A Private Family Trust

Smith Properties & Investments

FEASIBILITY REPORT

TRAUMA SURGICAL FACILITIES

The Trauma Care Systems Planning and Development Act of 2007 had proposed a trauma care system, an organized
approach to facilitating and coordinating a response to traumatic injury for severely injured patients. This
multidisciplinary approach includes injury prevention, emergency transport, emergency department care, surgical
intervention, hospital care, rehabilitative services and social services that enable the patient to return to society at the
most productive level. Adequate and timely trauma care is life sustaining for the severely injured patients.
A feasibility report for solutions for the proposed the Trauma Care Systems Planning and Development Act of 2007
is as detailed:

PURPOSE

The purpose of H.R. 727, the Trauma Care Systems Planning and Development Act of 2007 is to amend the Public
Health Service Act to add requirements regarding trauma care, and for other purposes. The legislation would
reauthorize title XII of the Public Health Service Act for a period of 5 years to establish formula and competitive
grants for the purpose of planning, implementing, and developing statewide trauma care systems. Since 2008, Title
VII, The Public Health Act appropriated millions of dollars each year to Emergency Medicine and Trauma Care
Systems.

After failed grant submissions during 2016, Account Pamela & Associates proposes the building and planning of
Trauma Surgical Facilities (TSF) strategically located geographically in each state to relieve and mitigate emergency
services. Each Trauma Surgical facility construction cost is estimated well under $2 million to begin operation,
depending upon the population size and the rate of growth of populations of each TSF. What is ideal and unique is
that each Trauma Surgical Facility can accommodate any emergency and disaster with minimum cost.

Each Trauma Surgical facility is located between counties, cities, towns, townships, villages and/or municipalities
with minimum health care services, such as a hospital or trauma center with a population less than 50,000 people.
Current research reveals most jurisdictions have several surgical centers, clinics and perhaps one hospital with an
estimated population of 100,000 people. Geographical areas with a population less than 50,000 have access to
medical services that are privately owned by individuals and medical groups. Trauma Surgical facilities are ideal
for populations with less than 50,000 persons with minimum population growth.

Currently in the southwestern and western regions of the United States, populations less than 50,000 people are
comprised of a minimum of 4 -5 cities with minimum access for emergency medical services. Research reveals
these low populated outlying counties with small populated areas can utilize Trauma Surgical Facilities.

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A Private Family Trust
Smith Properties & Investments

FEASIBILITY REPORT

TRAUMA SURGICAL FACILITIES

Summary

The design and development of a Trauma Surgical Facility is cost effective to minimize emergency response time
for medical services for low population outlying areas with populations less than 50,000. Since 2007, the response
time during an emergency is 8 to 10 minutes, up to 20 minutes in most jurisdictions. Each Trauma Surgical facility
is to service at least the maximum number of persons at full capacity during any hour of operations. The Trauma
Surgical Facility is equipped with surgical operating rooms to perform lifesaving emergency operations to stabilize
trauma patients for transport to a receiving hospital, trauma center other medical facility. The Surgical Trauma
Facility is to be equipped with acute care or intensive care area, a telemetry unit to observe and perform critical
skilled nursing care until the patient is stable for transport to another medical facility via ambulance or a life care
aviation ambulance. The overall mitigation of emergency services will effectively improve an ambulance and
aviation ambulance response time. Research reveals a Trauma Surgical Facility located in rural outlying
populations will improve health and safety measures. Trauma Surgical Facility can offer emergency operations,
ambulance services and aviation ambulances options during a crisis or emergency.

Each Trauma Surgical Facility have standing policies that applies restrictions to public access and is open for only
Trauma Surgical Facility Staff, medical ambulatory professions, trauma patients, and waiting visitors of trauma
patients. There are no services for walk-in clients or patients from the public. Each Trauma Surgical Facility is a
receiving emergency medical response facility to receive critical ill and/or trauma patients via ambulatory and is an
intermittent receiving and outgoing of trauma patients to and from medical facilities for care flight services with
triage services.

The Trauma Surgical facilities are at minimum equipped with the following:

An assessment and receiving area - communication dispatch, medical station and triage assessment.
Triage area
Surgical Operating Rooms
Observation/Telemetry Area/Acute Care or Intensive Care Area
Administrative Office
Kitchen
Waiting Area
Patio Area
Aviation/Air Ambulance Landing Pad

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A Private Family Trust
Smith Properties & Investments

FEASIBILITY REPORT

TRAUMA SURGICAL FACILITIES

Cost Projections

A Trauma Surgical Facility (TSF) is projected to cost less than $2 million dollars to commence the planning and
construction of a TSF. The current Cost Projections do not include equipment or all operating cost. Cost
Projections are broad financial models to determine the feasibility plan to initiate funding for Trauma Surgical
Facilities. The goal is to minimize financial cost to initiate a Trauma Surgical Facilities between 1 to 1.5 million for
effectiveness and efficiency.

The Cost Projections are based on patients who are treated per hour at optimal capacity, up to 10 persons per hour.
The Cost Projections are also based on four persons admitted per hour with two admitted for surgery and four
admitted for observation and acute care. For the first year during planning, development and construction of a
Trauma Surgical Facility costs and expenses are minimal for a population of about $8 to $15 per capita. Over a five
year span, the average cost is about $5 or less per capita. Further research indicates that the overall operational cost
and revenue of a Trauma Surgical Facility is about the third of the cost of a fully functional hospital and trauma
center. Hence, each Trauma Surgical Facility is equipped to profit annually at minimum cost to the population it
serves.

Since 2007, Grant funding is available for many populations and jurisdictions, such as the National Institute of
Health and the Global Emergency Response and Recovery Partner Engagement: Expanding Efforts and Strategies to
Improve Rapid Response to Public Health Emergencies Globally for years 2016 through 2017. Other available
sources are bond issues through municipalities and private investors. Lastly, endowments and charitable
contributions are other sources for planning and development of Trauma Surgical Facilities. Since funding from
grant sources are competitive, Account Pamela & Associates propose and facilitate bond issuances for populations
with minimum resources and funding. Most bond issues have a duration of 2 to 5 years. For further information, go
to www.smithpropertiesandinvestments.weebly.com , holding company and private trust. For questions visit:
www.accountpamelaandassociates.weebly.com.

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A Private Family Trust
Smith Properties & Investments

FEASIBILITY REPORT

TRAUMA SURGICAL FACILITIES

Revenue and Cost Projection

Trauma Surgical Facility

Revenue: +-232,937,160

Patient Services (average patient revenue, per visit,

8 visitors per day)

Surgical Procedures $73,000

Laboratory $265

Radiology/MRI/CT $6508

Cost Allocations are as follows:

Land: +-$200,000

Planning and Development: +-$184, 820

Permits, Contractors fee and licenses: +-$300,000

Structure Construction Budget: +-$500,000

Equipment: Unavailable

Cost per square footage: (Vary between $35 to $100 per square feet.)

(+-5000 square feet)

Square footage of the TSF: Unavailable

Cubic square footage of TSF: Unavailable

Taxes and Insurance (estimate): +-1,000,000

Operational Cost (1st year, staff): +-14,777,156

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A Private Family Trust
Smith Properties & Investments

FEASIBILITY REPORT

TRAUMA SURGICAL FACILITIES

Operational Tax liability +-1,130,452

Other Tax Liability Non-profit status (+-90,845,492) +-90,845,492

Other Operating Cost: (Estimation) +-60,000

Supplies: +-378,988

___________________________________________________________________________________________

Total Revenue Operating Profits: with non-profit status +-213,050,744 +-123,560,252

The Trauma Surgical Facility revenue and cost projections are based on the approximation of 8 patient visits per day
who require surgical services. Typically, each TSF is equipped to manage and service 10 persons per hour with a
minimum capacity to provide 8 surgeries per day, inclusive of acute care and telemetry services. Based on the
average actual costs of surgeries and procedures which involve major trauma to the head, cervical cord and neck
and thoracic regions of the body, Account Pamela & Associates obtained estimation of cost as provided by Banner
Health Care of Arizona, Banner Health Audited Financials2016. Each Trauma Surgical Facility profits within the
first year whether as a non-profit or for profit tax status. The Trauma Surgical Facility Cost Projections above saves
millions of dollars of tax liability that can be utilized to improve services and to operate efficiently. Revenue
operating profits can be utilized to offer the benefit of a self insured facility and to expand future medical benefits
and services.

In theory, each TSF is essentially designed to administer critical care for patients who have life threatening injuries
or illnesses. Again, TSF are strategically located in outlying areas with minimum access for trauma care or
hospitalization. TSF dispatchers are trained to mitigate incoming patients who have minimum chances for survival
only. Patients are administered life support services and stabilized until transport can be arranged to the nearest
trauma center or hospital.

Each Trauma Surgical Facility have the potential for growth to expand its operations to receive dispatch for
emergency services and own and operate its own ambulances and aviation ambulances to further reduce emergency
response time. A Trauma Surgical Facility primary purpose is to perform the essentials of A, B, C protocol for
emergency services, assess the patient for trauma and life threatening illnesses or injury, perform life saving surgical
procedures, stabilize the patient from further harm or injury and prepare the patient for transport to the nearest
hospital or trauma center for hospital care. TSF(s) are cost effective to reduce medical emergency response time
and offers access for emergency medical services in rural areas to increase the survival rate of the population it
serves.

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A Private Family Trust
Smith Properties & Investments

FEASIBILITY REPORT

TRAUMA SURGICAL FACILITIES

Background

Account Pamela & Associates was established during 2009, a small consultative financial company and publisher of
the ARIZONAN Publication, a social economic research publication. Today, Account Pamela & Associates offers
research and analysis of information including online medical screenings and life care services. Account Pamela &
Associates in the future will extend its services to offer mobile diagnostic medical services, whether at a clients
home or workplace, by referral, appointment or during an assessment. Currently, there are approximately 270
mobile medical operations known within the U.S. Account Pamela & Associates readily assists clients to manage
their medical care before or after prognosis and diagnosis of a chronic disease.

What is important and primary is to serve dense despairing populations and increase the accessibility of essential
medical services. The client must receive comprehensive information regarding managed care and guidance to
medical services. Today, no one should have to face life threatening diseases alone. It is very important that a person
receives medical services timely and accurately to improve any chances for recovery to prevent death. The best
benefit, each client will receive is access to insurance, continued managed medical care before prognosis and after
diagnosis to prevent any reoccurrences of symptoms associated with chronic medical conditions. It is imperative
clients receive information that will increase awareness and educate clients of the severity of chronic diseases and/or
illnesses timely and effectively.

There are several aspects to medical services and research offered by Account Pamela & Associates:

Medical Screenings
Consultation and case management
Referrals to medical and social services
Medical reporting and immunizations information
First aid and emergency preparedness information
Life care services

Most clients can log on: www.accountpamelaandassociates.weebly.com for a medical screening or contact Account
Pamela & Associates via email: accountpamela@yahoo.com

When a client completes a medical screening, he or she is able to determine if they should see a physician or
healthcare provider immediately. If the client is experiencing excessive pain, blood loss or loss of consciousness,
clients have directions to call 911 or their physician immediately. Each client can download his or her results to
share with their physician or primary medical provider. Clients can also obtain life care planning services to register
his or her medical directives with the Health Registry. A client can never receive a bill for medical services from
Account Pamela & Associates.

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A Private Family Trust
Smith Properties & Investments

FEASIBILITY REPORT

TRAUMA SURGICAL FACILITIES

What is the best way to contribute? Contributors can offer a charitable contribution to increase awareness for client
education to managed care. Contributors can assist with the preparations of fundraising or benefit events.
Contributors can support and sponsor the design and development of Trauma Surgical Facilities in all 50states and
possessions in the U.S. If you would like to learn more about life care planning or trauma Surgical Facilities,
Account Pamela & Associates accepts monetary payment, insurance, in-kind services, contributions, investments
and donations. For contributions, investment information and to learn more about Account Pamela & Associates
visit: www.accountpamelaandassociates.weebly.com or www.smithpropertiesandinvestments.weebly.com.

If you are uninterested in becoming a contributor or sponsor, contact APA directly. Account Pamela & Associates
is now accepting vitas, bios and resumes for an Advisory Committee and Trustees. Account Pamela & Associates
can appreciate those who are interested investors, community leaders, physicians, surgeons, emergency medical
staff, executive financial officers, attorneys and accountants who have a minimum of 5 years experience in the
development and management of emergency service facilities. We appreciate your support!

Thank you,

Pamela L. Smith,
Account Pamela & Associates
5900 E. Thomas Rd. #H221
Scottsdale, AZ 85251
www.accountpamelaandassociates.weebly.com
www.smithpropertiesandinvestments.weebly.com
Email: accountpamela@yahoo.com

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Revised June 2017