| Course | HLTH 5033 Financial Management in Public Health |
|---|---|
| Module | Module 1 |
| Paper type | Public health financial statement analysis |
| Length | 1,160 words, about 4 pages plus title and reference pages |
| Format | APA 7 student paper |
| School | American College of Education |
| Program | Master of Public Health |
| Updated | September 2026 |
Free sample paper for HLTH 5033 Module 1
Fifty-Two Cents of Every Dollar Comes With Strings: Analyzing a County Health Department's Revenue Sources and Financial Statements
Student Name
American College of Education
HLTH5033: Financial Management in Public Health
Module 1 Assignment
Instructor Name
October 5, 2026
The Organization and Its Statements
This paper analyzes the most recent annual financial report of a composite county health department serving about 310,000 residents. The department operates as a special revenue fund within the county's financial statements, which means its money is accounted for separately because much of it is legally restricted to specific purposes. Its fiscal year runs from July through June. In fiscal 2025, revenues were $31.4 million and expenditures were $30.9 million.
Public health agencies report differently from hospitals or businesses. They prepare governmental fund statements that focus on the flow of current financial resources, a modified accrual basis, rather than on profit. The questions that matter are therefore not about margins but about where the money comes from, what restrictions come with it, how much flexibility remains and whether cash arrives when bills are due.
Where the Money Comes From
Federal and state grants provided $16.2 million, or 52% of revenue. The largest were the WIC nutrition program at $3.9 million, immunization and epidemiology capacity grants at $2.1 million, the maternal and child health block grant at $1.4 million, public health emergency preparedness at $0.9 million and family planning at $0.7 million, along with $1.2 million from the county's share of opioid settlement funds. The county's own tax levy provided $9.8 million, or 31%. Fees and charges brought in $3.6 million, or 11%, mostly food establishment permits and inspection fees of $1.9 million, clinic and Medicaid billing of $1.1 million and vital records of $0.6 million. Other revenue made up the remaining $1.8 million.
The mix has consequences. Grant money can be spent only on the activities and costs each grant allows, usually on a reimbursement basis, and it can end when a federal or state program changes. Only the local levy and most fees are flexible. The department's budget is $31 million, but its room to set its own priorities is closer to $12 million.
Where the Money Goes
Personnel costs, salaries and benefits for about 240 employees, made up $21.0 million, or 68% of expenditures, a typical share for a service organization. Contracted services, including laboratory testing and home visiting partners, were $4.6 million; supplies, vaccines not provided through federal programs and equipment were $2.8 million; and facilities, vehicles and information technology were $2.5 million. By program, environmental health, communicable disease control and maternal and child health were the largest.
Evidence suggests that spending on local public health is not only a cost. Mays and Smith (2011), studying local health agencies over thirteen years, linked every tenth more in local public health spending with preventable-cause death rates that were 1.1% to 6.9% lower, and the benefit appeared largest where resources had been thinnest, though they cautioned that money alone is unlikely to produce sustained gains without better practice.
Fund Balance
Fund balance, the difference between a governmental fund's assets and liabilities, is the closest equivalent to reserves. Under the accounting standard that governs it, fund balance must be reported in five classifications according to how tightly the money is constrained (Governmental Accounting Standards Board, 2009): nonspendable, restricted, committed, assigned and unassigned. At the end of fiscal 2025, the department's fund balance was $6.1 million: $0.2 million nonspendable, mostly prepaid expenses; $2.4 million restricted by grantors and the opioid settlement; $0.9 million committed by the board of health for vehicle replacement; $0.8 million assigned by management to next year's budget; and $1.8 million unassigned.
The headline figure overstates the department's cushion. Only the unassigned $1.8 million is truly available for an unexpected need, equal to about 5.8% of annual expenditures, or roughly three weeks of operations. The board's own policy calls for unassigned balance equal to 60 days of expenditures, about $5.1 million, so the department is well below its target.
Receivables and Cash Timing
Because most grants reimburse costs after they are incurred, the department pays staff and vendors first and waits to be repaid. At year-end, it had $2.7 million in grant receivables, money spent on grant activities but not yet reimbursed, about 17% of annual grant revenue or roughly two months. Two state grants had been paid more than 90 days late during the year because of a new state reporting system. The county's cash pool covered the gap, but the delay tied up almost all of the unassigned fund balance for several months.
Federal grant rules also affect what the department can recover. Under the federal guidance for financial assistance, recipients without a negotiated indirect cost rate may charge a de minimis rate for indirect costs, which the 2024 revision raised to 15% of modified total direct costs (Guidance for Federal Financial Assistance, 2024). The department has never negotiated a rate and has not been claiming indirect costs on two of its federal pass-through grants, leaving administrative costs to be absorbed by local funds.
Three-Year Trends
A single year can mislead, so the analysis compared fiscal 2023 through 2025. Grant revenue grew from 46% to 52% of the total, largely because of one-time pandemic-era federal funds for epidemiology and laboratory capacity and the new opioid settlement payments. Two of those federal awards end in fiscal 2027, taking about $1.4 million a year with them, and the positions they support have no other funding source. The county levy was flat in dollars over the three years, which means it fell in real terms as prices rose. Personnel costs grew 11% over the period, driven by market adjustments needed to fill environmental health and nursing vacancies. Meanwhile, unassigned fund balance fell from $2.9 million to $1.8 million as the department used it to cover late grant reimbursements and the levy's shortfall against rising costs. The trend matters more than any single figure: the department is becoming more dependent on restricted and temporary money while its flexible cushion shrinks. Without a plan, the expiring federal awards will force either layoffs or a draw on the remaining fund balance within two years.
What the Analysis Means for the Board
Four conclusions follow. First, the department is heavily dependent on restricted grants, which fund essential services but leave little flexibility and carry the risk of sudden cuts. Second, its unassigned fund balance is well below the board's own target and is being consumed by slow grant reimbursement. Third, it is leaving money on the table by not recovering indirect costs on eligible federal funds. Fourth, its fee revenue, especially for food establishment permits, has not been reviewed in six years and may no longer cover the cost of inspections.
The board should direct management to claim the de minimis indirect rate on eligible grants immediately, negotiate faster reimbursement with the state, review the permit fee schedule against the cost of inspections, and adopt a plan to rebuild unassigned fund balance toward 60 days over three years. These steps would strengthen the department's resilience without reducing services.
References
Governmental Accounting Standards Board. (2009). Statement No. 54: Fund balance reporting and governmental fund type definitions.
Guidance for Federal Financial Assistance, 89 Fed. Reg. 30046 (2024).
Mays, G. P., & Smith, S. A. (2011). Evidence links increases in public health spending to declines in preventable deaths. Health Affairs, 30(8), 1585-1593. https://doi.org/10.1377/hlthaff.2011.0196
Reading the HLTH 5033 Module 1 instructions
HLTH 5033 Module 1 usually has you read the books of a health department or community health nonprofit. The instructions tend to call for identifying revenue sources and their restrictions, describe major expenditures, interpret the organization's reserves or fund balance, and explain its financial strengths and risks. Some sections supply a case; others ask you to use a real health department's published budget or audited financial report, or a nonprofit's Form 990. Graders expect you to use public sector concepts, such as restricted funds and fund balance, rather than hospital or business measures like profit margin. Cite the year of every figure, and check Canvas for whether a table of revenues and expenditures is required. If the prompt allows, add a three-year trend, because a single year of statements can hide a funding cliff or a shrinking reserve.
How this HLTH 5033 Module 1 example is built
The sample opens by describing the organization, its fund structure and why governmental reporting calls for different questions than business reporting. Revenue is broken down by source with amounts and shares, and the paper explains what the mix means for flexibility. Expenditures are analyzed by type and program, with research placing spending in context. Fund balance is broken into its five required classifications, showing that only the unassigned portion measures real reserves. Receivables and cash timing are tied to reimbursement-based grants, and an indirect cost gap is identified under federal guidance. Conclusions lead to four specific board actions.
Where the points sit in the HLTH 5033 Module 1 rubric
Rubrics for public health finance papers usually weigh correct use of governmental finance concepts, accurate analysis of revenue and spending, interpretation of financial health and practical recommendations. Graders deduct points when business concepts are applied without adjustment. The analysis criterion rewards breaking figures into meaningful categories and computing shares and ratios correctly. Interpretation earns credit when it explains what restrictions and reserves mean for the organization's choices. Recommendations score best when tied to specific findings. Current sources on public health finance and the standards that govern reporting strengthen the paper, and APA 7 formatting completes the rubric.
HLTH 5033 Module 1 help from the desk
The most common way these finance papers go wrong is by treating a health department like a business, talking about profit and margins instead of restrictions and fund balance. Another frequent problem is reporting the total fund balance as reserves without separating restricted and committed amounts. Students also ignore cash timing, which is where grant-funded agencies most often run into trouble. Use the organization's actual categories. Compute shares of revenue and months of reserves. Explain what each finding means for decisions. If you are analyzing a nonprofit clinic or a state agency instead, send its financial report and your rubric, and we can draft a Module 1 analysis from those statements.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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HLTH 5033 Module 1 questions, answered
What does HLTH5033 Module 1 usually ask for?
HLTH5033 typically opens by asking you to analyze a public health organization's revenue sources and financial statements, explaining the revenue mix, spending, reserves and what they mean for the organization's stability. The organization is set by your own section.
What is fund balance in a health department?
The difference between a governmental fund's assets and liabilities, reported in five classifications from nonspendable to unassigned according to how constrained the money is.
Why do grant-funded health departments have cash flow problems?
Most grants reimburse costs after they are incurred, so the department must pay staff and vendors first and wait, sometimes months, for repayment.
Where can I find a free HLTH 5033 Module 1 sample paper?
The full Module 1 financial statement analysis of a county health department is on this page: revenue mix, spending, fund balance classifications, grant receivables and indirect cost recovery, with four board actions.
What is an indirect cost rate?
A percentage used to recover shared administrative costs, such as finance and facilities, from grants. Recipients without a negotiated rate may use a de minimis rate set in federal guidance.