Strategic Business Plan Proposal to

Provide Sports Medicine Services to

Rural Secondary Schools

Strategic Business Plan Submission

Chad S. Fisher, JD, FACMPE

March 3, 2020

This paper is being submitted in partial fulfillment of the requirements of

Fellowship in the American College of Medical Practice Executives.

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Table of Contents

A. Project Summary – page 4

B. Executive Summary – page 5

a. The Company – page 5

b. Market Opportunities – page 5

c. Capital Requirements – page 7

d. Mission Statement – page 7

e. Management – page 7

f. Competitors and Competitive Advantages – page 8

g. Financial Projections – page 11

C. Part I: The Organizational Plan – page 12

a. Summary Description of the Business – page 12

i. Mission – page 12

ii. Business Model – page 12

iii. SWOT Analysis – Strengths, Weaknesses, Opportunities and Threats – page 14

iv. Strategy – page 16

v. Strategic Relationships – page 17

vi. Key Stakeholders/Key Decision-Makers – page 18

b. Services – page 18

c. Administrative Plan and Responsibilities – page 18

i. Organizational Chart – page 19

d. Operational Plan – page 19

i. Project Timeline – page 19

ii. Potential Operational Roadblocks and Resolutions – page 20

D. Part II: The Marketing Plan – page 22

a. Overview and Goals of the Marketing Strategy – page 22

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b. Market Analysis – page 22

i. The Company – page 22

ii. Market Opportunity – page 22

iii. Market Competition – page 22

iv. Capital Requirements – page 23

c. Marketing Strategy – page 23

d. Implementation of Marketing Strategy – page 24

E. Part III: Financial Documents – page 25

a. Summary of Financial Needs – page 25

i. Financing – page 25

ii. The Capital Outlay – page 25

iii. Resource Costs Associated/Opportunity Costs – page 26

b. Key Assumptions – page 26

c. Pro Forma Cash Flow Statement (Budget) – page 26

d. Three-Year Income Projection – page 26

e. Projected Balance Sheet – page 26

f. Break-Even Analysis – page 26

g. Financial Statement Analysis – page 27

F. Part IV: Innovative Elements and Expected Business Outcomes – page 29

a. Why and How Does This Business Positively Impact Health – page 29

b. Challenges Encountered – page 30

c. Next Steps – page 30

G. Works Cited – page 32

H. Exhibits – page 35

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Project Summary

Improving access to, and the quality of, healthcare in rural America has long been a

central focus of our nation’s healthcare policy. Although much of this focus has been placed upon

the services provided by physicians and advanced practice practitioners, there are numerous other

manners in which the standard of care provided to rural communities can be raised.

One such manner involves increasing the presence of full-time sports medicine services

within rural secondary schools. In current state, many of these rural secondary schools either do

not have any sports medicine coverage at their athletic events or, at best, have medical coverage

that is highly sporadic and provided by medical staff not fully dedicated to the practice of sports

medicine. By increasing the presence of full-time sports medicine services provided to student-

athletes at these academic settings, the standard of care can be raised within their rural communities.

This proposed business plan addresses the formation of a limited liability company

(hereinafter, the “Organization”) focused upon providing sports medicine services to rural

secondary schools. The Organization’s main focus will be upon the placement of athletic trainers

within these rural academic settings; such placement can be facilitated via partnerships with rural

healthcare systems (i.e. a physician group, a physical therapy group or a hospital) or via

partnerships with rural school systems.

As set forth within this proposed business plan, the Organization will focus first upon the

development of partnerships with rural healthcare systems and rural school systems. Once a

network of placement sites has been solidified, the Organization will focus upon the recruitment

and hiring of athletic trainers to fill the staffing needs created by the partnership commitments.

In summation, by providing full-time sports medicine services to rural secondary schools,

the Organization will help raise the standard of care provided within rural communities. As detailed

herein, this altruistic goal can be accomplished while also ensuring that the underlying business

operations provide the Organization’s Members with a positive return on their investment.

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Part I: Executive Summary

A) The Company – This proposed business plan outlines the formation of the Organization, a

limited liability company (hereinafter “LLC”) that intends to provide sports medicine services to

rural secondary school student-athletes. The Organization’s business model relies upon two distinct

contractual relationships:

1) A formal partnership with a rural physician group, a rural physical therapy group or a

rural hospital (hereinafter collectively referred to as a rural “healthcare system”).

Under this model, the Organization will assist the rural healthcare system with the

development of a sports medicine outreach program that contracts with a local rural

school system to provide sports medicine coverage. This model would be applicable

to rural markets that possess a healthcare system presence and possess a healthcare

system interested in providing sports medicine services.

2) A formal partnership with a rural school system. Under this model, the Organization

will contract directly with a local rural school system to provide sports medicine

coverage. This model would be applicable to rural markets that do not possess a

healthcare system presence or do not possess a healthcare system interested in

providing sports medicine services.

Exhibit “A” and Exhibit “B” to this proposed business plan, which are draft template agreements

between the Organization and a rural healthcare system and a rural school system, respectively,

provide a more expansive illustration of the operational structure of each of these contractual

relationships.

As expanded upon throughout this proposed business plan, the chosen contractual

relationship materially affects the business operations of the Organization, although the level of

service provided to rural student-athletes is largely static.

B) Market Opportunities – It is axiomatic to state that the health of student-athletes is a material

concern to all involved stakeholders (e.g. parents, coaches, school administrators, community

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members, etc.). However, full-time sports medicine coverage is simply not provided to many

secondary school student-athletes. Specifically, although a 2015 study published within The

Journal of Athletic Training found that “70% of public secondary schools in the United States had

access to athletic training services, only 37% of such schools had full-time athletic training

services.” i

Additionally, in regards to coverage within rural communities specifically, a 2018 study

published within The Journal of Athletic Training found that only 13% of rural high schools in

Wisconsin had a “high availability” of athletic training services.ii While this study only focused

upon athletic training services provided within Wisconsin high schools, for purposes of this

proposed business plan, the statistical data produced by the study is considered representative of

rural communities throughout the United States.

Although such coverage deficiency is multifactorial, many rural communities simply

lack access to a sports medicine program willing to service their secondary schools. In a 2017 study

published within The Journal of Athletic Training, this plight was set forth by secondary school

athletic directors (hereinafter “ADs”) as follows:

One barrier to providing [athletic training] services that was unique to public

secondary schools was being in a “remote location,” as cited by an Arizona AD.

Two Oregon ADs mentioned that reasons for not employing an [athletic trainer]

were “lack of availability in a rural area” and that “the closest athletic trainer was

60 miles away.” In the northeastern United States, a public school AD from New

York agreed with the previous statements and noted that they “would like to have

one but we have no athletic trainers in the area… even if we tried to access them,

the closest source is an hour away.” A similar reason was provided by a Virginia

AD who described the rural town as a barrier, stating, “We are a very rural setting

that doesn't provide a sports-minded community or resources for an athletic

trainer.” These quotes suggest that [athletic trainers] did not currently live in those

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areas and that [athletic trainers] might not want to relocate to the community,

creating a barrier for the schools.iii

By partnering with rural healthcare systems and rural school systems to overcome this initial barrier

to access, the Organization intends to help foster the growth of sports medicine services within

rural communities.

C) Capital Requirements – The Organization is a two Member LLC with the startup capital needs

funded jointly by the Members. As set forth within Part III of this proposed business plan, it is

anticipated that the Members will provide the Organization with a $50,000.00 initial loan which

will be repaid over the course of five years at 5.00% Annual Percentage Yield (hereinafter “APY”).

It is anticipated that this capital will fully fund the Organization’s initial startup expenses.

D) Mission Statement – The Organization’s primary mission is to provide full-time sports medicine

services to rural secondary school student-athletes. Such services encompass the full scope of an

athletic trainer’s permitted practice within a particular jurisdiction; as a non-exhaustive list, this

includes: 1) coverage of athletic events and practices, 2) injury prevention guidance, 3) the

treatment of acute injuries suffered during competition, 4) the support of injury rehabilitation

efforts, and 5) baseline concussion testing. Working together with other like-minded medical

providers, the Organization strives to raise the level of sports medicine care provided within rural

communities.

E) Management – During the Organization’s startup period, the Organization’s two Members will

share all management responsibilities. One Member will serve as the Chief Executive Officer

(hereinafter, the “C.E.O.”) and will be primarily responsible for business development efforts,

contractual negotiations, regulatory compliance, financial oversight and all other non-clinical

activities. It is anticipated that this individual will possess experience in healthcare administration

with an undergraduate degree in accounting and a doctorate-level law degree.

The second Member will serve as the Chief Clinical Officer and, as the title suggests,

will be primarily responsible for oversight of the Organization’s clinical activities. Such

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responsibility will include day-to-day management of the Organization’s employed athletic trainers

and assistance with the clinical activities of the Organization’s rural healthcare system partners. To

lend credence to the Organization’s experience within the sports medicine industry, this individual

will also assist the C.E.O. with business development activities. It is anticipated that this individual

will be a certified athletic trainer with both school-based athletic coverage experience and

administrative experience within an established sports medicine program.

After the initial three-to-five-year startup period, it is anticipated that the Organization’s

management team will expand to include a Director of Regulatory Compliance and Regional

Supervisors. These roles, which are broadly described within the Organizational Plan section of

this proposed business plan, will allow the C.E.O. and Chief Clinical Officer to focus

predominantly on business development opportunities and other long-term organizational needs.

F) Competitors and Competitive Advantages

a. Direct Competition - At the macro-level, there appears to be very few direct competitors

offering full-time sports medicine coverage to secondary schools. Based upon a review of their

respective websites, those that do exist appear largely focused on providing services within large,

urban areas of the country. As an example, while it appears one company does offer athletic training

staffing to a limited number of rural communities in New Jersey, New York and Pennsylvania, it

appears that company’s main focus is serving the urban communities within those states.iv

Of note, there are a number of companies that provide compliance-based sports medicine

consulting services to secondary schools and other entities that host athletic competitions. As an

example, one prominent company provides its affiliates with an extensive platform of consulting

services, including a detailed, personalized compliance-based review of its operations, incident

reviews and access to e-learning modules.v While this company, along with its direct competitors,vi

provide a service that is extremely valuable to the sports medicine industry, their consulting

services are distinguishable from the sports medicine staffing focus of the Organization.

Additionally, there are a number of companies focused upon the development of

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technology to allow for on-site athletic training coverage to be supplemented with a telemedicine-

based physician presence. As an example, during the 2016 Northern Arizona University football

season, the “VGo Robot” was used by Mayo Clinic neurologists to “test the feasibility of using a

telemedicine robot to assess athletes with suspected concussions.”vii Although this technology, and

other similarly developed products, will undoubtedly enhance the level of care provided to student-

athletes in the future, their services are likewise distinguishable from the sports medicine staffing

focus of the Organization.

Finally, at the micro-level, there does not appear to be a direct competitor that is currently

focused upon providing full-time sports medicine coverage to secondary schools within the

Organization’s targeted rural market. Thus, in summation, direct competition is not currently a

material threat to the Organization’s operations.

b. Indirect Competition - However, indirect competition from non-affiliated rural healthcare

systems is a material concern. Given their comparatively large breadth of service line

responsibilities, it is unlikely that a material number of rural healthcare systems will independently

focus upon the development of a sports medicine outreach program. However, the more limited

sports medicine services often offered by rural healthcare systems (e.g. athletic event coverage by

Emergency Medical System staff) may be deemed sufficient by some rural school systems, even if

such services objectively pale to those provided by a full-time athletic trainer. This mindset,

commonly referred to as “Community Interference” within the sports medicine industry, was

summarized as follows in a 2015 study published within The Journal of Athletic Training:

[Community Interference] encompassed local school resources and, in some cases,

medical coverage that can be provided free of charge. Interference was based on

the notion that other medical care providers who were community members or

local to the high school were sufficient to provide onsite coverage for games. Ten

[secondary school athletic directors] without [athletic trainers] mentioned

volunteer medical coverage from local EMS or other providers as filling the void

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of athletic training services.

Community Interference was a barrier to hiring an [athletic trainer] because

[athletic directors] who relied on it believed it was a way to provide appropriate

coverage in lieu of an [athletic trainer], or minimally, it was a sufficient means of

medical coverage. Our data suggested that [athletic directors] believed local

community members could fill in for the lack of the [athletic training] services at

the high school level and showcased the misconception of the [athletic trainer’s]

value and the need for continued care rather than onsite medical coverage only.

Furthermore, the data indicated that [athletic directors] viewed medical coverage

from [local EMS] as free and, thus, an easier, more practical option to provide

medical care at the secondary school level.viii

To combat this, the Organization will need to aggressively push its key differentiator,

namely its commitment to providing full-time sports medicine services within rural secondary

schools. The clinical benefits afforded via a full-time athletic trainer presence are well documented;

as an illustration, the following was set forth in a 2017 study published within The Journal of

Athletic Training:

It is crucial to have an [athletic trainer] on site, especially in remote locations

where emergency response times are longer. Grossman et al investigated

differences in prehospital care between urban and rural areas and found the mean

emergency response time for urban locations was 7.0 minutes, compared with 13.6

minutes in rural locations. In addition to response time, scene time and transport

time were also longer for rural areas. Once at the scene of the incident, traveling

to the hospital took 9 minutes longer in rural than urban locations. A more shocking

finding that offers the best justification for [athletic trainers] in remote areas is that

victims in rural settings are at more than 7 times the risk of death than their urban

counterparts if the emergency response exceeds 30 minutes. Employing on-site

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[athletic trainers] in these remote schools ensures immediate medical attention

and care: life-preserving skills such as cardiopulmonary resuscitation and

automated external defibrillator (AED) application can be performed by a medical

professional until emergency services arrive.ix

Accordingly, the experience possessed by the Organization and its Chief Clinical Officer

in providing school-based sports medicine services (e.g. the coverage of athletic events, the

coordination of preseason baseline concussion examinations, etc.) should be a strong competitive

advantage. It is axiomatic to state the majority of rural healthcare systems will not be able to cite

to an extensive amount of comparable experience, either organizationally or at their employee-

level. By highlighting this competitive advantage, the Organization should be able to effectively

impart the clinical benefits associated with the full-time presence of an athletic trainer. Assuming

this distinction can be effectively explained, it is anticipated that the Organization will be able to

distinguish itself from the sporadic coverage provided by a majority of its indirect competitors.

G) Financial Projections – Detailed financial projections are included within Part III of this

proposed business plan. As a brief summary, the balance of the financial statements reflect an

organization that is on solid footing, at least relatively for a start-up company. Of note, the

Organization is projected to finish each of its first three years of operation with an operating surplus

and a positive owner’s equity balance by the end of Year 2.

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Part I: The Organizational Plan

A) Summary Description of the Business – This proposed business plan is focused upon expanding

rural communities’ access to sports medicine services. Formalized relationships with rural school

systems will be facilitated indirectly via partnerships with rural healthcare systems and directly via

partnerships with the rural school systems.

a. Mission – The Organization’s primary mission is to provide full-time sports medicine

services to rural secondary school student-athletes. Currently, the presence of such dedicated

services within rural communities is sporadic at best.

Specifically, as previously mentioned, a 2018 study published within The Journal of Athletic

Training found that only 13% of rural high schools in Wisconsin provide their student-athletes

with a “high availability” of athletic training services; under the same analysis, 56% of urban high

schools in Wisconsin reached the “high availability” threshold.x Assuming that this Wisconsin-

based data is relatively representative of sports medicine coverage provided throughout the United

States, fulfillment of the Organization’s primary mission has the potential to positively affect a

large number of rural communities. By doing so, the Organization can help ensure that rural

secondary school student-athletes enjoy a standard of sports medicine care similar to the one

enjoyed by many of their urban peers.

b. Business Model – The Organization’s business model is constructed with intentional

fluidity, thereby allowing it to be configured to a broad base of operational needs. Initially, the

Organization, which will be a two Member LLC, will enter into each rural market with a goal of

partnering with a local healthcare system via a consulting relationship. The Organization will assist

these rural healthcare systems with the development of a sports medicine outreach program that

contracts with a local rural school system to provide full-time sports medicine coverage. Via this

relationship, the rural healthcare system will receive reimbursement from the school system to

cover an agreed-upon portion of the employment costs of the athletic training staff and will receive

standard patient revenue for any medical services provided under their purview. Of note, the

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amount of patient revenue received by a healthcare system via athletic trainer referrals can be

substantial; specifically, a 2018 study performed by AT Efficiency found that the average referral

revenue generated for a healthcare system by each athletic trainer is over $136,000, far exceeding

the employment cost of an athletic trainer.xi Under this model, for purposes of this proposed

business plan, the Organization will receive a consulting fee from the rural healthcare system

partner valued at $12,000.00 annually per covered secondary school.

In the event that there is not a healthcare system within a rural region willing to develop

a sports medicine outreach program, the Organization will attempt to contract with the surrounding

rural school systems directly. Via this model, the Organization will employ the athletic trainers and

will be reimbursed by the school system for the actual expenses associated with such employment.

Additionally, under this model, for purposes of this proposed business plan, the Organization will

receive a consulting fee valued at $12,000.00 annually per covered secondary school.

Long-term, the Organization’s large network of affiliated rural school systems has the

potential to create numerous other clinical and financial opportunities. Irrespective of acute sports

medicine services, the barriers associated with limited access to medical providers in rural

communities commonly results in reduced treatment abilities for a number of primary care medical

conditions.xii However, as an example, via the Organization’s presence within rural secondary

schools, a healthcare system partner could establish a school-based telemedicine network used to

initially assess and/or treat some primary care-related conditions. Although not represented within

this proposed business plan’s financial projections, facilitating the development of this rural school-

based telemedicine network, or other similar clinical initiatives, has the potential to lead to

additional consultant-based revenue for the Organization.

In summation, from an external perspective, the Organization’s business model will

be malleable and conversations with potential partners will be purposely open-ended. By allowing

for flexibility, the Organization will be able to provide a service tailored to the particular needs of

not only each partner, but also the gaps in sports medicine services found within each partner’s

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rural community. From an internal perspective, this flexibility is what will allow the Organization

to assist with a wide range of community-specific needs, thereby maximizing the amount of

services that can potentially be provided.

c. SWOT Analysis

i. Strengths

1. From a political perspective, the implementation of a sports medicine program

focused upon improving the quality of medical care provided to student-athletes

will likely be attractive to the politicians elected to serve on rural school boards.

2. Our nation’s current heightened focus on the need for specialized treatment of

pediatric concussions will differentiate the organization’s full-time athletic

trainer-driven staffing model from other “general” medical providers (e.g.

Emergency Medical System staff) often tasked with the sporadic coverage of

athletic events at rural secondary schools.

3. According to a 2015 study published within The Journal of Athletic Training,

27% of athletic trainers in secondary schools are employed by a “hospital or a

clinic.”xiii Thus, a material number of school systems are willing to rely upon

external healthcare system partners to provide sports medicine services to their

student-athletes.

4. As previously mentioned, currently there is not a material amount of direct

competition within the relevant rural marketplace.

ii. Weaknesses

1. Many rural school systems may not possess a sufficient amount of discretionary

capital to apply toward school-based sports medicine services.

2. Even if sufficient capital is present, some rural school systems may be apathetic

toward sports medicine-related issues, rendering them unwilling to dedicate

sufficient capital for sports medicine coverage.

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3. With each rural municipality/county overseeing their own school system, an

exhaustive number of conversations will need to be undertaken to grow the

Organization’s network of affiliated secondary schools, rendering the growth

rate slower than the growth rate found in many other healthcare-related

industries.

4. If the Organization is unable to partner with a rural healthcare system within a

particular region, the Organization has the potential to be labeled as an

“outsider” by some community members resistant to change, such as local

Emergency Medical System staff (hereinafter “EMS staff”) traditionally

responsible for the coverage of rural secondary school athletic events. This

barrier, referred to as “Community Interference,” was expanded upon previously

within this proposed business plan.

iii. Opportunities

1. Since 2009, every state and the District of Columbus has passed legislation

designed to protect student-athletes who suffer from concussions resulting from

participation in sport.xiv With such a heightened focus currently being placed

upon concussion-related injuries suffered by student-athletes, the pressure on

school systems to ensure their student-athletes are provided adequate sports

medicine services is likely to increase.

2. As previously mentioned, there is a dearth of sports medicine providers within

many rural communities. Consequently, the Organization possesses a relatively

unique opportunity to offer employment opportunities to athletic trainers who

desire to practice in rural communities.

3. Upon the development of a large, rural sports medicine network, the

Organization may be able to facilitate the development of other clinical

opportunities for partner rural healthcare systems, which would lead to

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additional consultant-based revenue for the Organization.

4. Although the Organization’s initial focus will be on sports medicine services

provided within secondary schools, the Organization may also be able to offer

similar service packages to rural colleges and rural universities who encounter

similar sports medicine-related shortcomings.

iv. Threats

1. There may be difficulties recruiting athletic trainers willing to be employed for

placement within rural communities.

2. To a limited extent, the presence of existing sports medicine coverage

agreements will reduce the number of rural school systems interested in

partnering with the Organization.

3. At some point after the initial establishment of the relationship, the rural

healthcare system or rural school system may believe that they can provide

sports medicine services themselves, thereby removing their desire to

compensate the Organization for its services.

d. Strategy – The Organization’s business strategy is to capitalize on the lack of sports medicine

services currently provided within rural communities. Preferably, the Organization will partner

with a rural healthcare system to provide such services, rather than directly with a rural school

system. This preferred partnership structure will be advantageous in a multitude of ways:

i. The rural healthcare system may be willing to absorb some of the expenses

associated with the employment of athletic trainers, thereby alleviating the need

for the school system itself to fully fund such employment. Although these

arrangements should be subjected to regulatory compliance review prior to

finalization, such a reduced cost to the school system should increase the likelihood

of affiliation.

ii. As previously mentioned, by partnering with an established rural healthcare

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system, the Organization is less likely to be subjected to “Community

Interference” from rural community members resistant to change (e.g. EMS staff

traditionally responsible for coverage of rural secondary school athletic events).

iii. The rural healthcare system will serve as the employer of the athletic trainers,

significantly reducing the human resource-related administrative responsibilities

of the Organization.

If the Organization is unable to partner with a rural healthcare system in a particular

market, direct discussions with rural school systems will need to be undertaken. Discussions under

this pathway will likely be much more expansive, as the Organization will have the sole

responsibility for the establishment of the relationship with the school system and will be directly

responsible for the identification, employment and placement of the athletic trainer. For such

reasons, the establishment of a relationship with a rural healthcare system, rather than a rural school

system, will be the Organization’s initial strategic goal for each identified market.

e. Strategic Relationships – The Organization’s central strategic relationships will be with rural

healthcare systems. As discussed above, such relationships are likely to reduce the funding burden

placed upon rural school systems and negate the likelihood of “Community Interference.” Both

outcomes will likely increase the rural school system’s willingness to contract for school-based

sports medicine services.

Of course, another necessary strategic relationship will be the rural school systems

themselves. As discussed above, despite the Organization’s best efforts, some rural communities

will inevitably be devoid of a rural healthcare system willing to develop a sports medicine outreach

program. In those communities, the Organization will be required to partner with the school system

directly to provide such services.

Finally, it will be imperative for the Organization to establish working relationships

with collegiate athletic training educational programs, particularly those located within rural

communities. It is axiomatic to state that without an adequate level of athletic trainer staffing, the

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Organization will be unable to operate as planned. Consequently, partnering with collegiate athletic

training educational programs in order to identify suitable employment candidates will be a crucial

component of the Organization’s growth.

f. Key Stakeholders/Key Decision-Makers – Despite an envisioned large geographical rural

network of service sites, the Organization’s key decision-makers should be relatively small.

Initially it is envisioned that the Organization’s executive team will be comprised of its two

Members, who possess distinct clinical and financial/legal skillsets.

B) Services – At the core of the Organization’s services are school-based sports medicine services.

These services will be tailored to the needs and desires of each particular partner. As an example,

services provided in conjunction with a robust rural healthcare system may include comprehensive

pre-participation exams and other physician-led initiatives. However, in the absence of a rural

healthcare system partner, services may be streamlined to focus solely upon athletic training

coverage and other standard components of care that can be provided to student-athletes by athletic

trainers (e.g. baseline concussion testing). In summation, there will not be a “cookie cutter” service

package provided by the Organization; each service package will be tailored to the unique needs

and resources present within each partnership.

C) Administrative Plan and Responsibilities – Given the envisioned large rural geographical scope

serviced by the Organization, administrative oversight of the Organization will undoubtedly be

challenging. As a summary, the following are the envisioned administrative roles within the

Organization and their responsibilities:

i) C.E.O. – The C.E.O. will be responsible for the overall administrative oversight

of the Organization, including, but not limited to, strategic planning decisions regarding new

partnerships with rural school systems and rural healthcare systems. The C.E.O. will also be

responsible for overseeing the procurement of contractual agreements with identified partners and

all financial oversight. The C.E.O. will serve as a 50% equity Member of the Organization.

ii) Chief Clinical Officer – As the title suggests, this role will be responsible for

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oversight of the Organization’s clinical activities. In the practical sense, this individual will be

charged with overseeing the delivery of sports medicine services to affiliated school systems. As

previously mentioned, such delivery will be tailored to the unique needs and desires of each

particular partner; however, via the Chief Clinical Officer’s central oversight, the Organization will

possess the ability to standardize some effective, high-quality clinical activities across numerous

rural academic settings (e.g. the coordination of preseason baseline concussion examinations).

Although the Organization’s reporting structure will require this individual to report to the C.E.O.,

the Chief Clinical Officer will serve as a 50% equity Member of the Organization.

iii) Director of Regulatory Compliance – There are a bevy of state-specific

governmental requirements placed upon issues affecting the Organization’s operations, such as

athletic trainer licensure and athletic trainer scope of practice. This role will be responsible for

ensuring the Organization’s activities are in compliance with the unique requirements found within

each jurisdiction. At the Organization’s onset (i.e. its initial three-to-five-years of operations), it is

anticipated that the C.E.O. will assume the vast majority of such compliance-related activities, thus

removing the need for an additional administrative employee. However, for purposes of long-term

planning, this role should be considered a standalone employment need.

iv) Regional Supervisors – At the Organization’s onset (i.e. its initial three-to-five-

years of operations), it is anticipated that the Director of Clinical Activities will be responsible for

the supervision of employed and affiliated athletic trainers, thus removing the need for additional

administrative employees. However, long-term, Regional Supervisors will be hired to assume such

responsibilities. Upon implementation, these roles will report to the Director of Clinical Activities.

a. Organizational Chart - Please see Exhibit “C” to this proposed business plan, which sets

forth the Organizational Chart during both the Organization’s onset (i.e. its initial three-to-five-

years of operations) and upon the Organization’s maturation.

D) Operational Plan

a. Project Timeline – The timeline for sports medicine services is calendar-driven and cyclical.

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As demonstrated within the Organization’s initial two-year operational timeline, attached hereto as

Exhibit “D,” there will often be a nine-to-twelve-month lag between the time that the Organization

initiates discussions with prospective partners (i.e. rural healthcare systems and rural school

systems) and begins providing sports medicine services at affiliated secondary schools.

b. Potential Operational Roadblocks and Resolutions - The most material potential operational

roadblocks, as detailed below, center upon the formation of relationships with rural healthcare

systems and rural school systems.

i. Lack of Perceived Need– The heightened focus upon youth concussions currently places

school-based sports medicine services at the forefront of many pediatric health discussions.

However, in the event that such attention wanes and the public refocuses its attention on a

new “public health crisis,” the level of funding earmarked for school-based sports medicine

services may correspondingly diminish. As such, it will be imperative for the Organization

to demonstrate to its partners that athletic trainers provide a scope of services that transcend

one particular area of care (e.g. concussion-related services). As a non-exhaustive list, such

scope of services include the treatment and rehabilitation of injured student athletes, the

development of emergency action plans and the oversight of “return-to-play” and “return-

to-learn” programs for injured student-athletes.

ii. Lack of Opportunity – Although, as previously discussed, it is relatively rare for sports

medicine services to be provided on a full-time basis within rural school systems, there are

certainly exceptions to that rule. As previously mentioned, according to a 2018 study

published within The Journal of Athletic Training, 13% of rural Wisconsin high schools

possessed a “high availability” of athletic training services.xv Consequently, some rural

secondary schools are already provided adequate sports medicine coverage via partnerships

with local healthcare providers or other means, thereby prohibiting the Organization from

having the opportunity to penetrate the market. To prevent the Organization from investing

time and resources on such unfruitful opportunities, the Organization will research a rural

21

school system’s existing sports medicine contractual relationships to confirm the

availability of a partnership prior to initiating dialogue. Such research can often be

performed relatively quickly via an online review of a rural school system’s board meeting

minutes.

iii. Lack of Commitment by Rural Healthcare Systems – As mentioned above, partnerships

with rural healthcare systems would allow the Organization to position itself as a “local”

partner to rural school systems and offload many of the human resource-related

administrative issues associated with the employment of athletic trainers. However, a rural

healthcare system’s willingness to partner with the Organization cannot be assumed; many

rural healthcare systems, especially ones without sufficient orthopaedic staffing, may view

the development of a sports medicine outreach program as an endeavor more financially

feasible for urban tertiary care centers. Accordingly, in conversations with such rural

healthcare systems, the Organization will have to demonstrate the benefits of a school-

based sports medicine presence, both directly (i.e. sports medicine-related clinical volume)

and indirectly (i.e. the strengthening of the relationship between the rural healthcare system

and the community via sports medicine coverage that is often viewed as altruistic by

community members).

22

Part II: Marketing Plan

A) Overview and Goals of the Marketing Strategy –The Organization’s marketing strategy will

focus upon identifying and educating key decision-makers, as opposed to the public at large, on the

need for, and the benefits of, full-time school-based sports medicine services. Such key decision-

makers will serve in administrative roles within rural school systems and rural healthcare systems.

By focusing marketing efforts on such key decision-makers, as opposed to the public at large, the

Organization will be able to limit its broad-based marketing expenditures and direct such capital

toward other operational needs.

B) Market Analysis

a. The Company – The Organization intends to be a national leader in the market of rural

school-based sports medicine services. The Organization aims to focus on the formation of

partnerships with a network of rural healthcare systems, first and foremost. In the event that a

particular rural market lacks a healthcare system compatible for partnership, the Organization will

pivot its efforts toward partnering directly with rural school systems.

b. Market Opportunity – As previously mentioned, according to a 2015 study published within

The Journal of Athletic Training, only 37% of U.S. public secondary schools had full-time athletic

training services.xvi While the need for full-time school-based sports medicine services is well

supported, like many areas of healthcare, the barriers to solving such access problems can often be

a tangled web.

Most notably, as previously mentioned, full-time sports medicine coverage is simply not

currently offered to many rural school systems. As such, the current diminutive presence of sports

medicine services within rural communities should not be viewed as reflective of consumer apathy

within the market; rather, it should be viewed as reflective of an access barrier to full-time sports

medicine services within the market. Via its service offerings, the Organization intends to solve

this access barrier and capitalize on the corresponding market opportunities.

c. Market Competition – As previously discussed, competition within the “athletic training

23

staffing” or “sports medicine consulting” sector appears to be fairly limited. An extensive internet-

based review of companies providing such services was relatively unfruitful, with a limited number

of companies currently in operation, including those previously discussed that offer sports medicine

consulting services distinguishable from those offered by the Organization.

However, in the narrow sense, competition within the “rural athletic training staffing” or “rural

sports medicine consulting” sector appears to be largely non-existent. As an example, while it

appears one company does offer athletic training staffing to a limited number of rural communities

in New Jersey, New York and Pennsylvania, it appears that company’s main focus is on the urban

communities within those states.xvii Thus, it appears a market competitor would not be found within

the vast majority of rural communities. Consequently, market competition within this sector should

not be considered a material barrier to the Organization’s success.

d. Capital Requirements – Because the Organization will not attempt to penetrate markets via

broad-based marketing efforts, the budgeted marketing expenses will be relatively small.

Specifically, the Organization has budgeted $9,000.00 for marketing expenses in Year 1 of

operations, and $6,000.00 for marketing expenses in both Year 2 and Year 3 of operations. The

majority of the budgeted marketing expenses in Year 1 will be tied to the development of print-

based materials (e.g. brochures, pamphlets, etc.), website development and limited search engine

optimization. Additionally, reasonable travel and entertainment expenses will be necessary to

support partnership development activities in Year 1 and thereafter in perpetuity. Consequently,

given the limited amount of expenses allocated to marketing activities, the Organization’s

marketing expenses will not be a highly material line item within its operational budget.

C) Marketing Strategy - As previously mentioned, the Organization’s marketing strategy will focus

upon relationship-building with rural healthcare systems and rural school systems. Consequently,

the Organization’s marketing strategy will shy away from broad-based business-to-consumer

opportunities and instead emphasize the coordination of face-to-face meetings and similar “direct

sales-esque” initiatives. Additionally, as previously mentioned, a limited amount of operational

24

funding will need to be provided for the development of print-based materials (e.g. brochures,

pamphlets, etc.), website development and limited search engine optimization. However, the

Organization’s marketing strategy should require far less capital outlay than the upfront

expenditures tied to the marketing of most new healthcare organizations.

D) Implementation of Marketing Strategy - Absent obtaining the full-time commitment from the

Organization’s two Members, there should not be extensive barriers to implementation of the

marketing strategy. Simply put, upon the completion of its standard legal and financial formation

responsibilities, the Organization may initiate its marketing strategy, most notably efforts to build

relationships with, and procure agreements from, rural healthcare systems and rural school systems

identified as possible partners.

25

Part III: Financial Documents

A) Summary of Financial Needs – The majority of the Organization’s long-term financial

expenditures will be tied to the employment of athletic trainers, an expense line that will be a “pass-

through” to the rural school system partners and not initiated until after the Organization begins

providing sports medicine services at affiliated secondary schools. Consequently, the

Organization’s initial financial needs will be relatively limited.

a. Financing - As previously mentioned, both the C.E.O. and Chief Clinical Officer will be

equity Members of the Organization and it is expected that they will forgo a salary draw until the

Organization is profitable. Additionally, it is anticipated that they will jointly provide a $50,000.00

loan to the Organization, which will be used to fund the Organization’s initial financial needs. It is

anticipated that the Organization will pay back this loan over the course of five years at a 5% APY,

resulting in a cumulative $57,744 expense (i.e. $50,000 in principal and $7,744 in interest) to the

Organization for the initial capital.

b. The Capital Outlay - As detailed within the following table, it is anticipated that this initial

$50,000.00 loan will fully fund the Organization’s initial startup expenses:

Expense Description Expense Amount Notes (* denotes expense applies to both Members)Fringe Benefit Expense - Health Insurance 10,800$ $600 per month* (Per www.Healthcare.gov)

Fringe Benefit Expense - Cell Phone Stipend 1,800$ $100 per month*

Marketing Expenses - Website Development 2,500$ $2,500 one-time fee for the development of a website

Marketing Expenses - Promotional Materials 2,500$ $2,500 one-time fee for the development and production of promotional materials

Travel Expenses - Lodging, Gas and Meals 9,750$ Lodging $125 per night, 2 nights per week*/Gas $300 per week/Meals $50 per day, 2 nights per week*

Business Development Expenses - Meals with Clients 3,000$ $100 per meal, 2 days or nights per "travel week"

Accounting and Legal Fees 4,455$ Initial business formation fees and expenses

Miscellaneous Expenses 1,125$ Funds set aside for unforseen expenses and/or budget variances

Total Expenses 35,930$

Initial Startup Expenses (Encompasses First 9 Months of Operations)

26

c. Resource Costs Associated/Opportunity Costs - Given the startup nature of the Organization,

there are no opportunity costs incurred by the Organization directly via its formation. Indirectly, it

is assumed that both the C.E.O. and Chief Clinical Officer will forego other gainful employment

opportunities to form the Organization, although their Member status will provide them with long-

term financial upside that should offset any initial opportunity costs they personally incur.

B) Key Assumptions - The financial projections are based upon the assumption that the

Organization’s partnerships will be split evenly between rural healthcare systems and rural school

systems (hereinafter referred to as the “Partnership Ratio”). A large variance in this projected

“Partnership Ratio” will have a material impact on numerous expense line items within the financial

statements, namely “Athletic Trainers Staff Salary” expense, “Athletic Trainers Staff Benefit”

expense and “Medical Supplies” expense. However, these expenses are essentially a “pass-

through” to the rural school system partners, so any increase in these expense line items will result

in a corresponding increase in the “Employment Expense Reimbursement” revenue line item.

Consequently, a large variance in the projected “Partnership Ratio” will not materially affect the

projected operating income figures.

C) Pro Forma Cash Flow Statement (Budget) – Please see Exhibit “E” to this proposed business

plan.

D) Three-Year Income Projection - Please see Exhibit “F” to this proposed business plan, which

sets forth both a summarized three-year income projection and a monthly income projection over

the first three years of operations.

E) Projected Balance Sheet - Please see Exhibit “G” to this proposed business plan.

F) Break-Even Analysis - The break-even analysis can be calculated through two different focal

points: the Organization and the Members. The Organization will break-even upon the payment of

the Year 1 consultant-based contractual fees on or about July 1st (i.e. the start of the academic year).

As provided within Exhibit “E,” the Year 1 Pro Forma Cash Flow Statement, this funding, coupled

with the Member’s investment funding, will provide a sufficient amount of capital to ensure the

27

Organization remains solvent throughout the first year of operations and in perpetuity thereafter.

The Member’s break-even point, calculated by the date in which the Member’s

compensation and other financial allocations exceed their initial $50,000.00 investment funding,

will occur at a later date, likely by the end of Year 2 of operations. As provided within Exhibit “F,”

the Three-Year Income Projection, it is anticipated that by the end of Year 2 of operations, the

Organization will have repaid the Members $23,098.00 of their initial investment funding and paid

the Members $40,000.00 cumulatively in salary. Coupled together, these two line items exceed the

Member’s initial $50,000.00 investment funding, rendering the end of Year 2 as the Member’s

break-even point.

G) Financial Statement Analysis – Cumulatively, the financial statements demonstrate that

adequate cash flow will be a material issue for the Organization during the first two years of

operation.

Specifically, the Members’ initial $50,000.00 investment loan will provide adequate

capital for the Organization’s first nine months of operations, at which point the Organization will

receive its consultant-based contractual fees for services provided during its first academic year.

This influx of cash, estimated to be $96,000.00 in Year 1, will ensure the Organization is financially

solvent over the next twelve months.

Perpetually thereafter, to remain financially solvent, the Organization will be dependent

on adequate and timely payment of its consultant-based contractual fees at the beginning of each

academic year. Of note in this regard, given the relative high solvency of governmental entities,

such as school systems, the effects of a payment default are not considered within the Financial

Statements; however, in the event of a default, it is likely that the Members would be forced to

forgo their salary and/or provide an additional investment loan until sufficient capital is received.

However, outside of the aforementioned cash flow concerns, as previously mentioned,

the balance of the financial statements reflect an organization that is on solid footing, at least

relatively for a start-up company. Of note, the Organization is projected to finish each of its first

28

three years of operation with an operating surplus and a positive owner’s equity balance by the end

of Year 2. In addition, the Organization is projected to provide salary-based compensation to its

two Members starting in Year 2, with the Member’s initial Investment Loan paid off, with interest,

by the end of Year 5. Cumulatively, assuming any cash flow-related problems are overcome, the

Organization’s financial statements demonstrate that the Organization should be on relatively solid

financial footing from the onset of operations.

29

Part IV: Innovative Elements and Expected Business Outcomes

A) Why and How Does This Business Positively Impact Health – The Organization’s core services

will undoubtedly raise the standard of care afforded to rural secondary school student-athletes. As

previously referenced, the following was set forth in a 2017 study published within The Journal of

Athletic Training:

It is crucial to have an [athletic trainer] on site, especially in remote locations

where emergency response times are longer. Grossman et al investigated

differences in prehospital care between urban and rural areas and found the mean

emergency response time for urban locations was 7.0 minutes, compared with 13.6

minutes in rural locations. In addition to response time, scene time and transport

time were also longer for rural areas. Once at the scene of the incident, traveling

to the hospital took 9 minutes longer in rural than urban locations. A more shocking

finding that offers the best justification for [athletic trainers] in remote areas is that

victims in rural settings are at more than 7 times the risk of death than their urban

counterparts if the emergency response exceeds 30 minutes. Employing on-site

[athletic trainers] in these remote schools ensures immediate medical attention

and care: life-preserving skills such as cardiopulmonary resuscitation and

automated external defibrillator (AED) application can be performed by a medical

professional until emergency services arrive.xviii

As a further illustration, a study published in 2018 examined the effect that reduced

access to athletic trainers has on the medical care provided to student-athletes. The results,

published within The Journal of Athletic Training, included the following conclusion:

Given the significant public health burden that adolescent [sport-related

concussions] impose, [athletic trainer] availability is crucial to rapidly identifying,

assessing, and managing patients with not only [sport-related concussions] but all

injuries and medical conditions that may occur during sporting events.xix

30

Given the aforementioned current deficiency of athletic trainer coverage within rural secondary

schools, and the research supporting the clinical benefits of the full-time presence of athletic

trainers, the Organization’s positive impact upon the health of rural student-athletes is self-evident.

B) Challenges Encountered – I encountered numerous challenges during the preparation of this

proposed business plan, the majority of which are undoubtedly encountered by all similarly-situated

Fellowship candidates (i.e. balancing personal and professional responsibilities with the time

commitment required to adequately prepare this submission). However, from a substantive

perspective, the most notable challenge was tied to the somewhat obscure nature of sports medicine

services to most members of the general public.

Simply put, many community members, including individuals with decision-making authority

over sports medicine services, incorrectly assume that the quality of care afforded via a sporadic

presence by community-based medical providers (e.g. EMS staff) is equivalent to that provided by

the full-time presence of an athletic trainer. Given the practical effect of such a large information

gap, it was imperative for me to construct the proposed business plan in a manner that allowed the

layperson to not only understand this issue, but become empathetic to the plight encountered by

student-athletes within rural communities. While my hope is that this proposed business plan

adequately addressed this challenge, I can say with certainty that my focus on doing so resulted in

a substantial increase in my knowledge base on this subject.

C) Next Steps – In order for the Organization to move forward with formation, numerous steps

would need to occur. First and foremost, a C.E.O. and a Chief Clinical Officer would need to form

and lead the Organization; as previously mentioned, these individuals would not only have to

possess distinct educational training and professional experience, they would also need to possess

the personal financial solvency to fund the Organization’s startup expenses, forgo the receipt of

salary for an extended period of time and bypass other gainful employment opportunities. Simply

put, finding two such individuals would not be an easy task, rendering this proposed business plan

purely theoretical at this point in time.

31

However, assuming these roles are filled, and after the standard business formation legal

requirements are satisfied, the Organization could begin to execute on the timeline referenced

previously within the Operational Plan, namely the identification of target markets and the initiation

of relationship-building activities. Assuming such efforts are fruitful, it is anticipated that the

Organization’s initial services could begin being provided within nine-to-twelve-months.

32

Works Cited

i Pryor RR, Casa DJ, Vandermark LW, et al. Athletic training services in public secondary schools:

a benchmark study. J Athl Train. 2015;50(2):156–162. doi:10.4085/1062-6050-50.2.03 (emphasis

added).

ii McGuine TA, Pfaller AY, Post EG, Hetzel SJ, Brooks A, Broglio SP. The Influence of Athletic

Trainers on the Incidence and Management of Concussions in High School Athletes. J Athl Train.

2018;53(11):1017–1024. doi:10.4085/1062-6050-209-18.

iii Pike AM, Pryor RR, Vandermark LW, Mazerolle SM, Casa DJ. Athletic Trainer Services in

Public and Private Secondary Schools. J Athl Train. 2017;52(1):5–11. doi:10.4085/1062-6050-

51.11.15 (emphasis added).

iv JAG-ONE-ATC Athletic Training Services - https://jagonept.com/sports-medicine/athletic-

training/

v U.S. Council for Athletes’ Health – https://www.uscah.com/

vi Walters, Inc. Consultants in Sports Medicine - https://rodwalters.com/

vii Mayo Clinic to Test Sideline Teleconcussion Robot at NAU Football Games -

http://www.vgocom.com/mayo-clinic-test-sideline-teleconcussion-robot-nau-football-games

viii Mazerolle SM, Raso SR, Pagnotta KD, Stearns RL, Casa DJ. Athletic Directors' Barriers to

Hiring Athletic Trainers in High Schools. J Athl Train. 2015;50(10):1059–1068. doi:10.4085/1062-

6050-50.10.01 (emphasis added).

ix Pike AM, Pryor RR, Vandermark LW, Mazerolle SM, Casa DJ. Athletic Trainer Services in

Public and Private Secondary Schools. J Athl Train. 2017;52(1):5–11. doi:10.4085/1062-6050-

51.11.15 (emphasis added).

x McGuine TA, Pfaller AY, Post EG, Hetzel SJ, Brooks A, Broglio SP. The Influence of Athletic

33

Trainers on the Incidence and Management of Concussions in High School Athletes. J Athl Train.

2018;53(11):1017–1024. doi:10.4085/1062-6050-209-18.

xi AT Efficiency - Healthy Roster Data Analysis Report -

https://static1.squarespace.com/static/55162543e4b0dfcc47bb7b16/t/5b212e6c03ce64490306229

6/1528901229328/AT+Efficiency+-+AT+ROI+Report.pdf

xii Leath BA, Dunn LW, Alsobrook A, Darden ML. Enhancing Rural Population Health Care

Access and Outcomes Through the Telehealth EcoSystem™ Model. Online J Public Health

Inform. 2018;10(2):e218. Published 2018 Sep 21. doi:10.5210/ojphi.v10i2.9311.

xiii Pryor RR, Casa DJ, Vandermark LW, et al. Athletic training services in public secondary

schools: a benchmark study. J Athl Train. 2015;50(2):156–162. doi:10.4085/1062-6050-50.2.03.

xiv Potteiger KL, Potteiger AJ, Pitney W, Wright PM. An Examination of Concussion Legislation

in the United States. The Internet Journal of Allied Health Sciences and Practice. 2018 Apr

05;16(2), Article 6.

xv McGuine TA, Pfaller AY, Post EG, Hetzel SJ, Brooks A, Broglio SP. The Influence of Athletic

Trainers on the Incidence and Management of Concussions in High School Athletes. J Athl Train.

2018;53(11):1017–1024. doi:10.4085/1062-6050-209-18.

xvi Pryor RR, Casa DJ, Vandermark LW, et al. Athletic training services in public secondary

schools: a benchmark study. J Athl Train. 2015;50(2):156–162. doi:10.4085/1062-6050-50.2.03.

xvii JAG-ONE-ATC Athletic Training Services - https://jagonept.com/sports-medicine/athletic-

training/

xviii Pike AM, Pryor RR, Vandermark LW, Mazerolle SM, Casa DJ. Athletic Trainer Services in

Public and Private Secondary Schools. J Athl Train. 2017;52(1):5–11. doi:10.4085/1062-6050-

51.11.15 (emphasis added).

xix McGuine TA, Pfaller AY, Post EG, Hetzel SJ, Brooks A, Broglio SP. The Influence of Athletic

34

Trainers on the Incidence and Management of Concussions in High School Athletes. J Athl Train.

2018;53(11):1017–1024. doi:10.4085/1062-6050-209-18.

35

Exhibit “A”- Draft Template Agreement Between the Organization and a Rural Healthcare

System

SPORTS MEDICINE CONSULTING SERVICES AGREEMENT

BETWEEN

_____________________________

AND

_______________________, LLC

This Sports Medicine Consulting Services Agreement (this “Agreement”) is made and entered into this

________ day of _______________________ 20______, (“Effective Date”) by and between

________________________ (“Rural Healthcare System”) and ___________________________,

LLC (the “Organization”). Rural Healthcare System and the Organization are sometimes referred

to in this Agreement individually as a “Party” and collectively as the “Parties.”

WHEREAS, Rural Healthcare System provides _____________________________ care to serve the

healthcare needs of ____________________ and its surrounding areas;

WHEREAS, Rural Healthcare System desires to collaborate with the Organization to design,

develop and provide strategic consultation to develop and coordinate sports medicine services

through Rural Healthcare System;

WHEREAS, the Organization is uniquely experienced in working collaboratively with healthcare

systems in the development and coordination of sports medicine services and is qualified to render

the services contemplated hereunder; and

WHEREAS, Rural Healthcare System desires to contract with the Organization to provide certain

sports medicine consulting services for Rural Healthcare System and the Organization desires to

provide such services.

NOW THEREFORE, IN CONSIDERATION OF THE MUTUAL PROMISES CONTAINED

HEREIN, the Parties do hereby agree as follows:

36

I. Responsibilities of the Organization

A. Services. Rural Healthcare System hereby engages the Organization to provide the

Services described in Exhibit “A,” attached hereto (the “Services”). The Organization hereby

accepts such responsibility and agrees to perform the Services on the terms and conditions set

forth herein.

B. Performance of Services. Furthermore, the Organization hereby covenants and

agrees that at all times during the term of this Agreement it will make a reasonable effort to:

1. Promptly and professionally carry out all of the Services required hereunder.

2. Comply with all applicable provisions of federal, state, local and other laws related to

the Services to be provided hereunder and shall abide by all reasonable administrative

rules, regulations, and all applicable policies and procedures of Rural Healthcare

System.

3. Maintain a positive and productive working relationship with all employees of Rural

Healthcare System, as well as professional peers, in providing the Services

contemplated hereunder.

II. Responsibilities of Rural Healthcare System. Rural Healthcare System hereby covenants and

agrees to the following:

A. Compensation. Rural Healthcare System agrees to pay the Organization Twelve

Thousand Dollars ($12,000.00) per year, per secondary school covered by the developed sports

medicine outreach program, for the Services performed pursuant to this Agreement, payable on or

before July 1st of each contract year. The Parties each acknowledge that, after reasonable inquiry,

they intend and believe the compensation provided to the Organization within this paragraph II(A)

to constitute fair market value for the geographic area in which the Services are performed.

B. Management Liaison. A Rural Healthcare System manager shall be responsible for the

day-to-day immediate oversight and direction of Rural Healthcare System’s employed athletic

trainers and other sports medicine staff. She or he will collaborate with the Organization on the

37

utilization of such athletic trainers and other sports medicine staff.

III. Terms and Conditions.

A. Term. This Agreement shall commence on the Effective Date and will continue

thereafter for a term of one (1) year.

B. Termination.

1. Termination Without Cause. Either Party may terminate this Agreement for any

reason, or no reason, upon one hundred and eighty (180) days’ prior written notice to

the other Party.

2. Termination For Material Breach. If either Party becomes aware of a material

breach by the other Party of an obligation of the other Party under this Agreement, the

non-breaching Party may give to the breaching Party written notice of that breach in

sufficient detail to enable the breaching Party to understand the specific nature of the

breach. If the breaching Party fails to cure the breach within thirty (30) days of the

giving of that notice, the non-breaching Party may thereafter terminate this Agreement

immediately by giving to the breaching Party of further written notice of termination.

C. Nature Of Relationship. It is expressly acknowledged that this Agreement is not

intended, nor shall be construed to create, an employer-employee relationship, principal-agent

relationship, joint venture or legal partnership between Rural Healthcare System and the Organization.

D. Entire Agreement. This Agreement contains the entire agreement between the Parties

with respect to the subject matter herein, and no prior verbal agreements shall be effective to vary

the terms of this written Agreement. Except as otherwise provided in this Agreement, no amendment

of this Agreement shall be effective unless reduced to writing and signed by both Parties.

E. No Waiver. No waiver of a breach of any provision of this Agreement shall be construed

as a waiver of any other breach of this Agreement, and no delay in acting with regard to any breach

shall be construed as a waiver of said breach.

F. Applicable Law and Venue. This Agreement and any amendments hereto shall be

38

governed by and construed and enforced in accordance with the laws of the State of _____________.

Venue of any legal proceedings arising from this Agreement will lie solely and exclusively in

__________ County, ____________.

G. Notices. Any notices required or permitted hereunder shall be sufficiently given if

personally delivered or sent by registered mail, return receipt requested, postage prepaid and

addressed as follows or to such addresses as shall be furnished in writing by either Party to the

other:

If to Rural Healthcare System:

__________________________

__________________________

__________________________

Attn: Legal Department

If to the Organization:

__________________________

__________________________

__________________________

Attn: Chief Executive Officer

Such notice shall be deemed to have been given, if mailed, as of the date mailed, and, if personally

delivered, as of the date delivered.

IN WITNESS WHEREOF, Rural Healthcare System and the Organization have executed this

Agreement as of the day and date first written above.

________________________________

[Rural Healthcare System]

By:

Its: ___________________________

Date: __________________________

39

___________________________, LLC

[The Organization]

By:

Its: ___________________________

Date: __________________________

EXHIBIT “A” – Services Description

Sports Medicine Consulting Services: To assist Rural Healthcare System in its development and

subsequent coordination of a sports medicine outreach program, the Organization will provide the

following services as outlined herein.

1. Sports Medicine Outreach Program Development – the Organization, in conjunction with Rural

Healthcare System, shall provide the following services:

a. Review existing strategic plan documents for compatibility with the development

of a sports medicine outreach program;

b. Identify necessary equipment and capital purchases or investments to establish a

sports medicine outreach program;

c. Make recommendations to Rural Healthcare System with respect to contracts for

products, items and services needed for the development of a sports medicine

outreach program.

2. Personnel Development and Training of Rural Healthcare System’s Athletic Trainers and Other

Sports Medicine Staff - the Organization agrees to:

a. Advise Rural Healthcare System regarding the staffing requirements needed for

the development of a sports medicine outreach program;

b. Develop clinical competencies for the periodic review and evaluation of athletic

trainers and other sports medicine staff;

c. Open access to Rural Healthcare System’s athletic trainers and other sports

medicine staff for any training made available to staff of the Organization.

40

3. Recruitment of Athletic Trainers and Other Sports Medicine Staff - the Organization and Rural

Healthcare System agree to the following:

a. The Organization will assist in the development of effective programs for the

recruitment of athletic trainers and other sports medicine staff for Rural Healthcare

System’s sports medicine outreach program;

b. The Organization will assist the Rural Healthcare System in evaluating credentials,

competence and professional conduct of Rural Healthcare System’s athletic

trainers and other sports medicine staff.

4. Communication between Rural Healthcare System and the Organization – as permitted by the

availability of the Organization and Rural Healthcare System staff members, the Parties agree to

the following communication schedule:

a. Weekly by Phone or Video;

b. Monthly Face-to-Face Meeting at Rural Healthcare System’s administrative

offices.

41

Exhibit “B” - Draft Template Agreement Between the Organization and a Rural School

System

AGREEMENT FOR CERTIFIED ATHLETIC TRAINER SERVICES

THIS AGREEMENT is entered into ____________ ____, 20________ between

__________ HIGH SCHOOL (“the School”), through its duly authorized school board

__________________ (“the School Board”), and __________________, LLC, a ______________

limited liability company (“the Organization”). In this Agreement, the School, the School Board

and the Organization are sometimes referred to individually as “Party” and collectively as the

“Parties.”

WHEREAS, the School is a secondary school located within __________ County,

______________ that is operated under the auspices of the School Board;

WHEREAS, certain students of the School (“Players”) participate in non-intramural football and

Olympic Sports in connection with the School’s athletic program;

WHEREAS, the School Board desires to have available to the School’s Players certain services of

a certified athletic trainer;

WHEREAS, the Organization employs a certified athletic trainer that it is willing to make available

to the School to provide certain services to the School’s Players as more fully described below;

WHEREAS, the School Board desires to have such services of a certified athletic trainer made

available to the School’s Players under the terms and conditions set forth in this Agreement.

NOW THEREFORE, IN CONSIDERATION OF THE MUTUAL PROMISES CONTAINED

HEREIN, the Parties do hereby agree as follows:

I. Certified Athletic Trainer. Commencing on _______________, 20_____, the Organization will

provide one (1) certified athletic trainer who shall provide those services to the School’s Players

that are set forth in Paragraph II.

II. Services To Be Provided. Services provided under this Agreement shall consist of the following,

subject to the availability of the certified athletic trainer:

42

A. Coverage at all home and away varsity football games;

B. Coverage for Olympic Sports and during football practices to the extent the certified

athletic trainer is available. As a non-exhaustive list, this dedicated coverage includes coverage for

the players and cheerleaders at home Olympic Sports events and appropriate coverage for all other

fall, winter and spring athletic teams and events;

C. The certified athletic trainer will be available to provide services to student-athletes at

the time and location requested by school administration, including summer practices, weekend

events and weekday morning activities. The certified athletic trainer shall be present and ready to

provide services on normal school days by 2:30 p.m. and up to one hour before Saturday practices

or competitions;

D. Consultation with the School staff and administrators concerning Players’ health care

upon receipt of appropriate authorizations from Players;

E. Provision of appropriate on-site and clinical diagnosis and treatment of injuries and

illnesses sustained by Players during practices or games;

F. The certified athletic trainer will be responsible for the Organization, inventory, and

requisition of all training room supplies and needed equipment;

G. The certified athletic trainer will provide baseline concussion testing to the School’s

Players via the concussion testing program selected by the School Board. The certified athletic

trainer will be certified or willing to obtain certification for the concussion testing program selected

by the School Board. Such services will be provided at the time and location requested by the

School’s administration;

H. The certified athletic trainer will provide services to students participating in the

marching band, dance team and other performing arts programs as requested by the School’s

administration;

I. The certified athletic trainer will provide coverage at Special Olympics events as

requested by the School’s administration;

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J. The certified athletic trainer will assist with sports medicine educational and community

activities held on the School’s campus, including, but not limited to, sports medicine student

interest groups as requested by the School’s administration;

K. As requested by the School’s administration, the certified athletic trainer will provide

informational training to teachers and staff about various sports medicine-related issues (e.g.

“Return to Learn” concussion protocols).

The services described in this Paragraph are all of the services to be furnished to the School by the

Organization pursuant to this Agreement, except for non-remunerated, non-professional volunteer

services. The aggregate services provided for in this Agreement are not intended to and do not

exceed the reasonable and necessary services for the purpose of the School to have available to its

Players the services of a certified athletic trainer.

III. Approval By The School. Any certified athletic trainer provided to the School by the

Organization shall be provided subject to the prior approval of the School. The Organization shall

require the certified athletic trainer to be licensed by the State of _______________, submit to a

criminal background check, and comply with any associated requirements established by state or

federal law or by the policies of the School Board.

IV. Compensation. For the services of the Organization in providing a certified athletic trainer to

the School under this Agreement, the School Board will compensate the Organization the sum of

Twelve Thousand Dollars ($12,000.00), payable on or before July 1st of each contract year.

Additionally, upon the receipt of an invoice issued monthly by the Organization, the School Board

will reimburse the Organization for the actual expenses incurred by the Organization for the

employment of the certified athletic trainer. Additionally, the School Board will reimburse the

Organization the sum of Five Thousand, Four Hundred Dollars ($5,400.00), payable on or before

July 1st of each contract year, for baseline concussion tests and other medical supplies provided by

the Organization and utilized by the certified athletic trainer at the School.

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V. Fair Market Value Compensation and Compliance. It is the intention and understanding of the

Parties that the compensation to be provided to the Organization set forth in Paragraph IV of this

Agreement constitutes fair market value compensation for the services to be provided by the

certified athletic trainer to the School.

VI. Status Of The Parties. Any certified athletic trainer assigned under this agreement shall remain

under the control and supervision of the Organization and shall be compensated exclusively by the

Organization. The School Board shall have no responsibility to make any payment or provide any

benefit to such certified athletic trainer. The Organization shall retain the ultimate authority with

regard to hiring, firing and disciplining any assigned certified athletic trainer, provided, however,

that neither such authority nor any other conduct of the Organization shall interfere with the

independent professional judgment of the certified athletic trainer. The School Board shall have

the unilateral right to request that any certified athletic trainer assigned under this Agreement be

reassigned by the Organization and the Organization shall comply with any such request.

VII. Insurance And Third-Party Claims. The School Board and the Organization shall maintain

throughout the term of this Agreement liability insurance covering itself and all its agents and

employees.

VIII. Term. This Agreement shall continue for a term of one (1) year ending __________, 20_____.

This Agreement shall be automatically renewed from year to year thereafter unless, at least thirty

days before the anniversary date of this Agreement or any renewals thereof, one of the Parties

provides to the remaining Party written notice to terminate the same as of such anniversary date.

IX. Amendment. This Agreement may be amended by the mutual written agreement of the Parties

upon the anniversary date of this Agreement or any renewals thereof.

X. Jurisdiction And Venue. This Agreement shall be governed by and construed and enforced

under the laws of the State of _____________. The Parties submit to the jurisdiction before the

Circuit Court of ___________ County, ____________________ should any dispute arising from

the interpretation, performance, breach or default of this Agreement occur.

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XI. Binding Agreement. This Agreement shall be binding upon and inure to the benefit of the

Parties, their successors and assigns.

WITNESS the following signatures and seals.

_________________________________________

SCHOOL

By: _______________________________

Its: __________________________

_________________________________________

SCHOOL BOARD

By: _______________________________

Its: __________________________

_____________________________________, LLC

THE ORGANIZATION

By: ________________________________

Its: __________________________

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Exhibit “C” – The Organizational Chart

Organizational Chart During the Organization’s Initial Three-to-Five-Years of Operations

Organizational Chart Upon the Organization’s Maturation

Chief Executive

Officer

Director of Regulatory Compliance

Chief Clinical Officer

Athletic Trainer

Athletic Trainer

Athletic Trainer

Chief Executive

Officer

Director of Regulatory Compliance

Chief Clinical Officer

Regional Supervisor

Athletic Trainer

Athletic Trainer

Athletic Trainer

Regional Supervisor

Athletic Trainer

Athletic Trainer

Athletic Trainer

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Exhibit “D” – The Organization’s Initial Two-Year Operational Timeline

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Exhibit “E” – Pro Forma Cash Flow Statement (Budget)

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Exhibit “F” – Three-Year Income Projection

50

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52

53

Exhibit “G” – Projected Balance Sheet

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