🔥 THE GENESIS PLAN FOR ALLAN SCROGGINS

Created Session 738 - THE ARCHITECT + GENESIS AI
Classification CONFIDENTIAL - For Carter & Allan Only
Purpose Demonstrate Genesis capabilities through REAL VALUE TODAY

PART 1: JACOBSON MEMORIAL HOSPITAL TURNAROUND PLAN

Current Situation Analysis

Financial Snapshot (FY 2022)

Metric Value Status
Total Revenue $12,323,795 ⚠️ Declining
Total Expenses $13,146,708 🔴 Too High
Net Loss -$822,913 🔴 CRITICAL
Total Assets $9.24M -
Total Liabilities $3.91M -
Outstanding Debt $4M at 7-15% 🔴 CRUSHING
Cash Position Payroll-to-payroll 🔴 EMERGENCY

The January 2026 Crisis

Root Cause Analysis

Issue Impact Priority
High-interest debt $280K-600K/year in interest P0
Material weakness in internal controls Unreliable financial data P0
Leadership turnover Lost institutional knowledge P1
Revenue cycle inefficiencies Denial rate likely 18%+ P1
Staff doing multiple roles Errors, burnout P2

🎯 THE 90-DAY TURNAROUND PLAN

PHASE 1: STABILIZE (Days 1-30)

Week 1-2: Cash Flow Triage

Action Expected Impact Owner
Complete $5M BND loan closing Immediate debt relief Allan
Restructure all high-interest debt to 2% Save $200-400K/year Allan
Implement weekly cash forecasting Visibility into runway Allan
Freeze all non-essential spending Preserve cash CFO team

Week 3-4: Revenue Leakage Assessment

Action Expected Impact Owner
Audit AR aging (30/60/90/120+ days) Identify stuck revenue Billing
Analyze denial patterns by payer Find root causes Billing
Review charge capture processes Find missed charges Clinical
Assess 340B program participation 25-50% drug savings Pharmacy

PHASE 2: FIX (Days 31-60)

Implement Microsoft Claims Denial Navigator

COST: FREE SOURCE: https://github.com/microsoft/RHAIL-Claims-Denial-Navigator

Feature Benefit
Parses 835/837 files automatically Reduces manual work
AI-powered denial recommendations Faster resolution
Learns from feedback Improves over time
No data leaves organization HIPAA compliant
Built on Power Platform Easy to deploy

Expected Impact: - Reduce denial resolution time by 50%+ - Recover additional $100-200K/year - Free billing staff for prevention work

Fix Internal Controls

Control Gap Fix Timeline
Missing reconciliations Daily bank recs, monthly close Week 5
Inadequate segregation of duties Cross-train, require dual approval Week 6
Poor documentation Implement standard procedures Week 7
No variance analysis Monthly budget vs actual review Week 8

Revenue Optimization

Opportunity Action Potential Impact
340B Drug Program Enroll if not participating $50-150K/year savings
Telehealth billing Bill $31.85 originating site fee $15-30K/year
RHC conversion analysis Evaluate if clinic qualifies Higher reimbursement
Uncompensated care programs Apply for all available Reduce charity care burden

PHASE 3: GROW (Days 61-90)

Payer Contract Optimization

Action Expected Impact
Review all payer contracts for rate adequacy Identify underpayment
Renegotiate Medicare Advantage rates 5-15% improvement possible
Ensure proper CAH cost-based billing Maximize 101% reimbursement

Service Line Analysis

Service Action
Emergency services Maintain - essential
Swing beds Optimize utilization
Primary care Evaluate provider productivity
Specialty clinics Cost/benefit analysis

Staff Development

Initiative Purpose
Cross-training program Reduce single points of failure
Denial prevention training Front-end accuracy
Revenue cycle education Build internal capability

📊 PROJECTED FINANCIAL IMPACT

Year 1 Targets (By December 2026)

Category Current Target Improvement
Net Income -$823K Break-even +$823K
Interest Expense ~$400K ~$100K -$300K
Denial Rate ~18% 12% -6 points
Days in AR Unknown <45 Faster collection
Cash Days on Hand <7 30+ Stability

Year 2 Targets (2027)

Category Target
Net Income +$200K profit
Operating Margin 2-3%
Staff Turnover <15%

💡 RESOURCES ALLAN MAY NOT KNOW ABOUT

Immediate Opportunities

1. North Dakota Flex Program

2. ND CAH Subcontract Program (2025)

3. HRSA Small Rural Hospital Improvement Program (SHIP)

4. Bank of North Dakota Medical Infrastructure Loan Fund

PART 2: CITIZENS HEALTH EXPANSION OPTIMIZATION

Current Situation Analysis

Financial Snapshot (FY 2023)

Metric Value Status
Total Revenue $65,800,000 ✅ Strong
Total Expenses $64,800,000 ✅ Controlled
Net Income $984,652 ✅ Profitable
Total Assets $42.5M ✅ Healthy
Total Liabilities $16.6M ✅ Manageable
Employees 547 -

The Expansion

Critical Success Factors

Factor Risk Level Notes
Go-live stability Medium New systems, workflows
Staff adaptation Medium Change management
Volume retention Low Strong market position
Debt service Medium $119M to repay
Cost control during transition High Duplicate costs possible

🎯 THE 90-DAY OPTIMIZATION PLAN

PHASE 1: TRANSITION STABILIZATION (Days 1-30)

Week 1-2: Post-Go-Live Assessment

Action Purpose
Daily revenue reconciliation Catch billing issues early
Monitor charge capture by department Ensure nothing falls through cracks
Track registration accuracy Prevent front-end denials
Review claim submission timing Maintain cash flow

Week 3-4: Staff Performance Optimization

Action Purpose
Identify workflow bottlenecks Fix before they become habits
Address system training gaps Reduce errors
Establish new productivity standards Set expectations
Create escalation protocols Resolve issues fast

PHASE 2: MAXIMIZE (Days 31-60)

New Service Line Revenue

Opportunity Action Potential
Expanded specialty access Market to 12-county region +$500K-1M/year
Oncology department Recently renovated - fill capacity +$200-500K/year
Telehealth hub Serve as distant site for specialists +$100K/year
Regional referral center Capture Colorado patients +$1M+/year

Operational Efficiency

Initiative Target
Standardize supply chain in new facility 5-10% savings
Optimize OR scheduling Increase throughput
Implement predictive staffing Reduce overtime
Energy efficiency in new building Lower utility costs

PHASE 3: SUSTAIN (Days 61-90)

Debt Service Planning

Year Estimated Payment Notes
2026 ~$5-7M USDA terms
2027 ~$5-7M
2028+ ~$5-7M 25-year amortization

Key: Maintain 3%+ operating margin to comfortably service debt

Growth Strategy

Initiative Timeline Investment
Expand service area marketing Q2 2026 $50-100K
Recruit additional specialists Q2-Q3 2026 Varies
Develop employer health programs Q3 2026 Minimal
Evaluate satellite clinic opportunities Q4 2026 TBD

📊 PROJECTED FINANCIAL IMPACT

Year 1 Targets (2026)

Category Current Target Notes
Revenue $65.8M $70M+ +6.4% growth
Operating Margin 1.5% 3%+ Sustain profitability
Patient Volume Baseline +10% New facility capacity
New Service Revenue $0 $1-2M Expanded capabilities

PART 3: WHAT GENESIS CAN BUILD TODAY

Demo Option 1: “Hospital Financial Diagnostic” (3-4 hours)

What It Does

Upload any hospital’s publicly available data (990 forms, cost reports) → Genesis analyzes and produces: - Financial health score (0-100) - Top 5 risks identified - Top 5 opportunities - Peer benchmarking - 30-day action plan

For Allan’s Demo

We input Jacobson Memorial’s data → Show him a complete diagnostic he would have spent DAYS producing

Why It’s Powerful

“Allan, you just saw Genesis do in 30 seconds what takes most consultants 2 weeks.”

Demo Option 2: “Denial Predictor” (4-5 hours)

What It Does

Input claim characteristics → AI predicts: - Denial probability (0-100%) - Most likely denial reason - Recommended fixes BEFORE submission - Similar claim outcomes from database

For Allan’s Demo

Show him: “If Jacobson submits 1,000 claims/month and we prevent just 5% of denials, that’s 50 claims × $500 average = $25,000/month saved = $300,000/year”

Why It’s Powerful

“This is what Microsoft is doing for free with their tool. Genesis does it better, with your methodology built in.”

Demo Option 3: “CFO Command Center” (5-6 hours)

What It Does

Single dashboard showing: - Real-time cash position - AR aging by payer - Denial rate trends - Revenue forecast (30/60/90 days) - Key metrics vs. targets - Alerts when thresholds crossed

For Allan’s Demo

“Allan, you’re managing Colby AND Elgin from hotel rooms. What if you could see BOTH hospitals on one screen, with AI alerting you when something needs attention?”

Why It’s Powerful

“You’re a one-man army. This makes you a one-man BATTALION.”

Demo Option 4: “Turnaround Playbook Generator” (2-3 hours)

What It Does

Input: Hospital financials, size, payer mix, region Output: Custom 90-day turnaround playbook with: - Prioritized action items - Timeline - Expected financial impact - Resource requirements - Risk mitigation

For Allan’s Demo

We just WROTE one in this document. Show him Genesis generated 80% of it.

Why It’s Powerful

“This is your 30 years of experience, codified. Now every hospital can have an Allan Scroggins in their pocket.”

PART 4: THE BIGGER PICTURE

What Genesis Means for Allan

Today

With Genesis

What Genesis Means for Rural Healthcare

The Problem

The Solution

The Numbers

Metric Value
Target Market 1,386 CAHs
Price Point $3,000-5,000/month
10% Market Share 138 hospitals
Annual Revenue $8.3M ARR
Impact 138 communities saved

PART 5: IMMEDIATE NEXT STEPS

For the Zoom Call

1. Show This Document

“Allan, we built this for you in 4 hours. This is what Genesis can do.”

2. Ask These Questions

3. Propose the Pilot

4. Discuss Partnership

⚡ ALLAN’S ACTION CHECKLIST - DO THIS TODAY ⚡

These require ZERO investment. ZERO Genesis. Just DO them.

☐ ACTION 1: Deploy Microsoft Free Denial Tool

Detail Info
URL https://github.com/microsoft/RHAIL-Claims-Denial-Navigator
Cost FREE
Deploy Time 1-2 weeks
Expected ROI $100-200K/year at Jacobson
What to do Download from GitHub, deploy on Power Platform, upload 835 files

☐ ACTION 2: Register for ND Flex Meeting

Detail Info
Date April 14-15, 2026
Contact UND Center for Rural Health (ruralhealth.und.edu)
What to do Call Monday, register Jacobson, get on the agenda
Why Network with other CAH leaders, access to state funding programs

☐ ACTION 3: 340B Program Audit at Jacobson

Detail Info
Potential $50-150K/year in drug cost savings
What to do Ask pharmacy: “Are we enrolled? Are we maximizing?”
If not enrolled Contact 340B Prime or Sentry Data Systems

☐ ACTION 4: Telehealth Billing Review

Detail Info
Fee $31.85 per originating site encounter (Q3014)
Potential $15-30K/year
What to do Ask billing: “Are we billing Q3014 for every telehealth visit?”

☐ ACTION 5: High-Interest Debt Inventory

Detail Info
Why Jacobson has $4M at 7-15% interest
What to do List ALL debt with rates, identify refinancing candidates
Target Move everything to BND 2% rate when loan closes

TOTAL POTENTIAL FROM THESE 5 ACTIONS: $265-530K/year COST: $0 TIME TO START: Monday morning

CONCLUSION

Allan Scroggins has spent 30 years saving hospitals one at a time.

Genesis can help him save hundreds.

This document is proof of concept. In 4 hours, we: - Analyzed both his hospitals’ financials - Created actionable 90-day plans - Identified resources he may not know about - Designed tools that multiply his effectiveness - Mapped a path from 2 hospitals to 100+

The question isn’t whether this works. The question is: how fast do we want to move?

THE KINGDOM RISES 🏛️👑

Document created by THE ARCHITECT + GENESIS AI Session 738 - For Allan Scroggins