DAILY UPDATE: Abbvie, Treasuries, Gold, Copper and the NASDAQ Rally

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The yield on the 10-year Treasury rose as investors wait for word from the FOMC on Wednesday, while oil initially rose on the news of the death of the president of Iran, though it fell back down to end the day lower after succession of the presidency was settled. But investors were clearly still feeling jittery as gold hit new highs on the back of geopolitical concerns. Copper also rose to a new all-time high.

Here’s where the major benchmarks ended:

  • The S&P 500 index gained 4.86 points (0.1%) to 5,308.13; the Dow Jones Industrial Average® ($DJI) lost 196.82 points (0.5%) to 39,806.77; the NASDAQ Composite rallied 108.91 points (0.7%) to 16,794.87.
  • The 10-year Treasury note yield (TNX) increased more than 2 basis points to 4.443%.
  • The CBOE Volatility Index® (VIX) rose 0.15 to 12.14.

Nvidia’s gain helped push the PHLX Semiconductor Index (SOX) more than 2% to a two-and-a-half-month high and just under a record close posted in early March. The small-cap Russell 2000® Index (RUT) added 0.3% and ended slightly below a six-week high posted last Wednesday. 

CITE: https://www.r2library.com/Resource

JPMorgan shares fell 4.5% as investors realized that they won’t have Jamie Dimon around forever—he told shareholders at a meeting today that his 5-year timetable for leaving the company no longer applies.

CITE: https://tinyurl.com/2h47urt5

After AbbVie’s Humira, the best-selling drug in the world, lost patent exclusivity in 2023, company executives placed their bets on two other AbbVie drugs, Skyrizi and Rinvoq, to make up for an anticipated steep decline in revenue.

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MICRO-CERTIFICATIONS: Financial Advisors Seeking Physician-Client Niche Success?

Micro-Credentials on the Rise

KNOWLEDGE RICHES IN SPECIALTY NICHES

DR. DAVID EDWARD MARCINKO MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Do you ever wish you could acquire specific information for your career activities without having to complete a university Master’s Degree or finish our entire Certified Medical Planner™ professional designation program? Well, Micro-Certifications from the Institute of Medical Business Advisors, Inc., might be the answer. Read on to learn how our three Micro-Certifications offer new opportunities for professional growth in the medical practice, business management, health economics and financial planning, investing and advisory space for physicians, nurses and healthcare professionals.

Micro-Certification Basics

Stock-Brokers, Financial Advisors, Investment Advisors, Accountants, Consultants, Financial Analyists and Financial Planners need to enhance their knowledge skills to better serve the changing and challenging healthcare professional ecosystem. But, it can be difficult to learn and demonstrate mastery of these new skills to employers, clients, physicians or medical prospects. This makes professional advancement difficult. That’s where Micro-Certification and Micro-Credentialing enters the online educational space. It is the process of earning a Micro-Certification, which is like a mini-degree or mini-credential, in a very specific topical area.

Micro-Certification Requirements

Once you’ve completed all of the requirements for our Micro-Certification, you will be awarded proof that you’ve earned it. This might take the form of a paper or digital certificate, which may be a hard document or electronic image, transcript, file, or other official evidence that you’ve completed the necessary work.

Uses of Micro-Certifications

Micro-Certifications may be used to demonstrate to physicians prospective medical clients that you’ve mastered a certain knowledge set. Because of this, Micro-Certifications are useful for those financial service professionals seeking medical clients, employment or career advancement opportunities.

Examples of iMBA, Inc., Micro-Certifications

Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:

  • 1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
  • 2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
  • 3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.

Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.

How to Start Learning and Earning Recognition for Your Knowledge

Now that you’re familiar with Micro-Credentialing, you might consider earning a Micro-Certification with us. We offer 3 official Micro-Certificates by completing a one month online course, with a live instructor consisting of twelve asynchronous lessons/online classes [3/wk X 4/weeks = 12 classes]. The earned official completion certificate can be used to demonstrate mastery of a specific skill set and shared with current or future employers, current clients or medical niche financial advisory prospects.

Mini-Certification Tuition, Books and Related Fees

The tuition for each Mini-Certification live online course is $1,250 with the purchase of one required dictionary handbook. Other additional guides, white-papers, videos, files and e-content are all supplied without charge. Alternative courses may be developed in the future subject to demand and may change without notice.

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Contact: For more information, or to speak with an academic representative, please contact Ann Miller RN MHA CMP™ at Email: MarcinkoAdvisors@msn.com [24/7].

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DAILY UPDATE: Fiduciary Rule with Stock Market Earnings Week

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For last the week, the NASDAQ Composite (^IXIC) rose more than 2% while the S&P 500 (^GSPC) popped more than 1.5%. The Dow Jones Industrial Average (^DJI) rose more than 1%, closing above 40,000 for the first time ever on Friday.

In the week ahead, highly anticipated earnings results from Nvidia (NVDA) are expected to be the key catalyst for markets. Results from Target (TGT), Palo Alto Networks (PANW), and Lowe’s (LOW) will also be closely tracked by investors.

The week is also expected to be quieter on the economic front, with updates on activity in the manufacturing and services sectors as well as the final reading of consumer sentiment for May on tap. Minutes from the Fed’s May meeting are also expected on Wednesday afternoon.

CITE: https://www.r2library.com/Resource

The rule, finalized last month by the Labor Department, requires investment advisers to provide “prudent, loyal, honest advice free from overcharges” and avoid recommendations that favor their interests at the expense of their clients. It also updates the definition of an investment advice fiduciary under the Employee Retirement Income Security Act (ERISA) and Internal Revenue Code. 

Under the new definition, a fiduciary includes any financial services provider who offers investment advice to a retirement investor for a fee and who claims to be acting as a fiduciary or who a reasonable investor understands to be a trusted adviser acting in their best interest. The update removes the requirement that fiduciaries provide advice on a regular basis, bringing one-time advice under the rule. The Biden administration has argued that the previous definition, which was written in 1975, is outdated and has not kept pace with changes to the retirement landscape. 

CITE: https://tinyurl.com/2h47urt5

And, confidence in the U.S. dollar has waned, as forecasts suggest that a dip in inflation might allow the Federal Reserve to slash interest rates. With a notable 5% climb earlier this year, the dollar is now bracing for its first loss of 2024, triggered by a promising inflation report.

CITE: https://tinyurl.com/tj8smmes

Finally, fourteen of the world’s 20 largest stock markets have hit all-time highs recently, including England, Japan, Brazil, India, and Canada, according to Bloomberg. In the USA, the S&P 500 (also at a record) hasn’t dropped more than 2% in a trading session in 311 days, the longest streak in five years.

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PHYSICIAN ENTREPRENEURS: Rising Again!

By Dr. David Edward Marcinko MBA

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Marcinko Associates is a financial guide. We help answer your questions in an empowering way. We educate and empower medical colleagues to understand their financial picture and to make better financial decisions. We strive to simplify everything, clear up confusion, and address specific needs and goals.

Whatever your financial situation, we do not shame, criticize, or sell. We enrich, educate and empower. We work with medical colleagues at every stage of their financial journey, through big life personal changes to annual employment reviews, in order to help them understand, invest, and protect their money and autonomy.

And, like the famed ‘Tibetan Sherpas“, we guide physician entrepreneurs from medical practice business plan creation, funding, start-up operations and strategic management improvement to maximize profits and stream-line patient care quality initiatives.

READ: https://marcinkoassociates.com/welcome-medical-colleagues/

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PODCAST: Healthcare Start-Up Accelerators and Incubators

By Dr. Eric Bricker MD

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DAILY UPDATE: Jerome Powell, DJIA, Reddit and Life Insurance

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Young adults are delaying life insurance purchases due to financial constraints and a preference for spending on immediate experiences. The insurance industry is responding with digital-first strategies and more flexible products.

CITE: https://www.r2library.com/Resource

The DJIA closed above 40,000 for the first time after briefly crossing the milestone the day before and clinching its fifth winning week. Reddit shot up after announcing a partnership with OpenAI that lets the AI train on your posts and gives Reddit advertising dollars and the ability to use the tech to make new tools.

But, GameStop stock plunged after the recently reinvigorated meme stock filed to sell 45 million new shares and revealed that sales were down last quarter.

CITE: https://tinyurl.com/2h47urt5

Jerome Powell, chair of the Federal Reserve has tested positive for Covid. But the economy needn’t worry because he’s working from home.

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CERTIFIED MEDICAL PLANNER™: How Niche Financial Advisors Thrive!

Think Different – Be Different  – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

Did you know that desperate doctors of all ages are turning to knowledgeable financial advisors and medical management consultants for help? Symbiotically too, generalist advisors are finding that the mutual need for knowledge and extreme niche synergy is obvious.

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planning

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But, there was no established curriculum or educational program; no corpus of knowledge or codifying terms-of-art; no academic gravitas or fiduciary accountability; and certainly no identifying professional designation that demonstrated integrated subject matter expertise for the increasingly unique healthcare focused financial advisory niche … Until Now! 

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Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

Think Different

 [Think Different – Be Different – Thrive]

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So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

 Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)* 8

DAILY UPDATE: Top Causes of Death, Narcan Saves Lives but Scientific Research Fraudulent as DJIA Tops 40,000

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Walgreens has released its own brand of naloxone, a medication that reverses the effects of an opioid overdose. Available online now, Walgreens Brand Naloxone HCl Nasal Spray comes with two doses for $34.99, about $10 cheaper than the name-brand version, Narcan. The over-the-counter medication will also be available in stores by the end of May in the pain aisle, according to a press release, making the life-saving nasal spray more accessible.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 6.17 points (0.1%) to 5,303.27, up 1.5% for the week; the Dow Jones Industrial Average gained 134.21 points (0.3%) to 40,003.59, up 1.2% for the week; the NASDAQ Composite® ($COMP) lost 12.35 points (0.1%) to 16,685.97, up 2.1% for the week.
  • The 10-year Treasury note yield (TNX) rose more than 4 basis points to 4.42%, down about 8 basis points for the week.
  • The CBOE Volatility Index® (VIX) fell 0.43 to 11.99.

Among major companies, Nvidia (NVDA) dropped 2% Friday but still posted a 2.9% advance for the week ahead of the semiconductor leader’s quarterly earnings Wednesday. Among sectors, energy shares led gainers behind a 1% jump in WTI Crude Oil (/CL) futures. The small-cap Russell 2000® Index (RUT) ended little changed but still gained 1.7% for the week.

CITE: https://www.r2library.com/Resource

Fraudulent research papers have cost scientific journal publishers millions in lost revenue. (the Wall Street Journal)

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The 10 Top Causes of Adult Death in the U.S.A.

1.  Heart disease 267.2* 2.  Cancer 142.3 3.  Unintentional injuries 64.0 4.  COVID-19 44.5 5.  Stroke 39.5 6.  Chronic lower respiratory disease 34.3 7.  Alzheimer disease 28.9 8.  Diabetes 24.1  9   Kidney disease 13.8 10. Chronic liver disease and cirrhosis 13.8 Deaths per 100,000 population.

Source: Jeffrey Bendix, Medical Economics [5/15/24]

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DAILY UPDATE: Core CPI and ERISA while Markets Remain High with Walmart Up

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Here’s where the major benchmarks ended:

America’s oldest popular stock index, the Dow Jones Industrial Average, hit a brief record high yesterday morning when it traded above 40,000, reflecting renewed hope for the market’s health after Wednesday’s promising inflation report.

  • The S&P 500® index (SPX) fell 11.05 points (0.2%) to 5,297.10; the Dow Jones Industrial Average declined 38.62 points (0.1%) to 39,869.38; the NASDAQ Composite® ($COMP) shed 44.07 points (0.3%) to 16,698.32.
  • The 10-year Treasury note yield (TNX) rose more than 2 basis points to 4.381%.
  • The CBOE Volatility Index® (VIX) dropped 0.03 to 12.42.

Walmart’s strength fueled a strong day for consumer staples shares. The S&P 500 Consumer Staples ($SP500#30), which includes Walmart as well as companies like Coca-Cola (KO) and Procter & Gamble (PG), surged 1.5% to its highest level in over two years. 

Among other companies, Applied Materials (AMAT) fell 1.6% ahead of the semiconductor industry supplier’s quarterly earnings report, which is expected after Thursday’s close.

CITE: https://www.r2library.com/Resource

And, Core CPI, which tracks the price of goods and services excluding volatile food and energy prices and is closely watched as an inflation indicator, rose 3.6% from the same period last year. That’s the smallest annual increase since April 2021. On a monthly basis, core CPI rose 0.3%, marking the first time in six months that its growth slowed from the prior month. Other good signs include:

  • Grocery prices dropped 0.2% from March, the first decrease in a year.
  • Health insurance and car insurance increased more slowly in April than in March.
  • A separate report released yesterday showed consumer spending stayed steady last month.

CITE: https://tinyurl.com/2h47urt5

Finally, Joe Manchin (D-W.Va.) and a group of Republican senators are moving to overturn a retirement investment planning rule that was finalized by the Labor Department last month. The Labor Department unveiled the new rule last month that would update the definition of an investment advice fiduciary under the Employee Retirement Income Security Act. Manchin and 15 Republican senators joined in co-sponsoring a Congressional Review Act (CRA) resolution that would overturn this new rule.

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DAILY UPDATE: Healthcare Monopolies, Ark Invest and the Stock Markets Mega Rally

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More people are interested in determining their “heart age” using new tests and tech tools, but some skeptics say it’s not a healthy data point to focus on. (the Wall Street Journal)

CITE: https://www.r2library.com/Resource

The Cathie Wood-led Ark Invest just made some significant trades. The most prominent among them were the increased stakes in Palantir Technologies Inc (NYSE:PLTR) and the reduced holdings in Coinbase Global Inc (NASDAQ: COIN).

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 61.47 points (1.2%) to 5,308.15; the Dow Jones Industrial Average added 349.89 points (0.9%) to 39,908.00; the NASDAQ Composite rallied 231.21 points (1.4%) to 16,742.39.
  • The 10-year Treasury note yield fell almost 10 basis points to 4.348%.
  • The CBOE Volatility Index® (VIX) dropped 0.97 to 12.45.

Chipmaker shares led the way higher Wednesday, lifting the Philadelphia Semiconductor Index (SOX) almost 3% to a 10-week high. Interest-rate-sensitive sectors like real estate and utilities were also strong. The small-cap Russell 2000® Index (RUT) advanced 1.1% to a seven-week high. The U.S. Dollar Index ($DXY) slumped to its weakest level in five weeks, reflecting expectations for lower interest rates that may reduce the appeal of U.S. fixed income assets.

Among companies, Cisco Systems (CSC) surged 1.5% ahead of its quarterly results expected after Wednesday’s close. Dow member Walmart (WMT) is expected to release results Thursday morning as the unofficial retail earnings season accelerates. 

CITE: https://tinyurl.com/2h47urt5

And The U.S. Department of Justice (DOJ) announced it has established a new task force to take on healthcare monopolies and collusion. The task force, made up of prosecutors, economists, healthcare industry experts and others, will guide the division’s enforcement strategy and policy approach in healthcare, including by facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets.

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DAILY UPDATE: Squarespace, Ark Invest & Hospitals as the Markets Rebound

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 25.26 points (0.5%) to 5,246.68, the highest since a record close March 28; the Dow Jones Industrial Average® ($DJI) gained 126.60 points (0.3%) to 39,558.11; the NASDAQ Composite climbed 122.94 points (0.8%) to 16,511.18.
  • The 10-year Treasury note yield (TNX) fell more than 3 basis points to 4.449%.
  • The CBOE Volatility Index® (VIX) decreased 0.18 to  13.42.

Among companies, Home Depot’s (HD) quarterly results reported earlier Tuesday kicked off the unofficial start of the retail earnings season. The home improvement retailer’s earnings topped expectations, but revenue missed forecasts, initially sending the company’s shares down sharply. 

Home Depot also reaffirmed its full-year guidance for a 1% decline in comparable-store sales and a 1% increase in total sales. The company’s shares bounced back to end with a 0.1% loss.

CITE: https://www.r2library.com/Resource

And, the Cathie Wood-led Ark Invest just made some significant trades. The most prominent among them were the increased stakes in Palantir Technologies Inc (NYSE PLTR) and the reduced holdings in Coinbase Global Inc (NASDAQ: COIN).

Moreover, the website-building platform Squarespace is to go private, which it announced it’ll be doing in an all-cash deal with Permira, a private equity firm. Squarespace, which was public for nearly three years, joins a group of other smaller tech companies like Qualtrics that have recently pulled themselves off the public market. (CNBC)

CITE: https://tinyurl.com/2h47urt5

Employers and private insurers are paying hospitals more for inpatient and outpatient services than in previous years, a study from RAND Corporation finds. The American Hospital Association dismissed the report saying it offers a “skewed and incomplete picture.”


And finally … Kaiser Permanente began its 2024 earnings season with more than $2.7 billion in net income and $935 million in operating income, just months after sharing plans to lay off workers.

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PODCAST: Early Retirement and Health Insurance

By Staff Reporters

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DAILY UPDATE: Moderna Down with Mixed Markets

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 1.26 points (0.02%) to 5,221.42; the Dow Jones Industrial Average lost 81.33 points (0.2%) to 39,431.51; the NASDAQ Composite® ($COMP) gained 47.37 points (0.3%) to 16,388.24.
  • The 10-year Treasury note yield (TNX) dropped almost 2 basis points to 4.487%.
  • The CBOE Volatility Index® (VIX) surged 1.05 to 13.60.

Biotechnology and food and beverage shares were among the market’s strongest sectors Monday, while communication services stocks were among the biggest laggards. Energy shares took pressure despite a jump of 1.2% in WTI Crude Oil (/CL) futures, which ended above $79 per barrel after slumping last week to two-month lows.

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Moderna is “bleeding money” as its forthcoming RSV vaccine doesn’t appear to deliver better results than other RSV shots already on the market. (Bloomberg)

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It’s ChatGPT-4o’s time to shine. The “o” stands for omni, and it’s the latest iteration of OpenAI’s signature chatbot. According to the company, it’s much faster with enhanced “capabilities across text, vision, and audio.”

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23% is the average portion of the bill hospitals collected from patients before treatment in Q1 of this year, up 3% YoY. (the Wall Street Journal)

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The Long and Short of Portfolio Construction

Long-Short Portfolio Construction vs. Long-Only

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[By Dr. David Edward Marcinko MBA MEd CMP™]

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Long-Short is an active portfolio construction discipline that balances long positions in high expected return securities and short positions in low expected return securities of approximately equal value and market sensitivity. This type of portfolio is “neutralized” or immunized against changes in value of the underlying market and, therefore, has zero systematic (beta) risk. If the selected securities perform as expected, the long-short positions will provide a positive return, whether the market rises or falls.

Misconceptions

While long-short portfolios are often perceived and portrayed as much costlier and much riskier than long-only, it is inherently neither. Much of the incremental cost and risk is either largely dependent on the amount of leverage employed or controllable via optimization. Those costs and risks that are not controllable—financial intermediation costs of borrowing shares to short, the trading costs incurred to meet long-short balancing, margin requirements, uptick rules, and the risks of unlimited losses on short positions—do not invalidate the viability of long-short strategies.

Long-Short Advantages

Compared with long-only portfolios, long-short portfolios offer enhanced flexibility not only in the control of risk and pursuit of return, but also in asset allocation. Basic market-neutral portfolios achieve a return consisting of three components: (1) interest on funds held as a liquidity buffer, (2) interest on the short sale proceeds maintained with the broker, and (3) the return spread between the aggregate long and aggregate short positions in the portfolios.

Disadvantages

Share borrow-ability and uptick rules make short-selling more difficult and costly than going long. Also, it may be legally or contractually restricted for some investors, such as mutual funds. Inefficiencies may be concentrated in overpriced stocks and, accordingly, short sales of the most overpriced stocks may offer higher positive returns than long purchases of underpriced stocks.

Assessment

Long-only portfolios are confined to altering the weighting of securities within an index in order to realize an excess return. Long-short portfolios are not constrained by index weights and, because they can short securities, they can “underweight” a security by as much as investment insights and risk considerations dictate. Long-short portfolios can be enhanced by “equitizing” them using stock index futures.

Note: “The Long and Short on Long-Short” by Bruce I. Jacobs and Kenneth N. Levy, The Journal of Investing, Spring 1997, pp. 73–86, Institutional Investor, Inc.

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About Tombstone Securities Advertising and the “New Issue” Propsectus

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A Primer for Physician Investors and Medical Professionals

By: Dr. David Edward Marcinko; MBA, MEd, CMP™

[Editor-in-Chief]

[PART 2 OF 8]

BU Dr. Marcinko

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

Despite the SEC restrictions, noted in Part I of this series, some idea of potential demand for a new security issue can be gauged and have a bearing on  pricing decisions.

For example, as CEO of a medical instrument company, or interested investor, would you rather see a great deal of interest in a potential new issue or not very much interest?  There is however, one kind of advertisement that the underwriter can publish during the cooling off period. It’s known as a tombstone ad.  The ad makes it clear that it is only an announcement and does not constitute an offer to sell or  solicit the issue, and that such an offering can only be made by  prospectus.  SEC Rule 134 of the 1933 Act  itself, refers to a tombstone ad as “communication not deemed a prospectus”  because it makes reference to the prospectus in the ad. Tombstones have received their name because of the sparse nature of details found in them.

However, the most popular use of the tombstone ad is to announce the effectiveness of a new issue, after it has been successfully issued. This promotes the success of  both he underwriter, as well as the company.

Since distributing securities involves potential liability to the investment bank, it will do everything possible to protect itself.  So, near the end of the cooling off period, a meeting is held between the underwriter and the corporation. It is known as a due diligence meeting. At this meeting they both discuss amendments that are going to be necessary to make the registration statement complete and accurate. The corporate officers, and the underwriters sign, the final registration statement. They have civil liability for damages that result from omissions of material facts or

Mis-statements of fact. They also have criminal liability if the distribution is done by use of fraudulent, manipulative, or deceptive means. Due diligence takes on a whole new meaning when  incarceration from a half-hearted effort underwriting efforts can occur. The investment bank strives to ensure that there have been no material changes to the issuer or the terms of the issue since the registration statement was filed.

Again, as a physician, how would you feel if you were an investment banker raising capital for a new pharmaceutical company that had developed a drug product that was highly marketable. But, on the day after the issue was effective, there was a major news story indicating that the company was being sued for patent infringement? What effect do you think that would have on the market price of this new issue? It would probably plunge. How could this situation have been prevented? The due diligence meeting is more than a cocktail party or a gathering in a smoke filled room. Otherwise, the company would require specially trained people, to do a patent search lessening the likelihood of this scenario. At the due diligence meeting, work is done on the preparation of the final prospectus, but the investment bank does not set the public offering price or the effective date at this meeting. The SEC will eventually set the effective date for the registration and it is on that date that the final offering price will be determined.

Once the SEC sets the effective date, sales may be executed and money can be accepted by the investment bank. It is at this time that the final prospectus, similar to the red herring but without the red ink and with the missing numbers, is issued. A prospectus is an abbreviated form of the registration statement, distributed to purchasers, on and after the effective date of  the registration. It is not the same as the registration statement. A typical registration statement consists of papers that stand more than a foot high; rarely does a prospectus go beyond 40 or 50 pages. All purchasers will receive a final prospectus and then it becomes permissible for the underwriter to provide sales literature.

In addition to the requirement that a prospectus must be delivered to a purchaser of new issues no later than with confirmation of the trade, there are two other requirements that healthcare executives investors should know.

90-day: When an issuer has an initial public offering (IPO), there is generally a lack of publicly available material relating to the operations of that issuer.  Because of this, the SEC requires that all members of the underwriting group make available a prospectus on an IPO for a period of 90 days after the effective date.

4O-day: Once an issuer has gone public, there are a number of routine filings that must be made with the SEC so there is publicly available information regarding the financial condition of that issuer. Since additional information is now available, the SEC requires that, on all issues other than IPOs, any member of the underwriting group must make available a prospectus for a period of 40 days after the effective date.

In the event that the investment bankers misgauged the marketplace, and the issue moves quite slowly, it is possible that information contained in the prospectus would be rendered obsolete by the SEC. Specifically, the SEC requires that any prospectus used more than 9 months after the effective date, may not have any financial information more than 16 months old. It can however, be amended or stickered, with updated information, as needed.

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  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Syndication Among Underwriters

Because the investment banking firm may be underwriting (distributing) a rather large dollar amount of securities, to spread its risk exposure, it may form a group made up of other investment bankers or underwriters, known as a syndicate. The syndicate is headed by a syndicate manager, or lead underwriter, and it is his job to decide whether to participate in the offering. If so, the managing underwriter will sign a non-binding agreement called a letter of intent. .

If all has gone well and the market place is sufficiently interested in the security, and the SEC has been satisfied with respect to the registration statement, it is time for all parties to the offering to formalize their relationships with a contract including the basic understandings reflected in the letter of intent. Three principal underwriting contracts are involved in the usual public offering, each serving a distinct purpose. These are the: Agreement among Underwriters, Underwriting Agreement, and the Dealer Agreement.

In the Agreement Among Underwriters (AAU), the underwriters committing to a portion of the issue, enter into an agreement establishing the nature and terms of their relationship with each other. It designates the syndicate manager to act on their behalf, particularly to enter into an Underwriting Agreement with the issuer, and to conduct the offering on behalf of each  of them. The AAU will designate the managing underwriter’s compensation (management fee) for managing the offering.

The authority to manage the offering includes the authority to: agree with the issuer as to the public offering price; decide when to commence the offering; modify the offering price and selling commission; control all advertising; and, control the timing and effectiveness of the registration statement by quickly responding to deficiency letters. Each underwriter agrees to purchase a portion of the underwritten securities, which is known as each under-writer’s allotment (allocation).  It is normally signed severally, but not jointly, meaning each underwriter is obligated to sell his allocation but bears no financial obligation for any unsold allotment of another underwriter. This is referred to as a divided account or a Western account. Much less frequently, an undivided or Eastern account, will be used. Each underwriter is responsible for unsold allotments of others, based upon a  proportionate share of the offering.

The above comments referred to firm commitment underwriting. Another type of underwriting commitment  however, is known as best efforts underwriting. Under the terms of  best efforts underwriting, the underwriters make no commitment to buy or sell the issue, they simply do the best they can, acting as an agent for the issuer, and having no liability to the issuer if none of the securities are sold. There is no syndicate formed with a best efforts underwriting. The investment bankers form a selling group, with each member doing his best to sell his allotment. Two variations of a best efforts underwriting are: the all-or-none, and the mini-max (part-or-none) underwriting. Under the provisions of an all-or-none offering, unless all of the shares can be distributed within a specified period of time, the offering will terminate and no subscriptions or orders will be accepted or filled. Under mini-max, unless a set minimum amount is sold, the offering will be terminated.

SEC Rule 15c2-4 requires the underwriter to set up an escrow account for any money received before the closing date, in the event that it is necessary to return the money to prospective purchasers. If the “minimum”, or the “all” contingencies are met, the monies in escrow go to the issuer with the underwriters retaining their appropriate compensation. In order to make sure that investors are properly protected, the escrow account must be maintained at a bank for the benefit of the investors until every appropriate event or contingency has occurred. Then, the funds are properly returned to the investors. If the money is to be placed into an interest bearing account, it must have a maturity date no later than the closing date of the offering, or the account must be redeemable at face with no prepayment penalty as regards principal.

Underwriter Compensation Hierarchy

As we have seen, in a firm commitment the underwriter buys the entire issue from the issuer and then attempts to resell it to the public. The price at which the syndicate offers the securities to the public is known as the public offering price. It is the price printed on the front page of the prospectus.

However, the managing underwriter pays the issuer a lower price than this for the securities. The difference between that lower price and the public offering price is known as the spread or underwriting discount. Everyone involved in the sale of a new issue is compensated by receiving part of the spread. The amount of the spread is the subject of negotiations between the issuer and the managing underwriter, but usually is within a range established by similar transactions between comparable issuers and underwriters. The spread is also subject to NASD [now FINRA] review and approval before sales may commence. The spread is broken down by the underwriters so that a portion of it is paid to the managing underwriter for finding and packaging the issue and managing the offering (usually called the manager’s fee); and a portion is retained by each underwriter (called the underwriting or syndicate allowance) to compensate the syndicate members for their expenses, use of money, and assuming the risk of the underwriting. The remaining portion is allocated to the selling group and is called selling concession. It is often useful to remember the compensation hierarchy pecking order in the following way:

  • Spread (syndicate manager).
  • Underwriters allowance (syndicate members)
  • Selling concession (selling group members)
  • Re-allowance (any other firm)

While the above deal with corporate equity, the only other significant item with respect to corporate debt is the Trust Indenture Act of 1939. This Federal law applies to public issues of debt securities in excess of $5,000,000. The thrust of this act is to require an indenture with an independent trustee (usually a bank or trust company) who will report to the holders of the debt securities on a regular basis.

Successful marketing of a new issue is a marriage between somewhat alien factors: compliance and numerous Federal, state, and self-regulatory rules and statutes; along with finely honed and profit-motivated sales techniques. It’s not too hard to see that there could be a real, or apparent, conflict of interest here. Most successful investment bankers have built their excellent reputations upon their ability to properly balance these two objectives consistently, year after year.

PART ONE:

Understanding investment banking rules, securities markets, brokerage accounts, margin and debt

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DAILY UPDATE: Ark Invest, Dell and “Buy Now-Pay Later”

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While Buy Now-Pay Later (BNPL) reduces friction when purchasing, it’s giving some economy watchers unease. As Americans’ budgets buckle under the weight of inflation and higher interest payments, some worry BNPL is more of an invisible burden than a boon, Bloomberg reports. Beware the “phantom debt,” a Wells Fargo economist recently warned, referring to the BNPL industry’s short-term loans, which go largely unaccounted for by those tracking Americans’ debt load. That’s because, unlike credit cards and auto loan providers, Afterpay, Affirm, Klarna, and other BNPL providers don’t usually report transactions to credit scoring agencies.

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The Cathie Wood-led Ark Invest just made some significant trades. The most prominent among them were the increased stakes in Palantir Technologies Inc (NYSE: PLTR) and her reduced holdings in Coinbase Global Inc (NASDAQ: COIN).

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Dell has recently seen a decline in its revenue. In its most recent earnings report, it revealed that its net revenue shrunk by 11% year-over-year during its fiscal 2024 fourth quarter. For full year 2023, the company’s revenue was down by 14% to $88.4 billion. Partly that was due to a weak personal-computer market and the costs associated with more than 6,000 layoffs. But investors are excited by Dell’s growth potential for its server and computer businesses because of artificial intelligence, the Motley Fool reported.

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DAILY UPDATE: National Nurses Week, Multiplan Lawsuit, Rite Aid and Fatburger Down

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HAPPY MOTHER’S DAY 2024

Fat Brands is the parent company of Fatburger, Johnny Rockets, and a few other restaurant chains. Last year, former CEO Andy Wiederhorn stepped down after the Los Angeles Times reported that the federal government was investigating him for fraud. He has since stayed on as the company’s chairman, but on Friday the Justice Department charged him with perpetuating a $47 million fraud against his own shareholders.

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In a recent Becker’s Health Care Newsletter, it is reported that a large multi-state hospital system is suing Multiplan for illegal price fixing and automatic significant price reductions, in particular, for out-of-network providers. The story states that Multiplan, by bombarding healthcare providers with automatic reductions in pricing, has made it impossible for providers to deliver healthcare.

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National Nurses Week, which ends today on May 12th, Florence Nightingale’s birthday

Rite Aid has announced that 39 stores are set to close their doors for good, this follows the decision to declare Chapter 11 bankruptcy back in October, 2023.    

The strategy? Reduce the total number of stores to 1,600 nationwide. 

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HEDGE FUNDS: A Brief Review for Physicians

By Christopher J. Cummings CFA CFP™

By Dr. David Edward Marcinko MBA MEd CMP™

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A hedge fund in the United States is generally a limited partnership providing a limited number of qualified investors with access to general partner investment decisions with little restriction in the type of investments or use of leverage. While the flexibility available to a hedge fund from a regulatory standpoint implies a high degree of potential risk, there is a wide range of investment philosophies, strategies, security types and objectives captured under the broad title of hedge fund.

Thus, generalizations regarding the characteristics of hedge funds are even less appropriate than with mutual funds, and evaluation of the investment characteristics and merits of a hedge fund strategy must be on a case-by-case basis. Likewise, the cost structure of a hedge fund often includes a base management fee to the general partner plus a performance-based fee or percentage of the profits, and must be evaluated on a case-by-case basis.

Several different investment vehicles operate under the oversight of varying regulatory bodies which provide access to an investment-managers’ discretionary decisions. While each approach generally represents ownership of an underlying pool of securities, there is usually a great deal of flexibility for the manager to deviate from a specific asset class or investment approach. Also, the fee structure of each vehicle can vary greatly and be quite large once distribution fees and sales charges are taken into account.

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Thus, it is important for a medical professional to remember the following:

1. Evaluate the features and costs of an investment vehicle carefully;

2. Consider the cash flows and valuations of the securities that the manager or management approach will focus on as if the investments were being made directly, and above all;

3. Read the prospectus or agreement carefully before making any investment.

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DAILY UPDATE: Mortgage Rates, Ascension Healthcare Network Security Event with Mixed Markets

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Novavax, the Covid vaccine-maker’s value doubled after it announced a $1.2 billion deal to develop new shots with Sanofi.

And, Mortgage rates fell for the first time since March, to just over 7%.

Here’s where the major stock market benchmarks ended:

  • The S&P 500 index rose 8.60 points (0.2%) to 5,222.68, up 1.9% for the week; the Dow Jones Industrial Average® ($DJI) advanced 125.08 points (0.3%) to 39,512.84, up 2.2% for the week and its eighth straight daily gain; the NASDAQ Composite® ($COMP) fell 5.40 points (0.03%) to 16,340.87, up 1.1% for the week.
  • The 10-year Treasury note yield (TNX) increased more than 5 basis points to 4.50%.
  • The CBOE Volatility Index® (VIX) fell 0.14 to 12.55.

Chip makers ranked among top gainers Friday after Taiwan Semiconductor Manufacturing (TSM) shares surged 4.5% after the company said its April revenue soared 60% behind AI-driven demand. The Philadelphia Semiconductor Index (SOX) climbed 1% and posted a 1.9% gain for the week. Consumer staples and transportation shares were also strong. Energy shares slipped behind a 1.2% drop in WTI Crude Oil (/CL) futures, though oil still ended slightly higher for the week.

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National hospital operator Ascension said a “cyber security event” has disrupted some of its clinical operations, according to a news release. Ascension, a St. Louis-based nonprofit and Catholic healthcare network, announced it had detected “unusual activity” on some of its systems. In response, the company kicked off an investigation and remediation efforts—including turning to outside cybersecurity firm Mandiant for help, as well as notifying the “appropriate authorities,” per the release.

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Planet Fitness to raise membership price for the first time since 1998. It’s going to take more than $10/month to join a gym once Planet Fitness raises the price of a basic membership for new members to $15 per month this summer. The $10 amount, which has held steady for 26 years, was considered a sweet spot where people were happy to sign up and wouldn’t bother to cancel once they gave up on their fitness goals. But after posting weaker-than-expected Q1 results, the gym chain decided it’s time to change, even though execs acknowledged that customers are looking to save rather than spend.

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The M1 and M2 Money Supply

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DEFINITION: In macro-economics, the money supply (or money stock) refers to the total volume of currency held by the public at a particular point in time. There are several ways to define “money”, but standard measures usually include currency in circulation (i.e. physical cash) and demand deposits (depositors’ easily accessed assets on the books of financial institutions . The Central Bank [FOMC] of a country may use a definition of what constitutes legal tender for its purposes.

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Though there are a few variations of money supply, most economists tend to focus on M1 and M2. The former takes into account cash and coins in circulation, as well as demand deposits in checking accounts and traveler’s checks. In other words, money that’s either in your hand or can be accessed very easily.

Meanwhile, M2 accounts for everything in M1 and adds savings accounts, money market funds, and certificates of deposit (CDs) below $100,000. It’s money you have access to, but it takes a little extra effort to put this capital to work. It’s M2 money supply that’s raising eyebrows on Wall Street and making history.

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What’s of interest is what’s happened to M2 money supply over the trailing year. Following a peak of $21.7 trillion in July 2022, M2 has fallen to a fresh reading of $20.81 trillion, as of May 2023. Although the May reading was higher than April and broke a nine-month downtrend, we’ve still witnessed a 4.1% aggregate drop in M2 from its all-time high. 

Considering that M2 enjoyed a historic expansion during the pandemic, it’s certainly possible that a 4.1% decline can be shrugged off as nothing more than money supply reverting back to the mean. But history suggests otherwise.

Though history rarely repeats itself on Wall Street, it often rhymes. We haven’t seen a meaningful year-over-year decline in M2 money supply since the Great Depression in 1933.

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And so, based on what we’re seeing from M2 money supply, commercial bank lending, and domestic banks tightening their lending standards for C&I loans, the ingredients for a U.S. recession are most definitely there. Stock losses have, historically, been most pronounced in the months that follow the official declaration of a recession by the eight-economist panel of the National Bureau of Economic Research.

However, Wall Street’s performance is largely dependent on your investment time frame. If you’re patient, these and other potentially worrisome money metrics represent nothing more than temporary white noise.

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DAILY UPDATE: Uber, Lyft and MSFT as the Stock Markets Rally

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Here’s where the major benchmarks ended:

  • The S&P 500 index gained 26.41 points (0.5%) to 5,214.08; the Dow Jones Industrial Average rose 331.37 points (0.9%) to 39,387.76; the NASDAQ Composite® ($COMP) advanced 43.51 points (0.3%) to 16,346.26.
  • The 10-year Treasury note yield (TNX) lost more than 2 basis points to 4.459%.
  • The CBOE Volatility Index® (VIX) fell 0.31 to 12.69.

Interest-rate-sensitive sectors, such as real estate and utilities, were among the strongest performers Thursday. Energy shares were also strong after WTI Crude Oil (/CL) futures rose for a second straight day after sinking to a two-month low earlier this week. Semiconductor shares were under pressure after disappointing revenue guidance from chip designer Arm Holdings (ARM) sent its shares down 2.3%.

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The Dow jumped for the seventh straight day while the S&P 500 closed above 5,200 for the first time in a month as stocks climbed across the board, possibly a reaction to data showing that the cooling labor market could translate into a Federal Reserve interest rate cut in a few months. But, Roblox, tanked 22% yesterday after the company cut its annual bookings forecast. The rough patch suggests that the game’s pandemic-induced popularity has likely peaked.

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Last year, Uber boasted its first full-year profit since going public. But yesterday, the company reported a surprise loss for the first quarter of 2024, dashing investors’ hopes for steady profits and sending its stock way down.

Meanwhile, Uber’s smaller rival Lyft appears to have its foot on the gas pedal. It posted better-than-expected quarterly results on Tuesday and saw a stock bump yesterday.

Microsoft plans to put the cash toward creating an AI data center. President Biden was on hand in Wisconsin to help announce the news—and not just to tout a big investment that’s expected to create jobs.

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DAILY UPDATE: Medicaid & CHIPS Unwind, Steward Health System Bankrupts as the Markets are Mixed

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It’s the first anniversary of the Medicaid unwinding for many states, a process that kicked off when federal rules that had kept people on Medicaid and the Children’s Health Insurance Program (CHIP) through the pandemic expired. And while states could redetermine eligibility again, things have “unwound” more than some experts predicted. Children were kicked off the rolls at higher rates than adults, according to a new study the Urban Institute released May 2. Twelve states—Montana, Iowa, South Dakota, Alabama, Idaho, Georgia, Texas, Arkansas, Oklahoma, Florida, Mississippi, Colorado—exceeded 100% of their total projections for disenrolling children.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was little changed at 5,187.67; the Dow Jones Industrial Average gained 172.13 points (0.4%) to 39,056.39; the NASDAQ Composite® ($COMP) declined 29.80 points (0.2%) to 16,302.76.
  • The 10-year Treasury note yield (TNX) rose more than 3 basis points to 4.496%.
  • The CBOE Volatility Index® (VIX) fell 0.23 to 13.00.

Retail and real estate shares were among the weakest areas Wednesday, while banks and utilities were firm. Utility shares extended a nearly month-long rally, which may in part reflect greater expectations for Fed rate cuts. Lower interest rates can make utility shares with high dividend yields relative to Treasuries more appealing. The Dow Jones Utility Average ($DJU) rose 0.5% to end at its highest level since late July and is up 12% from a mid-April low.

And, Shopify’s value plunged by nearly $20 billion after the online payments company released a gloomy forecast for this quarter. It’s the latest pandemic darling to stumble: According to the Financial Times, the firms that skyrocketed during lockdowns have lost a collective $1.5 trillion in value since the end of 2020.

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Steward Health Care System, the largest U.S. physician-owned hospital operator, is expected to file for chapter 11 bankruptcy as soon as Sunday, according to a WSJ report, which cited people familiar with the matter. Steward Health Care is the largest tenant of Medical Properties Trust (NYSE: MPW). Steward Health Care hired restructuring advisers to improve its liquidity and restore its balance sheet in January 2024.  

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DAILY UPDATE: Robinhood’s SEC Enforcement with Mixed Stock Markets

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index rose 6.96 points (0.1%) to 5,187.70; the Dow Jones Industrial Average gained 31.99 points (0.1%) to 38,884.26; the NASDAQ Composite® ($COMP) eased 16.70 points (0.1%) to 16,332.56.
  • The 10-year Treasury note yield dropped more than 3 basis points to 4.457%.
  • The CBOE Volatility Index® (VIX) fell 0.26 to 13.23.

Interest-rate-sensitive sectors, such as real estate and utilities, were among the market’s strongest performers Tuesday. The Philadelphia Utility Index (UTY) rose 1.3%, its fifth straight daily gain, and hit its highest level in almost a year. The recent strength may in part reflect heightened expectations for lower interest rates, which may make utility shares with relatively high dividend yields compared to Treasuries more appealing. The utilities sector is also coming off a strong April, during which it was the only S&P 500 sector with a positive return, with chart patterns suggesting a bullish long-term momentum shift.

The semiconductor sector was among the weakest sectors Tuesday, partly behind a 1.7% drop in Nvidia (NVDA). The shares fell after billionaire investor Stanley Druckenmiller told CNBC he reduced his stake in the chipmaker in late March, saying that artificial intelligence may be a “little overhyped” for the short term.

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Peloton is reportedly being circled by private equity firms for a potential buyout of the enfeebled fitness company.

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The SEC is preparing to sue over Robinhood’s crypto business. Robinhood just revealed that it’s been notified that the SEC plans to bring an enforcement action against its crypto unit for alleged securities violations. But the online brokerage said it’s not sweating: “We firmly believe that the assets listed on our platform are not securities and we look forward to engaging with the SEC to make clear just how weak any case against Robinhood Crypto would be on both the facts and the law,” Dan Gallagher, Robinhood’s chief legal, compliance, and corporate affairs officer, wrote in a blog post. Such a notice doesn’t always mean a suit will follow, but crypto companies and the agency have been sparring for years over whether crypto tokens count as securities.

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The Biden administration were quick to praise a new report that extends the lifespan of the Hospital Insurance Trust Fund, but the report renewed calls for increasing physician payments.


Amwell, a telehealth company, continues to struggle in the stock market, and both its bottom- and top-line results in the first quarter missed Street analysts’ estimates.


And … between the Change Healthcare cyberattack and Medicare Advantage headwinds, major insurers faced unique challenges in the first quarter.

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Stat: 8.7%. That’s the level to which US consumers can expect the 30-year mortgage rate to rise over the next year, which marks a series high, according to a New York Federal Reserve survey (MarketWatch)

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Appreciating the Six Types of Investment Fees

dr-marcinkoDR. DAVID EDWARD MARCINKO MBA MEd CMP

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investing

Investment fees matter. They can make a big difference to your financial health in the long run. Before you put money into any investment, it’s vital to uncover the real costs.They typically include these six types of fees:

1. An up-front commission earned by the salesperson or their firm. Don’t rely on a vague assurance or a verbal answer: get a specific number in writing.If you have trouble getting a number, ask, “If I buy this investment today and want to get out tomorrow, how much do I get back?” If the answer is not “all your money,” the difference is probably the upfront fees and commissions.

I don’t recommend purchasing financial products with significant upfront commission or costs. I have seen investments where these fees run as high as 30% of the money invested. If you were to earn 5% a year on the investment, it would take 8 years just to break even.

2. Ongoing advisory fees. These are monthly, quarterly, or annual fees you pay advisors for their investment advice and oversight. This includes working with you to pick the asset classes, set the diversification, select the managers, tax optimization, rebalancing, and other periodic tasks.

This fee can have many names including wrap fee or investment advisory fee. The normal “rule of thumb” is 1% of the assets the advisor is managing, although fees can range from 0 to 7%. This fee can be charged to you even if the advisor receives an upfront commission. It can be easy to see or hidden away in the fine print of the investment.

3. Additional fees for services. Find out specifically what services are included in the advisor fee. Additional fees for financial planning or ancillary services are rarely disclosed or discussed.

Services can range from minimal hand-holding only focused on your investments to comprehensive, holistic financial planning. Amazingly, there is no correlation between price and the breadth of services. That’s illogical, but the financial services industry gets away with this, in part because consumers don’t do their homework.

4. Ongoing fees charged by the managers of the specific funds or investment products. These fees are referred to as the fund’s expense ratio. This comes out of the profits generated by the manager, and it is one of the hardest fees to find. Only the most transparent advisor or salesperson will disclose it. It is incredibly well hidden; you will never see it in your brokerage statements or your advisor’s invoices. The only way to know the amount of this fee is to read the prospectus or some other third party analysis of the investment, like Morningstar.

These fees can vary greatly for the same investment, depending on the class of share you buy. For example, American Fund’s New Perspective Fund’s expense ratio ranges from0.45% to 1.54%.  The average expense ratio of a mutual fund that invests in stocks is 1.35%. Conversely, the average expense ratio of a Vanguard S&P 500 fund is 0.10%. The difference of 1.25% is staggering over time.

5. Miscellaneous fees. These are also rarely talked about and hard to find. Many advisors charge $50 to $100 a year per account, hundreds of dollars to open or close an account, and even fees to dollar cost average your funds into the market.

6. Transaction fees. Every time you buy or sell a fund, a fee is typically paid to a custodian. These can range from $5 to hundreds of dollars per transaction.

Assessment

Remember, it’s your job to persist until you find out the total costs of an investment. Next week I’ll suggest ways to ask the tough questions about fees.

Conclusion

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

DAILY UPDATE: FQHCs Down and Healthcare Bankruptcies Up as the Markets Extend Gains

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Low-income communities often struggle to access healthcare services, but a new analysis of federally qualified health centers (FQHCs)—which provide quality care to patients regardless of ability to pay—has helped nail down one reason. When it comes to screening for certain cancers, these nonprofit community health centers have fallen far behind the national average, according to a study led by cancer center researchers at the University of Texas MD Anderson and the University of New Mexico.

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Healthcare bankruptcies surged in 2023, and it turns out many of the companies that went under had one thing in common: private equity (PE) ownership. At least 21% of the 80 healthcare companies that filed for bankruptcy last year were PE-owned, according to a report from the nonprofit Private Equity Stakeholder Project (PESP).

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Warren Buffett on contemplated his own mortality at Berkshire’s meeting. Succession was the topic du jour at the Berkshire Hathaway shareholder meeting in Omaha last week. After his longtime business partner Charlie Munger died last year at 99, CEO Warren Buffett—who turns 94 in August—revealed his heir apparent, Greg Abel, will have the final say on investment decisions in his absence. Buffett ended his Q&A portion with the quip, “I not only hope you come next year. I hope I come next year.” Adding to the ominous vibes, Buffett said AI is a genie that “scares the hell out of me.”

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Here’s where the major benchmarks ended:

  • The S&P 500 index climbed 52.95 points (1.0%) to 5,180.74; the Dow Jones Industrial Average gained 176.59 points (0.5%) to 38,852.27; the NASDAQ Composite advanced 192.92 points (1.2%) to 16,349.25.
  • The 10-year Treasury note yield (TNX) fell about 1 basis  point to 4.491%.
  • The CBOE Volatility Index® (VIX) was little changed at 13.48.

Semiconductors were among the strongest performers Monday behind Micron Technology (MU), whose shares rallied 4.7% after Robert W. Baird upgraded the chipmaker to “outperform” from “neutral.” Micron Technology was the top gainer in the Philadelphia Semiconductor Index (SOX), which advanced 2.2% to near a four-week high.

Small-cap stocks also got out of the gate strong this week. The Russell 2000® Index (RUT) gained 1.2% to end at a four-week high but is still up just 1.7% for the year, while the S&P 500 has gained 8.6%.

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DAILY UPDATE: Cooling Labor Markets with Unemployment Rate Uptick

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A cooling labor market raises hopes for a rate cut in the summer. The latest Labor Department data shows the US added 175,000 jobs in April, but much less than the 300,000 added in March and also less than economists expected. Meanwhile, the unemployment rate ticked up to 3.9% from 3.8% in March, and wages rose less than anticipated. All that bad news for us was music to the ears of investors who are holding out hope that the Federal Reserve might still cut interest rates this summer despite most recent economic data showing that inflation is sticking around.

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Rate cuts appear to be back on the 2024 menu following Friday’s softer-than-expected jobs report, fueling gains for all three major stock indexes last week. With the report calming worries that inflation is ticking back up, investors now project a 50% likelihood that the Federal Reserve will reduce rates in September.

Coinbase is benefiting from the hype around new bitcoin ETFs. The crypto exchange reported a $1.2 billion quarterly profit last week, and net revenue rose by 115%.

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PODCAST: The Altman Corporate Bankruptcy ZETA Score Model

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By Dr. David Edward Marcinko MBA MEd CMP®

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What Is the Zeta Model Altman Score?

The Zeta Model is a mathematical model that estimates the chances of a public company going bankrupt within a two-year time period. The number produced by the model is referred to as the company’s Z-score (or zeta score) and is considered to be a reasonably accurate predictor of future bankruptcy.

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The model was published in 1968 by New York University professor of finance Edward I. Altman. The resulting Z-score uses multiple corporate income and balance sheet values to measure the financial health of a company.

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Altman's Z-Score Model - Overview, Formula, Interpretation

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READ: https://pages.stern.nyu.edu/~ealtman/ZETA-Analysis.pdf

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DAILY UPDATE: Sleep, Starbucks and Cell Phone Education

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Happy Cinco de Mayo 2024

Starbucks – The coffee company known for consistently outperforming itself reported less-than-spectacular earnings this week, sending its stock plunging 12% on Tuesday evening last week on the news—nearly as much as when the company shut all its doors during Covid 19. For the first time since 2020, US same-store sales declined, falling 3% alongside a 7% decrease in foot traffic. Meanwhile, revenue fell 1.8% to $8.56 billion as sales in China—the chain’s second-biggest market—declined 11%, and Starbucks lowered its sales outlook for the year.

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Educators have long pushed back against distraction machines (aka phones), with 77% of schools banning them in the classroom as of 2020, according to a National Center for Education Statistics survey. School time still overlaps with screen time: 97% of students are on their phones during school hours, according to a study by Common Sense Media, a nonprofit that informs parents about technology. While much of students’ phone use might be at lunch or recess, teachers complain that kids aren’t waiting for the bell to take a discreet peek at their screens.

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Creatine may counteract sleep deprivation. The dietary supplement all over your Instagram feed might one day help workers who have to do a lot on small amounts of sleep, like ER staff, first responders, and anyone sharing a house with a baby.

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DAILY UPDATE: Stock Markets Rally

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MAY THE FOURTH BE WITH YOU

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 63.59 points (1.3%) to 5,127.79, up 0.6% for the week; the Dow Jones Industrial Average® ($DJI) gained 450.02 points (1.2%) to 38,675.68, up 1.1% for the week; the NASDAQ Composite surged 315.37 points (2.0%) to 16,156.33, up 1.4% for the week.
  • The 10-year Treasury note yield (TNX) fell about 7 basis points to 4.50%, down about 16 basis points for the week.
  • The CBOE Volatility Index® (VIX) fell 1.19 to 13.49.

Technology shares were among the strongest performers Friday behind a 6% rally in shares of Apple (AAPL), which late Thursday reported stronger-than-expected quarterly results and said it will repurchase $110 billion in shares. Amgen (AMGN) soared nearly 12%, leading Dow gainers after the biotechnology company beat earnings expectations.

In other markets, WTI Crude Oil futures (/CL) extended a week-long slump to end just above $78 per barrel, the lowest since mid-March. Crude futures dropped almost 7% this week, partly reflecting rising U.S. supplies and signs of slower fuel demand.

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APRIL 2024: US Hiring Slows

By Staff Reporters

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Job growth slowed and unemployment ticked higher last month, marking a break from a string of data showing surprising strength in the labor market.

U.S. employers added a seasonally adjusted 175,00 jobs in April, the Labor Department reported on Friday. That was far less than in March, when gains exceeded 300,000, and also below what economists had expected. The unemployment rate ticked up to 3.9% from March’s 3.8%.

According to the WSJ, wages also rose less than anticipated, increasing 3.9% from a year earlier after rising 4.1% in March.

Friday’s report today is sure to stir immediate debate among economists and investors about whether the labor market is merely cooling in a welcome fashion or starting to show more serious strains under the pressure of higher interest rates.

Treasury yields, which largely reflect investors’ expectations for short-term rates set by the Federal Reserve, fell after the report. The yield on the benchmark 10-year U.S. Treasury note was 4.471% in recent trading, according to Tradeweb, down from 4.569% Thursday.

Stock futures climbed, suggesting investors were pleased with the data, which could increase optimism about the outlook for inflation.

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DAILY UPDATE: Stock Markets Up Beat!

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Yesterday, sales of Wegovy more than doubled last quarter, and at least 25,000 people are starting to take it in the US per week. It also posted a $3.65 billion net profit and increased its sales outlook for 2024. But its stock Novo Nordisk still dropped yesterday.

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iPhone sales are down but Apple share buybacks are up. Apple managed to keep investors happy, sending its stock shooting up after-hours yesterday, despite selling fewer iPhones last quarter. Sales of the signature phone dipped 10% year over year, and revenue fell 4.3% to $90.8 billion. But Apple also announced $110 billion in share buybacks, the largest in the company’s history, per CNBC. And sales in China, which has been a sore spot, came in at $16.4 billion, less than a year earlier but more than analysts had predicted.

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Stocks rose yesterday as investors digested Jerome Powell’s recent comments and decided they only had to fear fear itself—and not interest rate hikes. Investors changed into the fast lane to buy Carvana after the used car sales site reported its best earnings ever Wednesday evening.

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Stat: 16%. That’s the percentage by which CVS stocks plummeted Wednesday after the company reported earnings below expectations and cut its annual outlook, according to (CNBC).

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But Here’s where the major stock market benchmarks ended Thursday:

  • The S&P 500® index (SPX) rose 45.81 points (0.9%) to 5,064.20; the Dow Jones Industrial Average® ($DJI) added 322.37 points (0.9%) to 38,225.66; the NASDAQ Composite® ($COMP) surged 235.48 points (1.5%) to 15,840.96.
  • The 10-year Treasury note yield (TNX) dropped about 1 basis point to 4.583%.
  • The CBOE Volatility Index® (VIX) fell 0.71 to 14.68.

Transportation shares helped lead the market higher after C.H. Robinson (CHRW) reported stronger-than-expected quarterly results, sending the freight logistics and trucking company’s stock up 12%. The Dow Jones Transportation Average ($DJT) jumped 2.5%. Semiconductors were also strong after Qualcomm (QCOM) advanced 9.7% in the wake of the chip maker’s better-than-expected earnings.

Apple (AAPL) shares advanced 2.2% ahead of the company’s quarterly earnings report scheduled after Thursday’s close.

In other markets, WTI Crude Oil (/CL) futures bounced back to end with a slight gain after earlier dropping to a seven-week low under $78.50 per barrel.

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ESCHEW “C”: Medicare Advantage [Part C] Plans Now?

By Dr. David Edward Marcinko MBA MEd CMP

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Medicare [Dis] Advantage Plans [Medicare Part C] commenced in 2003 or so and I have railed against them since then. First, for their low physician payments. And then as a patient advocate for the last decade. And, today, for both reasons. As a doctor and independent health insurance agent myself, believe me when I speak thusly.

READ: https://medicalexecutivepost.com/2023/11/07/proposed-changes-medicare-advantage/

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Now, while Medicare Advantage plans are undoubtedly not the right choice for everyone, insurance companies still say there are some folks who will get exactly what they need from the plans and at a moderate price.

Nevertheless, Ernesto Jaboneta, the IT Director of California-based Medicare insurance agency Agent Pitstop, acknowledged there are many predatory salespeople who will jump to have you join a plan that doesn’t end up helping you in the long run. Still, there are precautions you can take to make falling into this trap less likely.

“The first thing anyone can do is invite along a family member or trusted friend to any appointments with an insurance agent,” Jaboneta told Newsweek. “Don’t feel pressured to decide right away.”

Before you commit to anything, you should compare plans and find out if your doctors will remain in your network. And if you’re unsure about some of the information you received from an insurance agent, you can also call 1-800-MEDICARE for more assistance.

Jaboneta also said there’s a big difference between captive insurance agents and independent agents, as well, and seniors should take note of this.

“A captive agent is an insurance agent who works directly for an insurance carrier,” Jaboneta said. “They have no incentive to compare options outside their own company, which is different than an independent agent who can compare all the options available. In many cases, when a beneficiary calls into an insurance company to find information, they will be talked into enrolling.”

The open enrollment period lasts from October 15th to December 8th, but there’s another enrollment period from January 1st to March 31st for anyone unhappy with their Medicare Advantage plan who wants to switch or revert to Medicare.

MORE: https://medicalexecutivepost.com/2023/12/24/medicare-part-c-humana-used-a-i-tool-from-unitedhealth-to-deny-medicare-advantage-claims/

INVESTING UPDATE: Managed-care companies are reporting that seniors on Medicare Advantage Part C plans used far more medical services than expected in the final months of 2023. The announcements have sparked two separate selloffs over the past week: The first came January 12th, when UnitedHealth Group announced its fourth-quarter earnings. The second came after Humana just laid out preliminary fourth-quarter results, and said the high utilization trends would have a material impact on its 2024 performance “if current trends continue.”

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ENDING MEDICARE ADVANTAGE: Humana Dis-advantage

By Staff Reporters

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Millions of Americans on Humana’s Medicare Advantage plans could see their health care benefits cut after the company makes major profit-boosting adjustments to its plans.

Humana said it would be ending some plans and cutting benefits for patients in 2025 as it hopes to boost its financial performance. Altogether, 6 million Americans are insured through Humana’s Medicare Advantage.

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DAILY UPDATE: Walmart, Women’s Health Month, UnitedHealth and the Mixed Stock Markets

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Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) fell 17.30 points (0.3%) to 5,018.39; the Dow Jones Industrial Average® ($DJI) gained 87.37 points (0.2%) to 37,903.29; the NASDAQ Composite® ($COMP) lost 52.34 points (0.3%) to 15,605.48.
  • The 10-year Treasury note yield (TNX) dropped more than 5 basis points to 4.63%.
  • The CBOE Volatility Index® (VIX) decreased 0.28 to 15.37.

Banks and other financial shares led the market’s afternoon upswing, reflecting renewed optimism over the outlook for interest rates. The KBW Regional Bank Index (KRX) jumped 2.4% and posted its first gain in five days. Biotechnology and communication services were also strong.

Energy shares were among the weakest performers as WTI Crude Oil (/CL) futures extended a week-long nosedive and dropped under $80 per barrel for the first time since mid-March. Crude futures sank over 3% after the Energy Information Administration reported U.S. oil inventories surged 1.6% last week. 

Among top companies, Amazon (AMZN) gained 2.2% after reporting stronger-than-expected earnings and revenue late Tuesday. Starbucks (SBUX) tumbled 16% following unexpectedly soft quarterly results. Apple (AAPL) eased 0.6% ahead of its quarterly results, expected after Thursday’s close.

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Speaking of stock companies, however big you think UnitedHealth is, it’s bigger than that. For example:

  • With a market cap of nearly $450 billion, it’s the fourth-largest company in the US by revenue this year, beating out Alphabet and Microsoft.
  • The company is eyeing a $24.7 billion profit in 2024.
  • One analyst estimated that more than 5% of US GDP flows through UnitedHealth’s systems daily.

And so, lawmakers in Washington are prepared to grill UnitedHealth CEO Andrew Witty in two congressional hearings today, months after a cyberattack on a subsidiary of the healthcare giant, Change Healthcare, rattled the industry and left pharmacies, doctors, and hospitals in the dark. Change processes roughly half of all Americans’ medical claims. Congress wants Witty to clarify how UnitedHealth handled the breach of patient data. But beyond that, it wants to investigate whether the company—the nation’s largest private health insurer—has grown too big and taken on too much risk.

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Retailer Walmart announced plans Tuesday to shutter its network of 51 health clinics in five states, along with its telehealth business. The impending closures signify that Walmart is scuttling its initial plans to expand the services, citing escalating operation costs and “challenging reimbursement environment,” the company said in a news release.

Finally – Happy Women’s Health Month! Women and people assigned female at birth are disproportionately affected by a range of health conditions, including autoimmune diseases, chronic pain, and dementia. The month of May is intended to raise awareness of these disparities and educate women on steps they can take to improve their health, such as getting annual breast exams. For all our woman-identifying readers, take some time to prioritize your health this month!

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DAILY UPDATE: Lumeris Health Tech – MultiPlan, UnitedHealth, Aetna & CVS Payer Data – Stock Melt Down

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MAY FIRST DAY

May Day is a European festival of ancient origins marking the beginning of summer, usually celebrated on 1 May, around halfway between the Northern Hemisphere’s Spring equinox and June solstice. Festivities may also be held the night before, known as May Eve. Traditions often include gathering wildflowers and green branches, weaving floral garlands, crowning a May Queen and setting up a Maypole, May Tree or May Bush, around which people dance. Bonfires are also part of the festival in some regions.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 80.48 points (1.6%) to 5,035.69; the Dow Jones Industrial Average® ($DJI) lost 570.17 points (1.5%) to 37,815.92, down 5% for the month; the NASDAQ Composite declined 325.26 points (2.0%) to 15,657.82.
  • The 10-year Treasury note yield jumped more than 7 basis points to 4.682%.
  • The CBOE Volatility Index® (VIX) rose 0.98 to 15.65.

Energy shares were among the weakest performers Tuesday, behind a drop in WTI Crude Oil (/CL) futures, which fell a third consecutive session and briefly dropped under $81 per barrel. The Philadelphia Oil Service Index (OSX) tumbled 4.5% to a seven-week low. The small-cap Russell 2000® Index (RUT) shed 2.1% and ended with a loss of 7.1% for the month.

But, it was a better day for Mounjaro maker Eli Lilly, which climbed nearly 6% after its popular weight loss drugs pushed it to raise its 2024 forecast.

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Lumeris Health, a health tech company supporting value-based care operations, raised $100 million in a new funding round to support expansion.

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class-action complaint was filed against MultiPlan and major payers like UnitedHealth Group and CVS Health’s Aetna, arguing payers’ claims data was being used to generate low reimbursement rates.

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PODCAST: Healthcare Revenue Cycle Management Explained

By Eric Bricker MD

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DAILY UPDATE: The CHIPS and Science Act & the FOMC as Stocks Edge Higher

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It’ll be a big week for hot takes on the US economy, after the Federal Reserve meeting Tuesday and Wednesday and the April jobs report dropping Friday. Because inflation has been sticking around, the FOMC is expected to hold interest rates steady at this meeting and for the foreseeable future. On the jobs front, economists are projecting another strong month for employment growth.

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In 2022, with bipartisan support, Congress passed the CHIPS and Science Act, an ambitious plan to juice domestic manufacturing of a product vital to national security: semiconductors. Two years later, the government has doled out more than half of the CHIPS Act’s $39 billion in incentives. According to the Financial Times

  • Chip companies and their suppliers have announced US investments of $327 billion over the next 10 years, per the Semiconductor Industry Association.
  • Construction of manufacturing facilities for computing and electronics devices has jumped 15x, government data shows.
  • By 2030, the US will likely produce around 20% of the world’s most advanced chips, according to USCommerce Secretary Gina Raimondo. Right now, it’s making 0%.

The proposed factories are massive and could transform regional economies. Micron, which received $6.1 billion in federal grants last week, plans to invest $100 billion in a manufacturing campus near Syracuse.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 16.21 points (0.3%) to 5,116.17, its highest close in over two weeks; the Dow Jones Industrial Average® ($DJI) gained 146.43 points (0.4%) to 38,386.09, the NASDAQ Composite® ($COMP) advanced 55.18 points (0.4%) to 15,983.08.
  • The 10-year Treasury note yield (TNX) fell more than 5 basis points to 4.616%.
  • The CBOE Volatility Index® (VIX) declined 0.36 to  14.67.

Communication services shares were among the market’s weakest performers Monday, reversing last Friday’s upswing as Alphabet (GOOGL) dropped more than 3% and Meta Platforms (META) lost 2.4%. Banks and retailers were also soft. The Philadelphia Semiconductor Index (SOX) climbed for the sixth-straight day and ended near a three-week high even though its biggest member, Nvidia (NVDA), ended little changed.

In other markets, the U.S. Dollar Index ($DXY) faded from early gains but is still up about 1% in April, driven by expectations domestic rates will remain high. “The U.S. dollar’s strength continues to reflect the relative strength of the economy and the wide interest rate differentials between the United States and other major developed markets,” Schwab Center for Financial Research analysts said in a report.

Despite last week’s strength, the S&P 500 index and the NASAQ Composite are still down 2.6% and 2.4%, respectively, for April and on track to break five-month winning streaks.

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Humana expects to exit Medicare Advantage (MA) markets in 2025, company executives told investors. The company reported its first quarter earnings April 24th. Humana posted $741 million in net income in the first quarter of 2024, beating investor expectations, but pulled its 2025 earnings guidance. 

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Hedging the Portfolio with Weapons of Mass Destruction

A SPECIAL REPORT

By Vitaliy N. Katsenelson CFA

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Uber’s business is doing extremely well. It has reached escape velocity – the company’s expenses have grown at a slow rate while its revenues are growing at 22% a year. This caused profit margins to expand and earnings and free cash flows to skyrocket. Our investment in Uber was based on the assumption that its services would become a utility – just like water and electricity. The company’s name is synonymous with ride sharing. 

I must confess that the biggest risk to our investment in Uber is me. Yes, you read that right. Uber has an incredible growth runway. It is not just going after ride sharing and food delivery, where it still has plenty of room to grow, it is also making serious inroads into the grocery market. It has terrific management that is putting a lot of daylight between Uber and its competitors.

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BANKS: Eight Types; plus 1

DOCTORS NEED TO KNOW

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By Dr. David Edward Marcinko MBA CMP

A general understanding of these bank types is suggested for any medical professional prior to launching a self-directed [ME, Inc] medical practice, clinic, guided investment strategy, personal financial plan or wealth building portfolio effort; etc.

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DAILY UPDATE: Republic First Bank Seized and Sold to Fulton Bank

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Republic First Bank. The FDIC said regulators seized the troubled Philadelphia-based bank and agreed to sell it to Fulton Bank. While news of a regional bank failure might take you back to March 2023 when Silicon Valley Bank bit the dust, Republic First was much smaller than SVB (and much smaller than the similarly named First Republic, which ultimately got absorbed by JPMorgan Chase as regional banks struggled). And, because there’s already a buyer, there are no lingering questions about the safety of deposits.

So, while the first bank failure of the year is a sign that regional banks are still in a bad way, it’s unlikely to spur a larger crisis.

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HOSPITALS: “Weighted Average Cost of Capital”

By Dr. David Edward Marcinko MBA CMP

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The Cost of Hospital Capital Is “WACC”

It is critical for physician executives to understand and to measure the total cost of hospital capital. Lack of understanding and appreciation of the total cost of capital is widespread, particularly among not-for-profit hospital and physician executives. The capital structure includes long-term debt and equity; total capital is the sum of these two, and, each of these components has cost associated with it.

For the long-term debt portion, this cost is explicit—it is the interest rate plus associated costs of placement and servicing. For the equity portion, the cost is not explicit and is widely misunderstood. In many cases, hospital capital structures include significant amounts of equity that has accumulated over many years of favorable operations.

Far too many executives wrongly attribute zero cost to the equity portion of their capital structure. Although it is correct that generally accepted accounting principles continue to assign a zero cost to equity, there is opportunity cost associated with equity that needs to be considered. This cost is the opportunity available to utilize that capital in alternative ways.

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In general, the cost attributed to equity is the return expected by the equity markets on hospital equity. This can be observed by evaluating the equity prices of hospital companies whose equity is traded on public stock exchanges. Usually, the equity prices will imply cost of equity in the range of 10%–14%. Almost always, the cost of equity implied by hospital equity prices traded on public stock exchanges will substantially exceed the cost of long-term debt. Thus, while many hospital executives will view the cost of equity to be substantially less than the cost of debt (i.e., to be zero) in nearly all cases, the appropriate cost of equity will be substantially greater than the cost of debt.

Hospitals need to measure their weighted average cost of capital (WACC). WACC is the cost of long-term debt multiplied by the ratio of long-term debt to total capital plus the cost of equity multiplied by the ratio of equity to total capital (where total capital is the sum of long-term debt and equity).

WACC is then used as the basis for capital charges associated with all capital investments. Capital investments should be expected to generate positive returns after applying this capital charge based on the WACC. Capital investments that do not generate returns exceeding the WACC consume enterprise value; those that generate returns exceeding WACC increase enterprise value. Therefore, physician and hospital executives need to be rewarded for increasing enterprise value.

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Behavioral Finance for Doctors?

On the Psychology of Investing [Book Review]

By Peter Benedek, PhD CFA

Founder: www.RetirementAction.com

Some of the pioneers of behavioral finance are Drs. Kahneman, Twersky and Thaler. This short introduction to the subject is based on John Nofsinger’s little book entitled “Psychology of Investing” an excellent quick read for all medical professionals or anyone who is interested in learning more about behavioral finance.

Rational Decisions?

Much of modern finance is built on the assumption that investors “make rational decisions” and “are unbiased in their predictions about the future”, however this is not always the case.

Cognitive errors come from (1) prospect theory (people feel good/bad about gain/loss of $500, but not twice as good/bad about a gain/loss of $1,000; they feel worse about a $500 loss than feel good about a $500 gain); (2) mental accounting (meaning that people tend to create separate buckets which they examine individually), (3) Self-deception (e.g. overconfidence), (4) heuristic simplification (shortcuts) and (4) mood can affect ability to reach a logical conclusion.

John Nofsinger’s Book

The following are some of the major chapter headings in Nofsinger’s book, and represent some of the key behavioral finance concepts.

Overconfidence leads to: (1) excessive trading (which in turn results in lower returns due to costs incurred), (2) underestimation of risk (portfolios of decreasing risk were found for single men, married men, married women, and single women), (3) illusion of knowledge (you can get a lot more data nowadays on the internet) and (4) illusion of control (on-line trading).

Pride and Regret leads to: (1) disposition effect (not only selling winners and holding on to the losers, but selling winners too soon- confirming how smart I was, and losers to late- not admitting a bad call, even though selling losers increases one’s wealth due to the tax benefits), (2) reference points (the point from where one measures gains or losses is not necessarily the purchase price, but may perhaps be the most recent 52 week high and it is most likely changing continuously- clearly such a reference point will affect investor’s judgment by perhaps holding on to “loser” too long when in fact it was a winner.)

Considering the Past in decisions about the future, when future outcomes are independent of the past lead to a whole slew of more bad decisions, such as: (1) house money effect (willing to increase the level of risk taken after recent winnings- i.e. playing with house’s money), (2) risk aversion or snake-bite effect (becoming more risk averse after losing money), (3) trying to break-even (at times people will increase their willing to take higher risk to try to recover their losses- e.g. double or nothing), (4) endowment or status quo effect (often people are only prepared to sell something they own for more than they would be willing to buy it- i.e. for investments people tend to do nothing, just hold on to investments they already have) (5) memory and decision making ( decisions are affected by how long ago did the pain/pleasure occur or what was the sequence of pain and pleasure), (6) cognitive dissonance (people avoid important decisions or ignore negative information because of pain associated with circumstances).

Mental Accounting is the act of bucketizing investments and then reviewing the performance of the individual buckets separately (e.g. investing at low savings rate while paying high credit card interest rates).

Examples of mental accounting are: (1) matching costs to benefits (wanting to pay for vacation before taking it and getting paid for work after it was done, even though from perspective of time value of money the opposite should be preferred0, (2) aversion to debt (don’t like long-term debt for short-term benefit), (3) sunk-cost effect (illogically considering non-recoverable costs when making forward-going decisions). In investing, treating buckets separately and ignoring interaction (correlations) induces people not to sell losers (even though they get tax benefits), prevent them from investing in the stock market because it is too risky in isolation (however much less so when looked at as part of the complete portfolio including other asset classes and labor income and occupied real estate), thus they “do not maximize the return for a given level of risk taken).

In building portfolios, assets included should not be chosen on basis of risk and return only, but also correlation; even otherwise well educated individuals make the mistake of assuming that adding a risky asset to a portfolio will increase the overall risk, when in fact the opposite will occur depending on the correlation of the asset to be added with the portfolio (i.e. people misjudge or disregard interactions between buckets, which are key determinants of risk).

This can lead to: (1) building behavioral portfolios (i.e. safety, income, get rich, etc type sub-portfolios, resulting in goal diversification rather than asset diversification), (2) naïve diversification (when aiming for 50:50 stock:bond allocation implementing this as 50:50 in both tax-deferred (401(k)/RRSP) accounts and taxable accounts, rather than placing the bonds in the tax-deferred and stocks in taxable accounts respectively for tax advantages), (3) naïve diversification in retirement accounts (if five investment options are offered then investing 1/5th in each, thus getting an inappropriate level of diversification or no diversification depending on the available choices; or being too heavily invested in one’s employer’s stock).

Representativenes may lead investors to confusing a good company with a good investment (good company may already be overpriced in the market; extrapolating past returns or momentum investing), and familiarity to over-investment in one’s own employer (perhaps inappropriate as when stock tanks one’s job may also be at risk) or industry or country thus not having a properly diversified portfolio.

Emotions can affect investment decisions: mood/feelings/optimism will affect decision to buy or sell risky or conservative assets, even though the mood resulted from matters unrelated to investment. Social interactions such as friends/coworkers/clubs and the media (e.g. CNBC) can lead to herding effects like over (under) valuation.

Financial Strategies

Nofsinger finishes with a final chapter which includes strategies for:

(i) beating the biases: (1) Understand the biases, (2) define your investment objectives, (3) have quantitative investment criteria, i.e. understand why you are buying a specific investor (or even better invest in a passive fashion), (4) diversify among asset classes and within asset classes (and don’t over invest in your employer’s stock), and (5) control your investment environment (check on stock monthly, trade only monthly and review progress toward goals annually).

(ii) using biases for the good: (1) set new employee defaults for retirement plans to being enrolled, (2) get employees to commit some percent of future raises to automatically go toward retirement (save-more-tomorrow).

Assessment

Buy the book (you can get used copies through Amazon). As indicated it is a quick read and occasionally you may even want to re-read it to insure you avoid the biases or use them for the good. Also, the book has long list of references for those inclined to delve into the subject more deeply.

You might even ask “How does all this Behavioral Finance coexist with Efficient Market theory?” and that’s a great question that I’ll leave for another time.

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Conclusion

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DAILY UPDATE: Cannabis, Healthcare and the Stock Market Rally!

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index gained 51.54 points (1.0%) to 5,099.96, up 2.7% for the week; the Dow Jones Industrial Average® ($DJI) increased 153.86 points (0.4%) to 38,239.66, up 0.7% for the week; the NASDAQ Composite jumped 316.14 points (2.0%) to 15,927.90, up 4.2% for the week.
  • The 10-year Treasury note yield (TNX) lost about 4 basis points to 4.665%.
  • The CBOE Volatility Index® (VIX) fell 0.34 to 15.03.

Alphabet’s rally helped communication services reverse Thursday’s downturn, which was driven by disappointing quarterly results from Meta Platforms (META). The S&P 500 Communication Services index ($SP500#50) surged 4.7% Friday and ended the week with a 2.7% gain. Semiconductor shares were also strong, led by a 6% gain in Nvidia (NVDA). The Russell 2000® Index (RUT) added 1.1% Friday and posted a 2.8% advance for the week.

In other markets, WTI Crude Oil (/CL) futures rose slightly Friday, ending around $83.65 per barrel and shutting down a three-week losing streak.

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  • Midi Health, a health clinic geared toward women in midlife, raised $60 million in Series B funding to expand its network to 150 clinicians by the end of the year, among other efforts. (MobiHealthNews)
  • “We’re fooling ourselves if we think that’s cheap or can be done less expensively.”—Carmela Coyle, president and CEO of the California Hospital Association, on hospital finances and cutting costs (AP)
  • The federal government implemented new staffing rules to improve patient care, but most nursing homes won’t be able to meet that demand. (KFF Health News/NPR)

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The Biden administration is considering a change that would downgrade cannabis from a Schedule I drug to a Schedule III drug this year. The reclassification would have major effects on the business of cannabis, but for that to happen, the Drug Enforcement Agency needs proof of medical effectiveness.

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DAILY UPDATE: GDP Worries as Markets Stumble with Meta but other Technology Stocks are Good

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New GDP numbers out yesterday show a worrying combo of stubborn inflation + waning growth that dampens hopes for a potential interest rate cut. Per the latest data from the Bureau of Economic Analysis, the first quarter of 2024 was a confounding one:

  • GDP increased at a 1.6% annualized rate, far below projections of 2.4% and notably down from 3.4% at the end of 2023.
  • While slow growth would typically signal that the Fed could cut rates, another metric complicates matters: Consumer prices (excluding volatile categories), a solid indicator of inflation, shot up to a much higher than anticipated 3.7%.

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Meta reported record Q1 revenue yesterday, but it was overshadowed by the billions of dollars the company is spending in its efforts to win the Artificial Intelligence race and make the Metaverse happen. Investors were unhappy with the company’s forecast that its spending will rise by $10 billion dollars to support Artificial Intelligence development, sending Meta’s stock price down 15% after hours.

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 23.21 points (0.5%) to 5,048.42; the Dow Jones Industrial Average lost 375.12 points (1.0%) to 38,085.80; the NASDAQ Composite® ($COMP) shed 100.99 points (0.6%) to 15,611.76.
  • The 10-year Treasury note yield (TNX) rose about 5 basis points to 4.704%.
  • The CBOE Volatility Index® (VIX) fell 0.64 to 15.33.

Communication services shares were the weakest S&P 500 sector Thursday behind the plunge in Meta Platforms. Late Wednesday, the Facebook parent provided lighter-than-expected second-quarter revenue guidance, while CEO Mark Zuckerberg discussed spending in currently unprofitable pursuits such as artificial intelligence (AI) and mixed reality. Meta’s first-quarter earnings and revenue both came above analysts ‘ estimates, however.

Meta’s slump helped send the S&P 500 Communication Services index ($SP500#50) down 4%. Banks were also particularly soft amid concern that persistently high interest rates may compress lender margins. Semiconductor and transportation shares were among the few pockets of strength.

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But, Alphabet, Microsoft, and Snap reported Q1 earnings yesterday, and were generally good. Alphabet issued its first-ever dividend and authorized $70 billion in stock buybacks, after it beat Wall Street’s revenue expectations. Microsoft also beat revenue forecasts on the strength of its cloud services. And Snap shares soared after it topped estimates and impressed investors with its 422 million global daily active users. It was a much-needed boost for the sector after Meta spooked the market with how much it’s spending on AI.

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MICROSOFT: The Artificial Intelligence Revolution

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Microsoft is looking at a broader AI future than just OpenAI

Microsoft has been at the forefront of the AI revolution through its $13 billion stake in the ChatGPT-maker, but recently it showed it’s also making other Artificial Intelligence bets, announcing it will pursue several partnerships and is investing $2.1 billion in French startup Mistral AI. Mistral’s tech will be available to Microsoft Azure users.

And then Microsoft President Brad Smith told Axios that OpenAI CEO Sam Altman is “brilliant”, but …… Read Axios Story.

Perhaps even to counter Mark Zuckerbergs META Platform.

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FOR 4 BIG BANKS: A Big Quarter

By Staff Reporters

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An uptick in corporate dealmaking fueled investment banking growth at the four largest US banksJPMorgan Chase, Bank of America, Wells Fargo, and Citibank—as well as at Goldman Sachs and Morgan Stanley. The result was “one of [investment banking’s] best quarters” since the Fed began hiking rates in 2022, the Wall Street Journal reported. Their earnings releases over the last week either matched or beat the consensus forecasts for revenue and earnings per share, according to the WSJ.

“It’s clear that we’re in the early stages of a reopening of the capital markets,” Goldman Sachs CEO David Solomon said in an earnings call last Monday. Goldman reported that growth in its investment banking and trading pushed its net income up 28% year over year, beating analyst expectations. Solomon said he expects more M&A activity will keep boosting the demand for debt underwriting at Goldman, which saw a 32% Year over Year jump in internet-banking revenue.

Solomon’s sunny outlook was beclouded the next day by Fed Chair Jerome Powell. The Fed had hoped inflation reports would show it could cut rates soon without overheating the economy, but instead inflation has continued to tick up.

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DOCTOR: Money “Disorders”

Behavioral Finance –  Are You Guilty?

By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com

As a young adult, what could you spend money on that would be a wise investment in your financial future? A home? Medical school education? A money management class?

Well, all of these may be good ideas, but there’s something else you can buy that could make an even greater difference in your long-term financial health: counseling.

Behavioral Finance

What does psychological counseling have to do with money? Sometimes; a lot!

For example, I was recently interviewed by a reporter for an article about money disorders. The conversation reminded me just how many problems can result from dysfunctional money beliefs and behaviors. Money disorders can impair people’s functioning and disrupt their lives just as significantly as disorders like alcoholism or other addictions.

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Common Maladies

Some common money disorders include the following:

  • Compulsive Spending is a consuming focus on spending. It can include buying things you can’t afford as well as shopping where no money is actually spent
  • Financial Enabling is a codependent attempt to help others that actually does more harm than good. A pattern of bailing kids out financially is a good example.
  • Hoarding is compulsively buying and storing things that you don’t need or will never use.
  • Financial Infidelity is keeping money secrets (such as spending, saving, or investment mistakes) from your partner because you would be ashamed to have them find out.
  • Financial Incest is inappropriate sharing of worries or financial details in ways that violate the boundaries between children and adults.
  • Workaholism, especially medical professionals, is a consuming focus on work or earning to a point of damaging your relationships.
  • Under-spending is frugality taken to extremes, such as inadequate spending on health care, nutrition, shelter, or clothing even when you can afford them.

Not about Money

How many of the above “disorders” are you guilty of?

All these disorders have one thing in common: fundamentally, they aren’t about the money. A given pattern of behavior around money can be someone’s unconscious response to emotional pain, in the same way addiction or anger might be.

For that particular person, the money behavior may just happen to be the medicator that works to cope with deep emotional stress. While one person may find relief in alcohol or drugs and another may find it in work, someone else might use shopping or hoarding as a way to feel better and function in the world.

An Addiction?

Just like addictions, however, money disorders only relieve pain for a short time. In the long term, they only cause more pain. The result is an escalating cycle of destructive behavior that has many negative consequences, including financial ones.

Rag Mags

To see how emotional health and financial health are linked, all you have to do is read a celebrity magazine or look around at the people you know. I’ve seen high-earning doctors and other medical professionals who have a negative self-worth because they can’t control their spending. We all know people who bounce from one financial mess to another, never seeming to learn from their money mistakes. Some very capable and intelligent doctors struggle financially and in their careers because of emotional issues that have nothing directly to do with money.

Counseling

Counseling to resolve emotional issues may seem to be a low-priority expense that comes far down the list after basic needs like housing, food, and transportation. Yet for anyone who struggles to overcome destructive patterns of behavior—even those that aren’t directly about money—counseling can pay off in very real monetary ways.

Assessment

Emotionally healthy and confident people make better choices about relationships, careers, and other major aspects of their lives. They also make better choices about money. This is why counseling is more than an investment in your emotional health. It can also make a measurable difference in your financial health.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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DAILY UPDATE: Retirement Security Rule, National Drug Take Back Day, Spotify, Cleveland Clinic, NAR and the Mixed Stock Markets

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Otherwise known as “National Prescription Drug Take Back Day,” National Drug Take Back Day on April 25th is sponsored by the Drug Enforcement Agency. Its goal is to keep the public aware of the dangers of prescription drug use and misuse. Many Americans don’t know how to safely dispose of the prescription drugs that have been sitting in the medicine cabinet past their prime. Using these expired drugs, or using someone else’s, is dangerous and puts both the public and the environment at risk.

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Spotify made money in Q1. According to Morning Brew, the streaming music giant grew its revenue last quarter by 20% to $3.8 billion on a record $180 million in profit, it announced yesterday. The smash report comes after Spotify cut costs last year, which included laying off more than a quarter of its workforce. The company also raised prices in 2023 for the first time in a decade as it further expanded beyond music into audio books and other categories. Spotify shares soared ~11% following the news.

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Here’s where the major benchmarks ended:

  • The S&P 500 index® (SPX) rose 1.08 points (0.02%) to 5,071.63; the Dow Jones Industrial Average® ($DJI) fell 42.77 points (0.1%) to 38,460.92; the NASDAQ Composite® ($COMP) added 16.11 points (0.1%) to 15,712.75.
  • The 10-year Treasury note yield rose more than 4 basis points to 4.644%.
  • The CBOE Volatility Index® (VIX) rose 0.28 to 15.97.

Transportation shares were among the market’s weakest performers Wednesday behind a drop of more than 10% in Old Dominion Freight Line (ODFL), which reported lighter-than-expected quarterly revenue. The shipper’s nosedive helped send the Dow Jones Transportation Average ($DJT) down 2.3%. Consumer staples, semiconductors, and utilities posted moderate advances. The Dow Jones Utility Index ($DJU) gained for the sixth straight day and ended at a three-and-a-half-month high.

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The National Association of Realtors’ $418 million settlement over an alleged conspiracy to inflate commissions received preliminary approval yesterday. It’s a new world order: Sellers won’t have to pay buyers’ agents anymore. There’s been talk of a metaphorical death of real estate agents, or a mass extinction; the jury is still out, but RE/MAX cofounder and chairman Dave Liniger doesn’t seem too concerned. 

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The Labor Department announced it has finalized its Retirement Security Rule, which aims to protect American workers who are saving for retirement and relying on advice from fiduciaries for it. The new rule will update the definition of an investment advice fiduciary under the Employee Retirement Income Security Act and the Internal Revenue Code.

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Clinicians don’t always get it right, and their mistakes can be costly: Studies show misdiagnoses lead to roughly 800,000 patient deaths or permanent disabilities each year in the US and cost the healthcare system an estimated $20 billion annually. Cleveland Clinic is using telehealth to try to combat misdiagnoses via its virtual second opinions program, which has saved an average of $8,705 per patient by avoiding unnecessary treatments, according to an analysis released in March.

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