and timeless wisdom from influential authors who just might be capable of leading us fearlessly into the future.
Out of hundreds of books to choose from, here are five that deserve a spot in any collection of business classics. I’ve summarized the insightful advice I took away from the authors, all business visionaries who helped transform the world with their genius. You will find that most of the advice is more timely, practical and relevant than you could possibly imagine considering today’s global economic climate.

Check it out.

Puffin' Up....3/7

Mike Browder (CEO, Essent) was interviewed for Hospitals & Health Networks recently:

Essent Healthcare’s Browder is also optimistic. Despite a drop in 2008 inpatient admissions and a 6 percent jump in bad debt, elective procedures have not yet declined, and the for-profit system’s regional diversification—with five hospitals spread between Texas and New England—has helped keep it on firmer financial ground than competitors, Browder says. In addition, Essent recently invested heavily in infrastructure, completing three major building projects. That means it won’t need to borrow large amounts of capital anytime soon.

So, being of an inquisitive nature, I wondered how the hospitals that were worried were doing. Since the only thing I can really pull from and have it publicly verifiable, I chose AHD.com. The president of Florida Hospitals in Orlando worried about donations, but they also posted a $137M profit during the same period that Essent lost $6M and PRMC lost $508,231.

OK, says I, how is ETMC-Clarksville doing, in the same period. Should be far worse than Paris--Clarksville has even a worse pay mix than here. ETMC made $902,309. Funny, it had the same profit level (percentage) as Florida Hospitals.

I'd look up Bonham, but with the physician group buying them, it's too new. Under the old management, it lost almost $1M. But, then again, it was sold....

Are You To Be Found on the Web?

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If you are trying to get and keep customers worldwide, you better have a global Web presence. After all, 95 percent of the world's population resides outside our North American borders and only about 17 percent percent of the world's Internet users live in North America. The balance of online folks are overseas.

Take a look for yourself (above) and right here at the World Internet Usage and Population Statistics. The greatest concentration appears to be in Asia with Europe following .