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Healthcare
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Volume 1

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Healthcare
Valuation

Volume 1
The Four Pillars of Healthcare Value

Robert James Cimasi

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Library of Congress Cataloging-in-Publication Data
Cimasi, Robert James.
  The four pillars of healthcare value / Robert James Cimasi.
   volumes cm.—(Wiley finance series)
 Includes index.
 ISBN 978-1-118-83297-4 (2 vol. set)—ISBN 978-1-118-29279-2 (vol. 1: cloth)—
ISBN 978-1-118-83291-2 (vol. 2: cloth)—ISBN 978-1-118-33173-6 (epub)—
ISBN 978-1-118-33402-7 (epdf)  1.  Medical care, Cost of—United States.
2.  Health insurance—United States.  3.  Health care reform—United States. I. Title.
 RA410.53.C56 2014
 362.10973—dc23
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1

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Dedicated to my wife,
Laura M. Baumstark, MBA, CAE

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Contents

Forewordxi
Prefacexiii
Acknowledgmentsxxiii
About the Author

xxv

Disclaimerxxvii

Volume 1
Introduction1
Chapter 1:
The Chronology of U.S. Healthcare Delivery:
From Caduceus to Corporatization
Chapter 2:
Reimbursement Environment
Chapter 3:
Regulatory Environment

5
85
261

Chapter 4:

Competition465
Chapter 5:
Technology531
Chapter 6:
Healthcare Reform

631

vii

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viii

Contents

About the Companion Website

675

Index677

Volume 2
Introduction1
Chapter 7:
Basic Valuation Tenets
Chapter 8:
Valuation Approaches and Methods
Chapter 9:

Costs and Sources of Capital

5
39
175

Chapter 10:
Planning and Process for Healthcare Valuation
Engagements215
Chapter 11:
Inpatient Enterprises

271

Chapter 12:
The Valuation of Outpatient Enterprises 

405

Chapter 13:
The Valuation of Other Healthcare-Related Enterprises

605

Chapter 14:
The Valuation of Tangible and Intangible Assets

709

Chapter 15:

Healthcare Services

863

Chapter 16:
The Threshold of Commercial Reasonableness

929

Epilouge

975


Contents

ix

Appendix: Subject Property Interest

979

Bibliography

983

Glossary

1061


About the Companion Website

1085

Index1087



Foreword

T

his comprehensive book traces the structure and economies of the
­healthcare system in the United States from its origins through the p
­ resent
day, as the foundation for the financial appraisal of healthcare enterprises,
assets, and services.
It is based on exhaustive research and the 20-plus years of experience of
Bob Cimasi’s firm, Health Capital Consultants (its library holds over 50,000
books, papers, etc.). The book is heavily documented—the first chapter
alone has more than 300 footnotes, and the second, more than 650!
While Bob is one of the most incisive authors covering the healthcare
system, he is at the same time one of the system’s harshest critics. For example, he makes reference to “the falling rank of U.S. health status as c­ ompared
to other developed nations,” and
The last two decades have seen the accelerated transformation of the
U.S. healthcare professions into a service industry enterprise, whereby
health services have been unitized, protocolized, and homogenized,
in order to facilitate their sale in the market, just as if they were any
other fungible market commodity, e.g., soybeans and pork bellies.
Note his frequent use of italics for emphasis, so that the reader can

almost hear him speaking.
His chapter on technology gets into the value drivers of management
technology, as well as what we more conventionally think of as scientific
technology. For example, he offers statistics on the rise in the incidence,
complexity, and cost of both Electronic Health Records (EHRs) and the
new version of the International Statistical Classification of Diseases and
Related Health Care Problems (ICD). Originally established in 1893, the
ICD is scheduled to implement its tenth revision, ICD-10, in 2014, which
will increase the number of procedure codes from 4,000 to 72,000 and
­diagnostic codes from 14,000 to 69,000.
Bob Cimasi introduces a lot of healthcare industry–specific acronyms,
(e.g., ACA for Affordable Care Act) and defines each acronym the first time
it is used, but most often not subsequently, so readers need to pay attention
to the sidebars of key terms included in each chapter and the acronyms

xi


xii

foreword

appearing at the end of each chapter (as well as the Glossary found in Volume 2) so that they don’t get lost in the sea of acronyms, which are seemingly endemic in healthcare.
As a layman with respect to healthcare, I was surprised and impressed
with the recent developments in clinical technology, both diagnostic and treatment, that Bob summarizes in his extensive chapter on healthcare technology.
He liberally sprinkles illustrative tables, charts, and graphs where
­applicable throughout the text. These are often quite helpful to the reader to
give more detail or a more lucid feeling for what the text is saying.
Prior to the chapters on the valuation of specific types of h
­ ealthcare

entities, there are three excellent general chapters on valuation in Volume 2,
“Basic Valuation Tenets”; “Valuation Approaches and Methods”; and “Costs
and Sources of Capital.” These comprehensive chapters delve into more
detail than I perceive the average reader may need to know, so I believe
that the average reader can skip over some of the more esoteric parts of
these chapters without losing the central essence of them, while the more
advanced professional may seek to focus on this robust content.
The several chapters on the valuation of specific types of healthcare enterprises, services, and their various tangible and intangible assets demonstrate
Bob’s insightful knowledge of the healthcare industry and its components.
For each major category of enterprises within the healthcare professions, he
explains the nature, value drivers, and relevant trends of each subcategory,
from hospitals to various types of clinical and nonclinical services.
For example, in the chapter on valuing inpatient enterprises, he points
out that for hospitals, both capacity and occupancy rates are among the
value drivers, and he provides a table of average occupancy rates by ownership category and size from 1975 through 2009. He gives a useful chart
of other variables to consider and another convenient chart of sources of
benchmarking data for these variables.
Readers should not delude themselves into believing that they will
become instant experts in healthcare valuation. This is not a “how to” book.
However, it provides both breadth and depth of detailed understanding into
many specialties within the healthcare field, for both facilities and services.
At this time of the greatest evolution in the history of healthcare valuation,
it provides both exhaustively researched information and keen insight into
value drivers and trends in most aspects of the healthcare field. It is a monumental contribution to the literature about the valuation of the healthcare
industry and the medical profession.
Shannon Pratt, CFA, FASA, MCBA, ARM, ABAR
Shannon Pratt Valuations, Inc.
Portland, Oregon




Preface

The great thing in this world is not so much where we stand, as in
what direction we are moving.
—Oliver Wendell Holmes

T

his year marks my thirtieth as a healthcare appraiser and the twentieth
anniversary of Health Capital Consultants (HCC), the consulting firm I
started in 1993. During that period, I’ve witnessed and experienced unprecedented change in both the healthcare industry and the valuation profession, as described in the following sections.

The Changing Healthcare Industry Paradigm:
The Corporatization of Medicine
The corporatization of medicine and the rise of for-profit healthcare have
replaced the cottage industry of Marcus Welby–physician practices and the
small community hospitals that were prevalent at the start of my career. The
last three decades have seen the accelerated transformation of the medical
professions into U.S. healthcare service industry enterprises, whereby healthcare services have been unitized, protocolized, and homogenized, in order
to facilitate their sale in the market, just as if they were any other fungible
market commodity, little differentiated from soybeans and pork bellies. This
new healthcare delivery paradigm has accelerated alongside the corporatization of medicine, as demonstrated by the increase in large hospital systems;
the retreat from private practice of medicine to employed physicians; and
the consolidation of payors by large, for-profit health insurance firms.

Changes in the Enterprises, Assets, and Services
Subject to Appraisal and Scope of Engagement
This changing paradigm has resulted in an evolving array in the types of
enterprises, assets, and services that are subject to being appraised. As

the complexities associated with healthcare transactions have increased

xiii


xiv

Preface

s­ignificantly, there has been a simultaneous increase in the opportunities
available for the business valuation profession in scope and diversity arising
from the growing demand for analysis related to both Fair Market Value
and commercial reasonableness opinions for pending transactions. There
will inevitably be fewer engagements focused on appraising solo and small
group medical practices, as the healthcare industry consolidates, and greater
numbers of physicians and other providers form larger organizations based
on new emerging models of organizing the delivery of care.
These emerging healthcare organizations (EHOs) will continue to be
driven by the need to develop new affiliations, capital structures, and governance configurations, in order to align the interests of patients/­consumers
with the various U.S. healthcare industry subsectors, including inpatient and
outpatient providers; payors and managed care entities; and suppliers and
vendors, in such a manner as to address the emergence of value-based reimbursement initiatives focused on both lowering costs and improving quality.
These factors have necessarily also changed the scope of appraisal assignments, with an increasing volume of appraisals focused on property interests
other than at the total enterprise level, and more emphasis on discrete property interests and services, as well as more focused attention on the highest
and best use concept and the selection of the appropriate premise of value,
that is, either value in-use as a going concern or value in-exchange. Given
these complexities, the opportunities for additional c­ollaboration among
the various appraisal disciplines, such as business valuation, intangible
assets and intellectual property, real estate, and machinery and ­equipment
and personal property, have never been greater.


Capital Market Changes: Availability of Capital and
New Financial Instruments
Changes in the capital markets related to both the availability of capital
sources and the types of financial instruments used in financing healthcare
transactions, particularly in recent years following the Great Recession,
have transformed the way that healthcare providers, as well as the healthcare
transactional marketplace, operate.1 Neither healthcare enterprises nor the
capital markets in which they operate, exist within a vacuum. Wide-ranging
factors have an impact on the global and national economy and reverberate
through markets, affecting the functioning of capital markets in healthcare,

1 As with other industries, healthcare was dramatically affected during the difficult
years following the collapse of the capital markets from 2007 through 2009.


Preface

xv

as well as in other industries. The effects of the economic downturn of the
Great Recession included a dramatic retraction in the availability of capital,
as well as the imposition of strict lending conditions on those few credits that
were being granted, even for stable and profitable healthcare enterprises.2

Changes in the Valuation Literature and Education
The valuation profession has also progressed significantly during the last
three decades. When I first began my appraisal education in the late 1970s,
the availability of business valuation literature related to the appraisal of
closely held enterprises was virtually nonexistent, with only a few seminal

interdisciplinary valuation works, for example, Taussig’s Principles of Economics (1918), Bonbright’s The Valuation of Property (1937), and Babcock’s
Appraisal Principles and Procedures (1968), with most other authoritative
texts relating only to real estate appraisal and corporate finance.3 However,
starting in the 1970s, several books began to address (albeit slowly) the
appraisal of other closely held businesses and business interests.4 During the
next two decades, several additional texts related to appraising closely held
business enterprises were published, including:
1977: How to Price a Business: A Special Report by Raymond C. Miles;
1981: Valuing a Business by Shannon Pratt;
■■ 1984: 
Basic Business Appraisal by Raymond C. Miles; and
■■ 1987: 
Appraisal and Valuation: An Interdisciplinary Approach by
Richard Rickert.5
■■
■■

2 
Gary S. Becker, “The Great Recession and Government Failure,” Wall Street Journal, September 2, 2011, />4576536930606933332.html (accessed April 26, 2012).
3 
F. W. Taussig, Principles of Economics (New York: Macmillan, 1918); James C.
Bonbright, The Valuation of Property (New York: McGraw-Hill Book Company,
1937); Henry A. Babcock, Appraisal Principles and Procedures (Washington, DC:
American Society of Appraisers, 1989).
4 
For example, McCarthy and Healy’s Valuing a Company, published by John Wiley
& Sons, in 1971, devoted just four pages to valuing professional practices and
services companies.
5 
Raymond C. Miles, How to Price a Business: A Special Report by Raymond C.

Miles (Englewood Cliffs, NJ: Institute for Business Planning, 1977); Shannon P.
Pratt, DBA, CFA, CFP, ASA, Valuing a Business (Homewood, IL: Dow Jones-Irwin,
1981); Raymond C. Miles, Basic Business Appraisal (New York: John Wiley & Sons,
1984); Richard Rickert, Appraisal and Valuation: An Interdisciplinary Approach
(Washington, DC: American Society of Appraisers, 1987).


xvi

Preface

Beginning in the 1980s, the cannon of professional valuation literature
related to appraising professional practices, including medical practices,
began to emerge, including such titles as:
1980: How to Value Professional Practices by Glenn Desmond;
1981: Valuing a Medical Practice by the American Medical Association;
■■ 1986: Valuing Small Businesses and Professional Practices by Shannon
Pratt;
■■ 1987: New Trends in Dental Practice Valuation and Associateship
Arrangements by James Jackson and Roger Hill;
■■ 1988: Selling the Medical Practice by Madeleine Pelner Cosman;
■■ 1989: Understanding the Valuation of Medical Practices by James
Unland;
■■ 1990: Valuing Professional Practices by James Horvath; and
■■ 1991: Financial Valuation of Your Practice by Linda Ginsburg.6
■■
■■

Since that time, there has been a flurry of books and peer-reviewed journal articles, as well as academic research sources and industry newsletters,
related to the various aspects of financial valuation, including the application of cost of capital, tax affecting, and discounts for lack of marketability

to the valuation of closely held businesses and professional practices. Today,
there are now excellent treatises and other authoritative texts and sources
related to those aspects of financial valuation, as well as benchmarking and
forecasting in both the transactional and litigation support arenas.
While healthcare financial appraisal literature has grown exponentially
in the last 10 years, its very availability and the volume of information
present a challenge to all professional consultants working at the forefront
of this competitive healthcare industry. Simply stated, how do we find the

6 
Glenn M. Desmond, How to Value Professional Practices (Los Angeles: Valuation
Press, 1980); Valuing a Medical Practice (Monroe, WI: American Medical Association, 1981); Shannon Pratt, DBA, CFA, CFP, ASA, Valuing Small Businesses and Professional Practices (Homewood, IL: Dow Jones-Irwin, 1986); James B. Jackson and
Roger K. Hill, New Trends in Dental Practice Valuation and Associateship Arrangements (Chicago: Quintessence Publishing, 1987); Madeleine Pelner Cosman, Selling
the Medical Practice (Tenafly, NJ: Bard Hall Press, 1988); James J. Unland, Understanding the Valuation of Medical Practices (Chicago: Health Capital Group, 1989);
James L. Horvath, Ca, CBV, ASA, CCH, Valuing Professional Practices (Canadian
Limited, 1990); Linda G. Ginsburg, Financial Valuation of Your Practice (Los
­Angeles: Practice Management Information Corporation, 1991).


Preface

xvii

time to sort through an accelerating ocean of information and data, select
what is relevant, analyze it, and report it to our clients in a comprehensible,
timely, and cost-effective manner? I addressed these challenges in my career
by making a commitment to act on behalf of those providers who lacked
the resources to adapt to change quickly enough to effectively compete in
today’s intensely competitive and dynamically turbulent market. Toward
that end, the development of a disciplined healthcare finance and economics

research staff and library resource was established as the focus of the core
services that HCC delivers to its clients.

Change in Valuation Profession Standards
Valuation standards and codes of ethics have also evolved during the last 30
years, concurrent with the development of professional business valuation
designations by the American Society of Appraisers, the Institute of Business
Appraisers, the National Association of Certified Valuators and Analysts,
and the American Institute of Certified Public Accountants. The emergence
of these various groups in promulgating standards has sometimes presented
the appraisal community with conflicting valuation standards—perhaps
due, in part, to changes in accounting concepts and procedures, for example, International Financial Reporting Standards (IFRS) versus Financial
Accounting Standards Board (FASB) pronouncements.
More recently, the International Valuation Standards Council (IVSC)
and other groups, building on the previous efforts of CLARENCE to develop
the international glossary of business valuation terms, and the National
Association Business Valuation Standards Council, which attempted to harmonize the standards of various appraisal organizations, have made efforts
to consolidate professional standards. The issuance of judicial gatekeeping
authority regarding expert witness testimony emanating from Daubert v.
Merrell Dow Pharmaceuticals, Inc., decided by the U.S. Supreme Court in
1993, superseded the Frye (1923) standard in federal courts regarding the
admissibility of scientific expert testimony, and in 1999, the Kumho Tire v.
Carmichael case held that Daubert’s factors should be extended to apply
to nonscientific expert testimony, thereby setting additional thresholds and
standards for appraisers.7

7 Frye v. US, 293 F. 1013 (D.C.C. 1923); Daubert v. Merrell Dow Pharms., Inc., 509
U.S. 579 (1993); Kumho Tire v. Carmichael, 526 U.S. 137 (1999).



xviii

Preface

Changes in Regulatory Scrutiny
During the last several years, there has been intensifying regulatory scrutiny
related to the healthcare transactional marketplace regarding the potential for
Anti-kickback, Stark, and other fraud and abuse violations involving Medicare and other government payors. Initiatives such as the Fraud Enforcement
and Recovery Act (FERA), the Healthcare Fraud Prevention and Enforcement Action Team (HEAT), and the Medicare Fraud Strike Force have only
been intensified with the passage of the 2010 Patient Protection and Affordable Care Act (ACA). A significant portion of this regulatory scrutiny has
focused on the issues of Fair Market Value and commercial reasonableness
related to the consideration being paid in transactions between tax-exempt
hospital organizations to for-profit physician groups as part of the massive
consolidation and integration initiatives currently being undertaken.
There has also been heightened regulatory scrutiny and the potential
for severe penalties aimed at appraisers under Section 6695A of the Pension
Protection and Affordable Care Act of 2006 for “substantial and gross valuation misstatements attributable to incorrect appraisals” that were “prepared by a person who prepared an appraisal of the value of property and
who knew, or should reasonably have known, the appraisal would be used
in connection with a return or claim for refund.”8

Changes in Client Expectations
Client expectations have also evolved, particularly as a result of technological advancements that have transformed the manner by which we communicate with our clients. The days of hanging wet copy fax pages on a clothesline
to dry and using a 56K dial-up modem have been replaced with cell phones,
e-mail, instant messaging, video teleconferencing, and secure back offices
and data rooms. Each of these advances has come with an accompanying
rise in client expectations and demands for access to appraisers, as well
as a rise in the requirement for appraisers to be instantaneously ­accessible
throughout the engagement. The way in which our financial models are
developed and prepared has also evolved, largely due to the accessibility
8 Substantial value is 150 percent or more than the amount determined to be correct (income tax); or the value is 65 percent or less than the amount determined to

be correct (estate or gift tax). Gross value is 200 percent or more than the amount
determined to be correct (income tax); or the value is 40 percent or less than the
amount determined to be correct. “Substantial and gross valuation misstatements
attributable to incorrect appraisals,” Internal Revenue Code, 26 USC § 6695A.


Preface

xix

of available data sources required for due diligence (particularly prevalent
in the healthcare arena) that we receive electronically through databases
and other data portals, as well as the exponential growth in the availability
of healthcare financial and economic literature, and the input of academic
theory, especially during the last 10 years.

Healthcare Industry Specialization
While the subject of industry specialization has been a point of contention
for many years, in 1999, Chris Mercer (a valuation thought leader whom I
greatly admire and respect), stated the issue succinctly as, “The basic question often boils down to: Should we hire an industry expert for this engagement, or is it preferable to hire a valuation professional?” Chris commented
that “I believe I can say, based on many years of valuation experience, that
valuation expertise combined with a broad base of industry experience, is
a preferable experience set than purely industry expertise.”9 Based on my
more than 30 years of healthcare valuation experience, I believe I can say
that I both agree (in part) and disagree (in part) with Chris’s comment.
I hold both valuation “generalists” and healthcare “industry specialists”
in high regard; each group has contributed enormously to the advancement
of the valuation profession. I would certainly agree that a strong base of
general business knowledge and experience, as well as a thorough education in economic and financial principles, basic valuation tenets, appraisal
methodology, and professional standards, are prerequisites to a successful

appraisal engagement. However, given the complexities associated with
understanding the value drivers that are often unique to the healthcare
industry, the explosion of information and data available to appraisers, the
heightened regulatory scrutiny, and the volatile dynamics of the new paradigm of healthcare reform, the valuation profession has ­necessarily evolved
toward industry specialization. This is generally the result of the recognition that to be credible in performing a healthcare valuation, the appraiser
also needs to possess an in-depth, informed understanding of the esoteric
and complex attributes of the healthcare industry, which often appears to
operate under a disparate, seemingly counterintuitive, f­ ramework of market
economics (e.g., demand-driven, inelastic pricing).
The in-depth, robust knowledge required of a healthcare appraiser
often can begin with a background of healthcare industry expertise, such
9 Mercer Capital Management, Inc., “The ‘Valuation Professional’ vs. the ‘Industry
Expert,’” E-Law Business Valuation Perspective Newsletter, 1999-17 (December 15,
1999).


xx

Preface

as in hospital financial management, but that experience alone is not sufficient without a thorough valuation education. Furthermore, credibility as
an appraiser of healthcare interests requires a continuing commitment to
keep abreast of the almost daily changes in national and regional economic
conditions impacting the healthcare industry; payment and reform initiatives, reimbursement trends, regulatory and enforcement trends, the payor/
delivery system mix, healthcare manpower and labor practices, supplyside dynamics, capital costs, emerging and declining models of healthcare organizations, and other issues related to the healthcare industry and
transactional markets. For those valuation professionals who lack specific
healthcare industry expertise, there has never been greater access to data
and information related to the economic financial, and transactional areas
of healthcare. Also, there is an increasing availability for both valuation
education and professional development, as well as for obtaining a comprehensive understanding of the healthcare arena through healthcare associations and medical societies; online newsletters, journals, and health law and

policy reporters; academic curricula; and courses, conferences, workshops,
and symposiums, many of which are available through distance education,
for example, audio conferences webinars.
There has long been a discernible pattern of consensus among h
­ ealthcare
industry clients to engage healthcare valuation specialists, at least for projects of any size or complexity. Recently, there also appears to be a growing
acknowledgment in the valuation profession that industry specialization, in
this case, with a professional focus on research and training specific to the
healthcare industry, is warranted. Toward that end, on January 28, 2012,
the Board of Governors of the American Society of Appraisers (ASA), “the
oldest and only major appraisal organization representing all of the disciplines of appraisal specialists,” passed a resolution establishing the “ASA
Advanced Multidisciplinary Education in Healthcare Valuation” program
as developed by the ASA Healthcare Special Interest Group (ASA HSIG)
educational subcommittee.10

Why I Wrote This Book
The healthcare industry is a vast and diverse part of the American economy
that is undergoing a sustained and dramatic transformation. While the ultimate course that U.S. healthcare reform initiatives will follow is ­uncertain,
10 “About

US,” American Society of Appraisers, www.appraisers.org/AboutUs/­
AboutUs.aspx (accessed April 22, 2013).


xxi

Preface

and there is still a quandary of unresolved issues posed by this perfect
storm, one thing I know for certain is that whether one views it as a blessing or a curse, it is undeniable that there will be exponential growth in the

demand for healthcare valuation professional services, and that the financial
appraisal of healthcare enterprises, assets, and services will continue to grow
in scope and complexity.11
In writing Healthcare Valuation, I focused, first and foremost, on the
historical development of the U.S. healthcare industry and medical profession and the broad underlying market conditions and trends in which
healthcare transactions and litigation take place, as well as the related basic
tenets of financial economics in regard to the approaches and methods of
healthcare valuation. The objective of this text is to gather and present the
technical aspects of business valuation methodology relative to the financial
appraisal of emerging healthcare organizations, within the context of the
Four Pillars of the healthcare industry, that is, reimbursement, regulatory,
competition, and technology.
This book is intended to supplement, not supplant, the existing c­ annon
of professional valuation literature and builds on a solid foundation of
authoritative texts, treatises, and research by professionals who have
­contributed greatly to that literature, as well as to the development of the
business valuation profession, many of whom I am proud to call my friends
and colleagues of many years and gratefully acknowledge as mentors. It is
my hope that this book will augment what they have previously contributed.
Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA
Health Capital Consultants
Saint Louis, Missouri
March 2013

11 See

the Introduction.




Acknowledgments

T

he assistance and support of a number of my Health Capital Consultants
(HCC) colleagues were instrumental to the development and publication
of this book.
Todd A. Zigrang, MBA, MHA, FACHE, ASA, HCC President, and Anne
P. Sharamitaro, Esq., HCC Executive Vice President and General Counsel, were central to the development of this project and greatly assisted by
­contributing to this work.
Other HCC colleagues who contributed significantly to this book
include Vice President Matthew J. Wagner, MBA; Vice President John R.
Chwarzinski, MSF, MAE; Senior Financial Analyst Jonathan T. Wixom; and
Senior Financial Analyst Grant D. Heggie, MBA, MHA.
In addition, HCC’s research and library staff, as well as members of
HCC’s consulting and administrative support team, were of great help.
Also, many thanks to our professional colleagues and clients who
served as reviewers of, and commentators on, the various drafts of this
work along the way, including Dr. Shannon Pratt, CFA, FASA, MCBA,
ARM, ABAR, for his encouragement and inspiration over many years, as
well as his comments on this text and his contribution of the Foreword;
David Grauer, Esq., of Squire Sanders, LLP; Bob Morrison, ASA, BV/IA;
Robert Schlegel, ASA, CBA, CCP, CDP, CISA, CSP; Richard M. Wise, FASA,
MCBA, FCBV, FRICS, CVA, FCA, CPA, CA; Chris M. Mellen, ASA, MCBA,
CVA, ABAR, CM&AA, MBA; Michael Gregory, ASA, AVA, PE; James B
Lurie, ASA, CBA, CVA, BVAL; Howard Lewis, MS, GVA, AVA; Robert L.
Wilson, Jr. Esq.; Lari B. Masten, MSA, CPA, ABV, CFF, CVA, ABAR; John
Paglia, PhD, MBA; Dick Thorsen, CPA, CMEA, CVA; Morton Cohen, CPA;
and, Tim Alexander, MLS, for their helpful review and commentary.


xxiii