Beruflich Dokumente
Kultur Dokumente
CA
PHONE NO:
OWNER:
94609
GENERAL INFORMATION
TYPE OF CONTROL: Non-Profit Corporation
TYPE OF CARE:
Specialty
LICENSED BEDS*
ACUTE
50
4/13/2015
1 OF 5
01/01/2013
12/31/2013
(510)653-5040
ADOLESCENT TREATMENT CENTERS, INC.
COUNTY:
HSA NO:
AVAILABLE BEDS
Alameda
05
HFPA NO:
0417
EMERGENCY SERVICES
INTENSIVE
INTENSIVE
DATE PREPARED:
PAGE:
REPORT PERIOD:
THRU
ACUTE
50
EMERGENCY ROOM
TRAUMA CENTER DESIGNATION
LONG-TERM
LONG-TERM
OBSERVATION
OTHER
OTHER
ORTHOPEDIC
50
PSYCHIATRIC
73.50%
HELICOPTER
TOTAL
OCCUPANCY RATE
50
73.50%
TOTAL
OCCUPANCY RATE
NO. BASSINETS
TOTAL
MEDI-CAL
TRADITIONAL
CO. INDIGENT
TRADITIONAL
10,300
107
96.3
96.3
CO. INDIGENT
MANAGED CARE
THIRD PARTY
TRADITIONAL
3,103
33
94
94
$6,029,839
$90,499
$768,144
$5,275,620
$76,574
$394
$37,416
$261
13,607
$393
MEDI-CAL
MANAGED CARE
THIRD PARTY
MANAGED CARE
$4,632,777
$1,395,472
$583,779
$4,048,998
$168,850
$1,226,622
$393
$37,841
$395
$37,170
OTHER
INDIGENT
OTHER
PAYERS
3
1
3
MEDICARE
MANAGED CARE
13,406
141
95.1
95.1
293
MEDICARE
TRADITIONAL
3
293
$1,590
$90,499
$13,925
$1,590
FACILITY NO:106010782
THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL
LIVE BIRTH SUMMARY
NATURAL BIRTHS
CESAREAN SECTIONS
TOTAL LIVE BIRTHS
$6,120,338
$1,590
$583,779
$168,850
$13,925
$768,144
$5,352,194
$506,371
$6,593,042
($734,477)
$78,061
($656,416)
$2,849,030
$1,301,303
$195,681
$684,594
$339,088
$462,805
$119,037
$167,686
$473,818
$6,593,042
$5,175,215
$386
$36,704
$79,141
$270
$3,898,564
$45,542
$816,751
$457,487
$1,013,490
$361,208
$6,593,042
$5,924,045
$442
$42,015
$64,788
$221
$6,029,839
$90,499
$0
$6,120,338
PERCENT OF TOTAL
98.5
1.5
.0
100.0
$1,969,240
$103,182
$790,748
$30,737
$821,485
EQUITY
TOTAL LIABILITIES AND EQUITY
$2,072,422
3 OF 5
$1,250,937
$2,072,422
FORMULAS
2.49 (TOTAL CURRENT ASSETS + BOARD DESIG. CASH + BOARD DESIG.
INVESTMENTS) / TOTAL CURRENT LIABILITIES
.80 (CASH + MARKETABLE SECURITIES + BOARD DESIG. CASH + BOARD DESIG.
INVESTMENTS) / TOTAL CURRENT LIABILITIES
0.03% (PROVISION FOR BAD DEBTS / TOTAL GROSS PATIENT REVENUE) X 100
PROFITABILITY RATIOS
NET RETURN ON OPERATING ASSETS
( 35.44%) ((NET FROM OPERATIONS + INTEREST-WORKING CAPITAL + INTERESTOTHER) / (TOTAL CURRENT ASSETS + NET PROPERTY, PLANT AND
EQUIPMENT)) X 100
OPERATING MARGIN
UNITS OF
SERVICE
UNIT
CODE
BURN CARE
DEFINITIVE OBSERVATION
MEDICAL/SURGICAL ACUTE
PEDIATRIC ACUTE
OBSTETRICS ACUTE
AMBULATORY SERVICES
EMERGENCY SERVICES
ADJ DIRECT
EXP PER UNIT
ADJ TOTAL
EXP PER UNIT
PROFIT/LOSS
PER UNIT
$449.79
$386.04
$245.75
$441.90
($55.86)
$449.79
$386.04
$245.75
$441.90
($55.86)
1
13,406
ADJ REV
PER UNIT
CORONARY CARE
GROSS REV
PER UNIT
1
1
13,406
2
3
4
CLINICS
OBSERVATION CARE
UNITS OF
SERVICE
UNIT
CODE
ANCILLARY SERVICES
LABOR AND DELIVERY SERVICES
SURGERY AND RECOVERY SERVICES
MEDICAL SUPPLIES SOLD TO PATIENTS
CLINICAL LABORATORY SERVICES
CARDIAC CATHETERIZATION SERVICES
RADIOLOGY - DIAGNOSTIC
MAGNETIC RESONANCE IMAGING
COMPUTED TOMOGRAPHIC SCANNER
DRUGS SOLD TO PATIENTS
RESPIRATORY THERAPY
LITHOTRIPSY SERVICES
PHYSICAL THERAPY
GROSS REV
PER UNIT
ADJ REV
PER UNIT
7
8
9
10
11
11
11
11
14
12
11
27
UNITS OF
SERVICE
31,905
28,748
22,727
24,424
6,120
185
UNITS OF
SERVICE
73
1,150
6,120
UNIT
CODE
16
17
18
19
20
21
22
ADJ DIRECT
EXP PER UNIT
$12.12
$0.18
UNIT
CODE*
23
24
25
22
26
21
20
ADJ DIRECT
EXP PER UNIT
$10,904.38
$4.63
$11.86
$23.18
$1,545.37
$159.96
$5.79
DATE PREPARED:
PAGE:
REPORT PERIOD:
THRU
4/13/2015
5 OF 5
01/01/2013
12/31/2013
MANAGEMENT
AND
SUPERVISION
5.47%
%
%
5.42%
TECHNICAL
AND
SPECIALIST
8.07%
%
%
7.99%
REGISTERED
NURSES
8.55%
%
%
8.47%
LICENSED
VOCATIONAL
NURSES
%
%
%
%
AIDES
AND
ORDERLIES
57.85%
100.00%
%
58.29%
%
%
21.19%
21.88%
37.21%
%
%
%
21.01%
16.58%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
9.40%
%
8.80%
%
6.79%
%
%
%
46.78%
%
$39.70
$23.71
$25.73
$0.00
$16.14
ENVIRON.
AND
FOOD SERV.
%
%
%
%
%
%
78.81%
%
0.04%
CLERICAL
AND OTHER
EMPLOYEES
4.30%
%
%
4.26%
%
%
%
57.10%
46.17%
REGISTRY
AND
TEMP HELP
15.75%
%
%
15.58%
%
%
7.18%
2.91%
12.89%
TOTAL
PRODUCTIVE
HOURS
126,700
1,330
TOTAL
PAID
HOURS
137,080
1,620
128,030
138,700
8,635
9,213
11,306
10,288
10,525
13,642
4.27%
%
9.99%
%
13.98%
%
159,529
173,155
$20.64
$23.86
$28.67
66
10
41
8. Street Address:
390 40TH STREET
9. City:
OAKLAND, CA
10.Zip Code:
94609
12. City:
15. Title:
PRESIDENT EAST BAY R
37.
Through:
39.
Through:
30. State :
CA
12/31/2013
40. Was this disclosure report completed after an independent financial audit ?
__X__
Yes
____
No
41. Are audit adjustments made by the independent auditor reflected in this report ?
__X__
Yes
____
No
HOSPITAL DESCRIPTION
Line
No
MISC INFORMATION
(1)
TYPE OF CONTROL
50
Church
10
Available Beds
50
Non-Profit Corporation
15
50
20
HSA No
25
(2)
12/31/2013
TYPE OF CARE
(3)
Line
No
Short-Term - General
Short-Term - Childrens
10
Non-Profit Other
Short-Term - Psychiatric
15
Investor - Individual
Short-Term - Specialty
20
Investor - Partnership
Long-Term - General
25
30
Investor - Corporation
Long-Term - Childrens
30
35
State
Long-Term - Psychiatric
40
County
Long-Term - Specialty
45
Regional
City/County
45
50
Community
City
50
55
Intermediate
District
Line
No
GOVERNMENT PROGRAMS
(1)
35
X
40
55
PREPAID PROGRAMS
(2)
No.of
Each Type
24 HR. ON PREMISES
COVERAGE
(3)
Line
No
60
Medicare
HospitalBased
Emergency Services
60
65
Medi-Cal
Psychiatric ER
65
70
State Contracts
Physician
70
75
Short-Doyle
Federal Contracts
Pharmacist
75
80
CHAMPUS
Operating Room
80
85
County Indigent
Laboratory Services
85
90
Other (Specify)
Radiology Services
90
95
Anesthesiologist
95
100
100
105
105
ACTIVE MEDICAL STAFF PROFILE - MD's, DO's, Podiatrists and Dentists (Enter No)
Line
No
CLINICAL SPECIALTY
HOSPITAL BASED
Board
Certified
(1)
Board
Eligible
(2)
Other
(3)
NON-HOSPITAL BASED
Board
Certified
(4)
Board
Eligible
(5)
Other
(6)
RESIDENTS/FELLOWS
(Enter FTEs)
Residents
(7)
Line
No
Fellows
(8)
110
115
120 Anesthesiology
120
125
130
135
140 Dental
140
145 Dermatology
145
150
155
160 Gastroenterology
160
165
170
175
180
185
190 Neurology
190
195
200
205
210 Oncology
210
215 Ophthalmology
215
220
HOSPITAL DESCRIPTION
CLINICAL SPECIALTY
HOSPITAL BASED
Board
Certified
(1)
Board
Eligible
(2)
Other
(3)
NON-HOSPITAL BASED
Board
Certified
(4)
Board
Eligible
(5)
Other
(6)
12/31/2013
RESIDENTS/FELLOWS
(Enter FTEs)
Residents
(7)
Line
No
Fellows
(8)
225
230 Otolaryngology
230
235 Pathology
235
240 Pediatric-Allergy
240
245 Pediatric-Cardiology
245
250 Pediatric-Surgery
250
255 Pediatrics
255
260
265
270 Podiatry
270
275 Psychiatry
275
280
285
290 Radiology
290
295
300
305 Urology
305
310
315
320 TOTAL
320
SERVICES INVENTORY
Line
No
(1)Co
de
10
Burn
15
Coronary
20
12/31/2013
(2)
Code
(3)Co
de
Microbiology
Dental
Necropsy
Dermatology
Serology
Diabetes
Medical
Surgical Pathology
Drug Abuse
25
Neonatal
Family Therapy
30
Neurosurgical
Computed Tomography
Group Therapy
35
Pediatric
Cystoscopy
Hypertension
40
Pulmonary
Metabolic
45
Surgical
Neurology
50
Ultrasonography
Neonatal
55
X-Ray - Radiology
Obesity
60
DIAGNOSTIC/THERAPEUTIC
SERVICES
Obstetrics
65
Geriatric
Audiology
Ophthalmology
70
Medical
Biofeedback Therapy
Orthopedic
75
Neonatal
Cardiac Catheterization
Otolaryngology
80
Oncology
Cobalt Therapy
Pediatric
85
Orthopedic
Diagnostic Radioisotope
Pediatric Surgery
90
Pediatric
Echocardiology
Podiatry
95
Physical Rehabilitation
Electrocardiology
Psychiatric
100
Post Partum
Electroencephalography
Renal
105
Surgical
Electromyography
Rheumatic
107
110
Endoscopy
Rural Health
Surgery
115
Gastro-Intestinal Laboratory
120
125
Lithotripsy
130
Hospice Care
Nuclear Medicine
135
Occupational Therapy
140
LONG-TERM CARE
Physical Therapy
145
150
155
Intermediate Care
Radiation Therapy
160
Residential/Self Care
Radium Therapy
165
Self Care
Radioactive Implants
Jail Care
170
Recreational Therapy
175
Sub-Acute Care
177
Sub-Acute Care-Pediatric
179
180
Speech-Language Pathology
AMBULATORY SERVICES
185
Alcohol
Spotcare Medicine
190
Drug
Stress Testing
195
Therapeutic Radioisotope
200
Alcohol
205
Drug
PSYCHIATRIC SERVICES
CODE
1- Service is available at the hospital.
SERVICES INVENTORY
Line
No
(1)Co
de
12/31/2013
(2)
Code
(3)Co
de
210
PSYCHIATRIC SERVICES
215
220
OTHER SERVICES
225
Milieu Therapy
230
Night Care
Dietetic Counseling
Psychiatric Therapy
Psychopharmacological Therapy
Family Planning
Genetic Counseling
235
240
OBSTETRIC SERVICES
245
Abortion Services
Sheltered Workshop
250
RENAL DIALYSIS
Medical Research
255
Hemodialysis
260
Infertility Services
Patient Representative
265
Peritoneal
270
SURGERY SERVICES
Self-Dialysis Training
275
Dental
Organ Acquisition
Toxicology/Antidote Information
280
General
Blood Bank
Vocational Services
285
Gynecological
290
Heart
Pharmacy
295
Kidney
300
Neurosurgical
EMERGENCY SERVICES
305
Open Heart
310
Ophthalmologic
315
Organ Transplant
320
325
Approved Fellowship
Non-Approved Residency
Orthopedic
Otolaryngologic
Heliport
330
Pediatric
Medical Transportation
335
Plastic
340
Podiatry
345
Thoracic
350
Urologic
Nurse Anesthetist
355
Anesthesia Services
Trauma Treatment E. R.
Nurse Practitioner
Nurse Midwife
Occupational Therapist
360
365
LABORATORY SERVICES
CLINIC SERVICES
370
Anatomical Pathology
AIDS
Pharmacy Intern
375
Chemistry
Alcoholism
Physician's Assistant
380
Clinical Pathology
Allergy
Physical Therapist
385
Cytogenetics
Cardiology
Registered Nurse
390
Cytology
Chest Medical
Respiratory Therapist
395
Hematology
Child Diagnosis
400
Histocompatibility
Child Treatment
405
Immunology
Communicable Disease
CODE
1- Service is available at the hospital.
12/31/2013
A. Are any costs included which are a result of transactions with a related organizations as defined in 42 CFR 413.17?
1.
Yes
B. Are any costs included which are a result of transactions with a related organization of which a hospital employee, board member or member of
the which medical staff, or relative of such person is an officer or owner ? (Ignore stock ownership less than 3%)
2.
Yes
C. Complete the following to show the relationships of the hospital with related organizations and with organizations with related personnel from
the hospital obtained services, facilities, or supplies during the reporting period.
Line
No
Code
(1)
Percent
Ownership of
Hospital (3)
Related Organizations
Name
(4)
Percent
Ownership(5)
Type of Business
(6)
SUTTER HEALTH
100
HEALTHCARE
100
HEALTHCARE
5
6
7
8
9
10
11
12
Expense Included on
Line
No
Amount
(7)
(8)
Page
(9)
Column (10)
Line (11)
ALLOCATION
$132,482
18
205
ALLOCATION
$76,791
18
205
5
6
7
8
9
10
11
12
COMMENTS:
13
14
15
16
Codes
Use Codes A,B, and G to indicate the relationship of the hospital to related organizations and codes C,D,E,F and G to indicate relationship of hospital with organizations
with related personnel.
A. Corporation, partnership or other organization has ownership interest in hospital. [Complete columns (4) through (11).]
B. Hospital has ownership interest (stockholder, partner, etc.) in both related organization and hospital. [Complete columns (4) through (11).]
C. Individual has ownership interest (stockholder, partner, etc.) in both related organization and hospital. (Complete all columns.)
D. Director, officer, administrator or key person or relative of such person has ownership interest in related organization. [Complete columns(2),(4) through (11).]
E. Individual is director, officer, administrator or key person of hospital and related organization. [Complete columns(2), (4) through (11).]
F. Director, officer, administrator or key person or related organization or relative of such person has ownership interest in hospital. [Complete columns(2),(4) through (11).]
G. Other (ownership or non-financial) interest, specify on lines 13-16. (complete columns as applicable.)
NOTE: Relatives are defined as: spouse, son, daughter, grandchild, great grandchild, stepchild, brother, sister, half-brother, half-sister, stepbrother,
stepsister, parent, grandparent, great grandparent, stepmother, stepfather, niece, nephew, aunt, uncle, son-in-law, daughter-in-law,
father-in-law, mother-in-law, brother-in-law, or sister-in-law.
12/31/2013
Partners
Corporation Officers
prietorship
Line
No
Name
(1)
Percentage
of
Customary
Work Week
Devoted to
Business
(3)
Percent
Share of
Operation
Profit or
(Loss)
(4)
Percentage
of
Customary
Work Week
Devoted to
Business
(5)
Percent of
Provider's
Stock
Owned
(6)
Percentage
of
Customary
Work Week
Compensation
Devoted to Included in Costs
Business for the Period
(7)
(8) *
17
18
19
20
21
* Compensation as used in this schedule has the same definition as 42CFR 413.102
NOTE: Relatives are defined as: spouse, son, daughter, grandchild, great grandchild, stepchild, brother, sister, half-brother, half-sister, stepbrother,
stepsister, parent, grandparent, great grandparent, stepmother, stepfather, niece, nephew, aunt, uncle, son-in-law, daughter-in-law,
father-in-law, mother-in-law,brother-in-law, or sister-in-law.
E. Are any funds held in trust by an outside party which are not reflected on the Balance Sheet ?
22.
Yes
F. Section 1191 of the Hospital Accounting and Reporting Manual references six general types of financial arrangements which exist between
hospital and hospital-based physicians. Check the appropriate boxes below to indicate the type of financial arrangement which exists in
your hospital for the various hospital cost centers having such arrangements. If none of the six types of financial arrangements described
are appropriate, check the Other column and describe the arrangement in the comment section. For cost centers other than those listed
below, please complete the Other line
Financial Arrangement
Line
No
23
24
25
Nuclear Medicine
26
Cardiology Services
27
Emergency Services
28
Gastro-Intestinal Services
29
30
Psychiatric Therapy
31
Anesthesiology
32
Other (Specify)
COMMENTS:
33
34
35
36
Joint
(2)
Contracted
(3)
Rental
(4)
Independent
(5)
Agency
(6)
Salaried
(7)
Other
(8)
12/31/2013
Line
No
Name
Occupation
(2)
(1)
Check if
Owner
(3)
Percentage of Check if
Hospital
Board
Ownership
Member
(4)
(5)
Compensation*
(6)
37
JACK RIPSTEEN
PRESIDENT
$0
38
BARBARA D'ANNEO
$0
39
TOM BONAS
$0
40
CAMDEN MCEFEE
$0
41
CHARLES MANCE
RETIRED
$0
42
DAVE PREUSS
$0
43
DON SHIMER
RETIRED
$0
44
TONI ADAMS
$0
45
WARREN KIRK
$0
46
ROBERT PETRINA
$0
47
STEVEN WRIGHT
$0
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
* Compensation paid to the individual from all sources for services rendered personally to or on behalf of the hospital.
12/31/2013
To be completed by all closely held corporations. If a physician is an owner or an owner of the corporation which owns the hospital,
identify all business relationships between the physician and the hospital. This would include percentage of stock owned by the physician,
all contracts between the physician and the hospital, and all lease arrangements between the physician and the hospital. If more than ten
owners, provide data for the ten with the largest percentage of stock owned.
Line
No
(1)
Physician Name
(2)
Percent of Stock Owned
(3)
Describe Contract, Lease and Other Arrangements
70
71
72
73
74
75
76
77
78
79
J. Is this facility operated by a management firm ?
80.
Yes
84. State:
86. Amount paid to the management firm for the reporting period:
Yes
No
93
89
94
90
95
91
96
92
97
M. Are the amounts paid to the management firm functionally accounted and reported as required ?
98.
Yes
No.
Please explain why amounts paid to the management firm are not functionally accounted and reported.
99
100
101
102
Line
No
(1)
Licensed
(End of
Period)
(2)
Available
(Average)
(4)
Adult
(5)
Pediatric
12/31/2013
DISCHARGES
(11)
Service
(12)
Total
Line
No
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
70
50
50
50
13,406
141
75
90
100
101
105
110
115
120
125
145
50
50
50
13,406
141
150
155
ACCOUNT DESCRIPTION
(1)
Total Units of
Service [Sum of
columns (7) and
(13)]
(7)
Total Inpatient Units
of Service
12/31/2013
(13)
Total Outpatient
Units of Service
Line
No.
AMBULATORY SERVICES
160 Emergency Services
Visits
160
Occasions of Service
165
Visits
170
175 Clinics
Visits
175
Visits
180
Operating Minutes
Visits
Observation Hours
195
200
205
Visits
210
Visits
215
ANCILLARY SERVICES
230 Labor and Delivery Services
Deliveries
230
Operating Minutes
235
Operating Minutes
240
245 Anesthesiology
Anesthesia Minutes
245
250
255
Tests
260
Tests
265
270
275 Echocardiology
Procedures
275
Procedures
280
Procedures
285
290 Electromyography
Procedures
290
295 Electroencephalography
Procedures
295
Procedures
300
Procedures
305
Procedures
310
Procedures
315
320 Ultrasonography
Procedures
320
Procedures
325
330
335
Procedures
340
Hours of Treatment
345
350 Lithotripsy
Procedures
350
Procedures
355
Sessions
360
Sessions
365
Sessions
370
Treatments
380
Sessions
385
Sessions
390
Organs acquired
395
185
293
293
190
OTHER STATISTICS
(1)
Total Units of
Service
(7)
Inpatient Units of
Service
12/31/2013
(13)
Outpatient Units of
Service
Surgeries
505
510
Surgeries
515
520
525
530
Surgeries
535
540
545
550
555
293
(1)
Total Births [Sum of
columns (7) and
(13)]
293
(7)
Natural Births
560
(13)
Cesarean Sections
600
605
610
615
620
625
12/31/2013
(1)
Medicare Traditional
(2)
Medicare Managed Care
(3)
Medi-Cal Traditional
(4)
Medi-CalManaged Care
(5)
County
Indigent
Programs Traditional
(6)
Line
County
No
Indigent
Programs Managed Care
Acute Care
10
Psychiatric Care
10
15
20
Rehabilitation Care
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
40
45
45
10,300
15
30
10,300
35
(7)
Other Third
Parties
Traditional
(8)
(9)
Other Third
Other Indigent
Parties
Managed Care
(10)
Other Payors
(11)
Total Patient
Days
Line
No
Acute Care
10
Psychiatric Care
10
15
20
Rehabilitation Care
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
40
45
45
3,103
13,406
15
30
3,103
13,406
35
DISCHARGES
TYPE OF CARE
Line
No
(12)
Medicare Traditional
(13)
Medicare Managed Care
(14)
Medi-Cal Traditional
(15)
Medi-CalManaged Care
(16)
County
Indigent
Programs Traditional
(17)
County
Line
Indigent
No
Programs Managed Care
Acute Care
10
Psychiatric Care
10
15
20
Rehabilitation Care
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
40
45
45
107
15
30
107
35
DISCHARGES
TYPE OF CARE
Line
No
(18)
Other Third
Parties
Traditional
(19)
(20)
Other Third
Other Indigent
Parties
Managed Care
(21)
Other Payors
(22)
Total
Discharges
Line
No
Acute Care
10
Psychiatric Care
10
15
20
Rehabilitation Care
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
40
45
45
33
141
15
30
33
141
35
12/31/2013
OUTPATIENT VISITS
TYPE OF OUTPATIENT VISIT
(1)
Medicare Traditional
(2)
Medicare Managed Care
(3)
Medi-Cal Traditional
(4)
Medi-CalManaged Care
(5)
County
Indigent
Programs Traditional
(6)
County
Indigent
Line
Programs No
Managed Care
Line
No
60
60
65
65
70
70
75
75
80
80
85
Hospice - Outpatient
85
90
Outpatient Surgeries
90
95
Private Referred
95
100 Other *
100
105 Total
105
OUTPATIENT VISITS
TYPE OF OUTPATIENT VISIT
(7)
Other Third
Parties Traditional
(8)
Other Third
Parties Managed Care
(9)
Other Indigent
(10)
Other Payors
(11)
Total
OutPatient
Visits
Line
No
Line
No
60
60
65
65
70
70
75
75
80
80
85
Hospice - Outpatient
85
90
Outpatient Surgeries
90
95
Private Referred
95
100 Other *
293
293
100
105 Total
293
293
105
Includes Chemical Dependency Services, Adult Day Health Care, & Renal Dialysis Visits
Line
No
ASSETS
12/31/2013
Account No
$634,100
$628,545
Line
No
CURRENT ASSETS
5
Cash
1000
10
Marketable securities
1010
15
1020
$700,678
$837,565
15
20
1040
($84,376)
($110,872)
20
25
1050
30
1060
$689,682
$498,697
35
1070
40
Inventory
1080
$10,213
$6,552
45
Intercompany receivables
1090
50
1100
$18,943
$22,646
50
55
$1,969,240
$1,883,133
55
10
25
30
35
40
45
1110
60
65
1120
65
70
1130
70
75
75
Land
1200
85
Land improvements
1210
90
1220
$33,333
$33,333
95
Leasehold improvements
1230
$645,122
$645,122
95
1240
$354,147
$354,147
100
$1,032,602
$1,032,602
105
($929,420)
($810,382)
195
$103,182
$222,220
200
100 Equipment
105 TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 80 through 100)
195 Less accumulated depreciation and amortization
1260
200 NET TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 105 & 195)
205 Construction in progress
80
85
90
1250
205
1310
210
1320
215
1330
220
1340
225
1350
230
235 TOTAL INVESTMENTS IN OTHER ASSETS (Sum of lines 210 through 230)
235
INTANGIBLE ASSETS
245 Goodwill
1360
245
1370
250
1380
255
1390
260
265
TOTAL
270 TOTAL ASSETS (Sum of lines 55, 75,200,205,235 , and 265)
Line
No
OTHER INFORMATION
$2,072,422
$2,105,353
270
Line
No
405 Current market value - current assets marketable securities (Line 10)
405
410
415
420
Line
No
Account No
(4)Prior Year
Line
No
CURRENT LIABILITIES
5
2010
10
Accounts payable
2020
$410,296
$420,387
10
15
2030
$351,123
$357,894
15
20
2040
20
25
2050
25
30
2060
30
35
2070
35
40
2080
45
Intercompany payables
2090
$13,101
50
55
2100
$16,228
60
40
45
50
$790,748
55
$778,281
60
DEFERRED CREDITS
65
2110
70
2120
75
2130
80
65
70
$30,737
$30,737
75
$30,737
$30,737
80
Mortgages payable
2210
85
90
Construction loans
2220
90
95
2230
95
2240
100
2250
105
2260
110
2270
115
120
125 Less amount shown as current maturities (Must agree with line 50)
125
130
$821,485
$809,018
135
$1,250,937
$1,296,335
140
2310
2310
145
2320
150
2330
155
2340
160
2350
165
2310
170
2320
175
2710
180
2720
185
2730
190
2740
195
2750
200
$1,250,937
$1,296,335
205
$2,072,422
$2,105,353
270
TOTAL
270 TOTAL LIABILITIES AND EQUITY (Sum of lines 135 and 205)
(a) Complete Report Page 5.1 to provide detailed long-term debt information.
(6)Date Obligation
Incurred (Year Only*)
(8) Interest
Rate (a)
12/31/2013
Line
No
10
10
15
15
20
20
25
25
30
30
35
35
40
40
45
45
50
50
55
55
60
60
65
65
70
70
75
75
80
80
85
85
90
90
95
95
100
100
105
105
110
110
115
115
120
120
125
125
130
130
135
135
140
140
145
145
150
150
155
155
160
160
165
165
170
170
175
175
180
180
185
185
190
190
195
195
200
200
205
205
210
210
215
215
220
220
225
225
230
230
235
235
240
240
245
245
250
250
Line
No
(6)Date Obligation
Incurred (Year Only*)
(8) Interest
Rate (a)
12/31/2013
Line
No
255
255
260
260
265
265
270
270
275
275
280
280
285
285
290
290
295
295
300
300
305
305
310
310
315
315
320
320
(2)
(3)
(4)
(5)
12/31/2013
(6)
Additions
Line
Line
No
Description
Beginning
Balance(a)
Purchase
Donation
Transfers
Disposals and
Retirements
Ending
Balance (b)
No
Land
10
Land Improvements
10
15
$33,333
$33,333
15
20
Leasehold Improvements
$645,122
$645,122
20
25
Equipment
$354,147
$354,147
25
30
Construction-in-progress
35
TOTAL
$1,032,602
$1,032,602
30
(a) Column(1), line 35 must agree with page 5, column(2), sum of lines 105 and 205.
(b) Column(6), line 35 must agree with page 5, column(1), sum of lines 105 and 205.
35
Line
No
ASSETS
Account
No
12/31/2013
(2)
Prior Year
Line
No
Cash
1510
10
1521
10
15
Other Investments
1529
15
20
Receivables
1530
20
25
1540
25
30
Other assets
1550
30
75
75
Cash
1410
105
110
1421
110
115
Mortgages investments
1422
115
120
1423
1424
120
125
Other Investments
1429
125
130
Receivables
1430
130
135
1440
135
140
Other assets
1450
140
170
170
ENDOWMENT FUNDS
205
Cash
1610
205
210
1621
210
215
Mortgages
1622
215
220
1623
1624
220
225
Other investments
1629
225
230
Receivables
1630
230
235
1640
235
240
Other assets
1650
240
275
Line
No
OTHER INFORMATION
275
(1)
Current Year
(2)
Prior Year
Line
No
405
Current market value - specific purpose funds marketable securities (Line 10)
405
410
Current market value - Property Replacement & Exp. funds marketable securities (line
110)
410
415
415
Account
No
12/31/2013
(4)
Prior Year
Line
No
2510
10
2520
10
15
2530
15
70
Fund balance
2570
70
75
75
2410
105
110
2420
110
115
2430
115
165
Fund balance
2470
165
170
170
ENDOWMENT FUNDS
205
Mortgages
2610
205
210
2620
210
215
2630
215
220
2640
220
225
2650
225
270
Fund balance
2670
270
275
275
12/31/2013
RESTRICTED FUNDS
Line
No
ASSETS
(1) Funds
Unrestricted
(4) Endowment
Line
No
10
10
15
Restatement (describe)
15
$1,296,335
20
20
25
25
30
30
35
35
40
40
45
45
50
$1,296,335
50
55
ADDITIONS (DEDUCTIONS):
Net Income (Loss)
($656,416)
55
60
60
65
65
70
70
75
75
80
85
90
Dividends declared
95
100
Intercompany transfers
105
110
$17,058
115
$289,093
115
120
($8,842)
120
($45,398)
125
80
$0
85
90
95
$313,709
100
105
110
125
130
TRANSFERS:
Property and equipment additions
130
135
135
140
Other (Describe)
140
145
145
150
150
155
155
160
160
165
165
170
170
175
185
175
$1,250,937
185
Line SECTION I
No
5
OPERATING REVENUES:
Daily hospital services
10
Ambulatory services
15
Ancillary services
30
105
107
110
NET PATIENT REVENUE (Line 30 minus line 105 plus line 107)
135
140
(1)
Current Year
12/31/2013
(2)
Prior Year
Line
No
$6,029,839
$3,620,625
$90,499
$72,280
10
$1
15
$6,120,338
$3,692,906
30
$768,144
$803,934
105
$5,352,194
$2,888,972
110
$506,371
$2,496,316
135
$5,858,565
$5,385,288
140
146
OPERATING EXPENSES:
Daily Hospital Services
$3,898,564
$3,703,222
146
151
Ambulatory Services
$45,542
$46,445
151
156
Ancillary Services
$56,785
156
161
Research Costs
166
Education Costs
171
General Services
$816,751
$744,591
171
176
Fiscal Services
$457,487
$388,037
176
181
Administrative Services
$1,013,490
$1,113,161
181
186
Unassigned Costs
$361,208
$299,303
186
190
195
200
$6,593,042
$6,351,544
200
205
($734,477)
($966,256)
205
210
215
220
220
225
Deferred
225
230
NET INCOME BEFORE EXTRAORDINARY ITEMS: (Line 215 minus 220 and
225)
107
161
166
190
195
$78,061
($656,416)
($656,416)
210
($966,256)
($966,256)
215
230
EXTRAORDINARY ITEMS:(Specify)
235
235
240
245
240
NET INCOME (Line 230 minus lines 235 and 240)
($656,416)
(a) Report Page 8, Section II must be completed to provide detailed deductions from revenue information.
(b) Report Page 8, Section II must be completed to provide detailed capitation premium revenue information.
(c) Report Page 8, Section III must be completed to provide detailed non-operating revenue and expense information.
($966,256)
245
Line SECTION II
No
(1)
Current Year
12/31/2013
(2)
Prior Year
Line
No
$15,691
300
300
305
305
310
310
315
315
320
320
325
Disproportionate share payments for Medi-Cal patient days (SB 855) (credit bal)
(d)
325
330
335
340
$168,850
345
$13,925
350
350
355
355
360
360
365
365
370
370
375
Policy discounts
375
380
Administrative adjustments
380
385
395
430
430
435
435
440
440
445
445
450
450
$1,590
$583,779
$479,134
330
335
340
$309,109
345
385
$768,144
(d) Disproportionate share funds transferred back to a related public entity must be reported on page 7, column(1), line 105.
$803,934
395
Account
No
(1)
Current Year
12/31/2013
(2)
Prior Year
Line
No
500
NON-OPERATING REVENUES:
Gains on sale of hospital property
9010
505
9030
510
Unrestricted contributions
9040
515
Donated services
9050
520
9060
525
9070
525
530
9080
530
535
9090
535
540
9100
540
545
9150
545
550
9160
550
555
9170
555
560
9180
560
565
9190
565
570
State appropriation
9200
570
575
9210
575
580
9220
580
585
9230
585
590
9250
590
595
9260
595
600
9270
600
605
9280
605
610
9290
610
615
9400
625
640
NON-OPERATING EXPENSES:
Loses on sale of hospital property
9020
640
645
9030
645
650
9510
650
655
9520
655
660
9530
660
665
9540
665
670
9550
670
675
9800
675
685
700
705
500
505
$79,332
510
515
($1,271)
520
615
$78,061
625
685
$78,061
700
705
Line
No
5
15
Adjustments to reconcile net income to net cash provided by (used for) operating activities and
non-operating revenue :
Depreciation and amortization
17
20
30
Change in accounts and notes receivable, net of allowance for uncollectible receivables and
third-party contractual withholds
35
40
45
50
Change in inventory
55
57
60
12/31/2013
Line
No
($656,416)
($966,256)
$119,037
$121,805
15
17
20
$110,391
($131,066)
($190,985)
($59,744)
($3,661)
($62)
$3,703
($12,933)
57
($10,091)
$97,567
60
65
($6,771)
$29,247
65
70
70
75
75
80
80
85
85
87
90
$13,101
95
$16,228
35
87
90
($13,403)
95
($3,191)
100
$205,731
102
103
50
55
40
45
30
104
$256,683
$28,220
105
($399,733)
($938,036)
115
130
($11,000)
135
$142,523
140
141
142
NET CASH PROVIDED BY (USED FOR) INVESTING ACTIVITIES (Sum of lines 130 through
145 142)
$131,523
145
160
165
170
175
180
185
190
$414,129
$450,000
191
($8,841)
($6,420)
192
NET CASH PROVIDED BY (USED FOR) FINANCING ACTIVITIES (Sum of lines 160 through
195 192)
$405,288
$443,580
195
$5,555
($362,933)
205
$628,545
$991,478
215
$634,100
$628,545
225
205 NET INCREASE (DECREASE) IN CASH (Sum of lines 115, 145 and 195)
(1)Units of
Service
from Page 17,
Column (13)
(2)Adjusted
Direct Expenses
from Page 20,
Column (1)
(4)Total Patient
Care Costs from
Page 20, Column
(16),Lines 505 - 915
12/31/2013
(5)Average Unit
Patient Care
Costs, Column
(4) (1)
Line
No
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
70
13,406
$3,294,467
$2,629,578
$5,924,045
$441.90
75
95
100
101
105
110
115
120
125
145
$3,294,467
$2,629,578
$5,924,045
150
AMBULATORY SERVICES:
160 Emergency Services
160
165
170
175 Clinics
175
180
185
293
$45,542
$19,246
$64,788
$221.12
190
195
200
205
210
215
220
$45,542
$19,246
$64,788
225
12/31/2013
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
70
$5,924,045
$441.90
75
95
100
101
105
110
115
120
125
145
$5,924,045
150
AMBULATORY SERVICES:
160 Emergency Services
160
165
170
175 Clinics
175
180
185
$64,788
$221.12
190
195
200
205
210
215
220
$64,788
225
(11) Gross
Revenue from
Page 12,
Columns (21) +
(22)
(12)Deductions (13)Adjustment
(14)Net Revenue
from Revenue for Professional Column (11) - (12) from Page 12,
Component
(13)
Column 23 Line from Page 15,
455 - 457
Columns (9) &
(13)
12/31/2013
(15)Average Unit Line
Net Revenue
No
Column (14) (1)
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
70
$6,029,839
$756,786
$97,838
$5,175,215
$386.04
75
95
100
101
105
110
115
120
125
145
$6,029,839
$756,786
$97,838
$5,175,215
150
AMBULATORY SERVICES:
160 Emergency Services
160
165
170
175 Clinics
175
180
185
$90,499
$11,358
$79,141
$270.10
190
195
200
205
210
215
220
$90,499
$11,358
$79,141
225
10 Coronary Care
10
15
20
25
30 Burn Care
30
35
40 Definitive Observation
40
45 Medical/Surgical Acute
45
50 Pediatric Acute
50
55
60
65 Obstetrics Acute
65
70
($748,830)
($55.86)
75
80
85
90
95 Nursery Acute
95
100
101
105
110
115
120
125
145
($748,830)
150
AMBULATORY SERVICES:
160 Emergency Services
160
165
170
175 Clinics
175
180
185
$14,353
$48.99
190
195
200
205
210
215
220
$14,353
(16) Net
(17) Average Line
Revenue Minus
Unit Net
No
Net Costs
Column (16)
Column (14)
(1)
minus (9)
225
12/31/2013
(1)Units of
Service
from Page 17,
Column (13)
(2)Adjusted
Direct Expenses
from Page 20,
Column (1)
12/31/2013
(4)Total Patient
Care Costs from
Page 20, Column
(16),Lines 505 - 915
(5)Average Unit
Patient Care
Costs, Column
(4) (1)
Line
No
ANCILLARY SERVICES:
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
$3,340,009
$2,648,824
$5,988,833
415
420
425
430
$3,340,009
$2,648,824
$5,988,833
435
12/31/2013
ANCILLARY SERVICES:
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
$5,988,833
415
420
425
430
$5,988,833
435
(11) Gross
Revenue from
Page 12,
Columns (21) +
(22)
(12)Deductions (13)Adjustment
(14)Net Revenue
from Revenue for Professional Column (11) - (12) from Page 12,
Component
(13)
Column 23 Line from Page 15,
455 - 457
Columns (9) &
(13)
12/31/2013
(15)Average Unit Line
Net Revenue
No
Column (14) (1)
ANCILLARY SERVICES:
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
$6,120,338
$768,144
$97,838
$5,254,356
415
$78,061
420
425
430
$5,332,417
435
ANCILLARY SERVICES:
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
($734,477)
415
420
425
430
($656,416)
(16) Net
(17) Average Unit Line
Revenue Minus Net Column (16) No
Net Costs
(1)
Column (14)
minus (9)
435
12/31/2013
12/31/2013
MEDICARE
Traditional
(1) Gross
Inpatient Revenue
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Managed Care
(2) Gross
Outpatient
Revenue
(3) Gross
Inpatient Revenue
(4) Gross
Outpatient
Revenue
Account
No
Revenue Subclassifications
Line
No
.04
.44
.14
.54
3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
Definitive Observation
3150
40
45
Medical/Surgical Acute
3170
45
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
3510
90
95
Nursery Acute
3530
95
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
150
AMBULATORY SERVICES:
160 Emergency Services
4010
160
4040
165
4060
170
175 Clinics
4070
175
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
220
225
12/31/2013
MEDI-CAL
Traditional
(5) Gross
Inpatient Revenue
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Managed Care
(6) Gross
Outpatient
Revenue
(7) Gross
Inpatient Revenue
(8) Gross
Outpatient
Revenue
Account
No
Revenue Subclassifications
Line
No
.05
.45
.15
.55
3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
Definitive Observation
3150
40
45
Medical/Surgical Acute
3170
45
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
3510
90
95
Nursery Acute
3530
95
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
150
AMBULATORY SERVICES:
160 Emergency Services
4010
160
4040
165
4060
170
175 Clinics
4070
175
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
220
225
12/31/2013
PATIENT
REVENUE PRODUCING CENTERS
Managed Care
(10) Gross
Outpatient
Revenue
(11) Gross
Inpatient Revenue
(12) Gross
Outpatient
Revenue
Account
No
Revenue Subclassifications
Line
No
.07
.47
.17
.57
3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
Definitive Observation
3150
40
45
Medical/Surgical Acute
3170
45
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
75
3420
80
3440
80
85
3470
85
90
3510
90
95
Nursery Acute
3530
95
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
70
$4,632,777
75
145
$4,632,777
150
AMBULATORY SERVICES:
160 Emergency Services
4010
160
4040
165
4060
170
175 Clinics
4070
175
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
220
225
12/31/2013
PATIENT
REVENUE PRODUCING CENTERS
(14) Gross
Outpatient
Revenue
Managed Care
(15) Gross
Inpatient Revenue
(16) Gross
Outpatient
Revenue
Account
No
Revenue Subclassifications
Line
.02, .03, .06
.12,.13,.16
No
3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
Definitive Observation
3150
40
45
Medical/Surgical Acute
3170
45
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
75
3420
80
3440
80
85
3470
85
90
3510
90
95
Nursery Acute
3530
95
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
70
$1,395,472
75
145
$1,395,472
150
AMBULATORY SERVICES:
160 Emergency Services
4010
160
4040
165
4060
170
175 Clinics
4070
175
4180
180
4200
4220
4230
195
4260
200
4290
205
4310
210
4320
215
4390
185
$90,499
190
220
$90,499
225
OTHER INDIGENT
(17) Gross
Inpatient Revenue
Line
No
PATIENT
REVENUE PRODUCING CENTERS
(18) Gross
Outpatient
Revenue
12/31/2013
OTHER PAYORS
(19) Gross
Inpatient Revenue
(20) Gross
Outpatient
Revenue
Account
No
Revenue Subclassifications
Line
.08
.48
.00, .09
.40, .49
No
3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
Definitive Observation
3150
40
45
Medical/Surgical Acute
3170
45
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
75
3420
80
3440
80
85
3470
85
90
3510
90
95
Nursery Acute
3530
95
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
70
$1,590
75
145
$1,590
150
AMBULATORY SERVICES:
160 Emergency Services
4010
160
4040
165
4060
170
175 Clinics
4070
175
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
220
225
12/31/2013
TOTAL
(21) Gross
Inpatient Revenue
Line
No
PATIENT
REVENUE PRODUCING CENTERS
(22) Gross
Outpatient
Revenue
Account
No
Line
3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
Definitive Observation
3150
40
45
Medical/Surgical Acute
3170
45
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
75
3420
80
3440
80
85
3470
85
90
3510
90
95
Nursery Acute
3530
95
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
70
$6,029,839
$6,029,839
75
145
$6,029,839
$6,029,839
150
AMBULATORY SERVICES:
160 Emergency Services
4010
160
4040
165
4060
170
175 Clinics
4070
175
4180
180
4200
4220
4230
195
4260
200
4290
205
4310
210
4320
215
4390
185
$90,499
$90,499
190
220
$90,499
$90,499
225
12/31/2013
MEDICARE
Traditional
Line
No
PATIENT
REVENUE PRODUCING CENTERS
(1) Gross
Inpatient Revenue
Account
No
Revenue Subclassifications
.04
Managed Care
(2) Gross
Outpatient
Revenue
(3) Gross
Inpatient Revenue
.44
.14
(4) Gross
Outpatient
Revenue
Line
No
.54
ANCILLARY SERVICES:
230 Labor and Delivery Services
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
290 Electromyography
4610
290
295 Electroencephalography
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
4740
345
350 Lithotripsy
4750
350
4760
355
4770
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
400
405
415
MEDICARE
Traditional
Inpatient
Outpatient
MEDICARE
Managed Care
Total
420
425
426
430 Charity
430
435
440
445
450
455
457
460
12/31/2013
MEDI-CAL
Traditional
Line
No
PATIENT
REVENUE PRODUCING CENTERS
(6) Gross
Outpatient
Revenue
(7) Gross
Inpatient Revenue
(8) Gross
Outpatient
Revenue
.05
.45
.15
.55
Account
No
Revenue Subclassifications
Managed Care
(5) Gross
Inpatient Revenue
Line
No
ANCILLARY SERVICES:
230 Labor and Delivery Services
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
290 Electromyography
4610
290
295 Electroencephalography
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
4740
345
350 Lithotripsy
4750
350
4760
355
4770
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
400
405
415
MEDI-CAL
Traditional
Total
MEDI-CAL
Managed Care
Total
420
425
426
430 Charity
430
435
440
445
450
455
457
460
12/31/2013
PATIENT
REVENUE PRODUCING CENTERS
Account
No
Revenue Subclassifications
Managed Care
(9) Gross
Inpatient Revenue
(10) Gross
Outpatient
Revenue
(11) Gross
Inpatient Revenue
(12) Gross
Outpatient
Revenue
.07
.47
.17
.57
Line
No
ANCILLARY SERVICES:
230 Labor and Delivery Services
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
290 Electromyography
4610
290
295 Electroencephalography
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
4740
345
350 Lithotripsy
4750
350
4760
355
4770
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
400
405
$4,632,777
COUNTY INDIGENT PROGRAMS
Traditional
Inpatient
Outpatient
415
CO. INDIGENT
PROGRAMS
Managed Care
Total
420
$583,779
425
426
430 Charity
430
435
440
445
450
$583,779
455
457
$4,048,998
460
12/31/2013
PATIENT
REVENUE PRODUCING CENTERS
Account
No
Revenue Subclassifications
Managed Care
(13) Gross
Inpatient Revenue
(14) Gross
Outpatient
Revenue
(15) Gross
Inpatient Revenue
(16) Gross
Outpatient
Revenue
.12,.13,.16
Line
No
ANCILLARY SERVICES:
230 Labor and Delivery Services
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
290 Electromyography
4610
290
295 Electroencephalography
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
4740
345
350 Lithotripsy
4750
350
4760
355
4770
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
400
405
$1,395,472
OTHER THIRD PARTIES
Traditional
Inpatient
Outpatient
$90,499
415
OTHER THIRD
PARTIES
Managed Care
Total
420
$168,850
$13,925
425
426
430 Charity
430
435
440
445
450
$168,850
$13,925
$1,226,622
$76,574
455
457
460
OTHER INDIGENT
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
Revenue Subclassifications
12/31/2013
OTHER PAYORS
(17) Gross
Inpatient Revenue
(18) Gross
Outpatient
Revenue
(19) Gross
Inpatient Revenue
(20) Gross
Outpatient
Revenue
.08
.48
.00, .09
.40, .49
Line
No
ANCILLARY SERVICES:
230 Labor and Delivery Services
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
290 Electromyography
4610
290
295 Electroencephalography
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
4740
345
350 Lithotripsy
4750
350
4760
355
4770
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
400
405
OTHER INDIGENT
Inpatient
Outpatient
$1,590
OTHER PAYORS
Inpatient
$1,590
415
Outpatient
420
425
426
430 Charity
430
435
440
445
$0
450
$1,590
455
457
460
12/31/2013
TOTAL
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(21) Gross
Inpatient Revenue
(22) Gross
Outpatient
Revenue
ANCILLARY SERVICES:
230 Labor and Delivery Services
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
290 Electromyography
4610
290
295 Electroencephalography
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
4740
345
350 Lithotripsy
4750
350
4760
355
4770
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
400
405
$6,029,839
$90,499
Total Inpatient
Total Outpatient
$6,120,338
415
Total
$1,590
420
$766,554
425
426
430 Charity
430
435
440
445
450
$768,144
455
457
$5,352,194
460
(1)
12/31/2013
Other Operating
Revenue
Line
No
5650
10
5660
10
15
5670
20
5680
25
Other Commissions
5710
25
30
5730
30
35
Other (Specify)
40
15
$19
35
TRUST PROGRAM
$335,754
VOCATIONAL PROGRAM
$170,486
45
50
20
40
45
50
65
5470
65
70
Donated Blood
5750
70
75
5690
75
80
Television/Radio Rentals
5720
80
85
5520
85
90
5760
90
95
Other (Specify)
95
100
100
105
105
110
110
115
115
120
$506,259
120
130
5320
130
135
5340
135
140
5350
140
145
5370
145
150
5380
150
155
5390
155
160
Parking Revenue
5430
160
165
5440
165
170
5480
170
175
5700
175
180
5740
180
185
5790
185
190
5782
195
5770
196
Reinsurance Recoveries
5781
200
Other (Specify)
190
$112
195
196
200
205
205
210
210
215
215
220
$112
225
220
5010
225
230
5220
230
235
5230
235
240
5240
240
245
5250
245
250
5260
250
255
5270
255
260
5280
260
270
5790
270
275
TOTAL PART IV
280
275
$506,371
280
12/31/2013
COMPENSATION
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
(1)
Salaries
and Wages
No
.07
(2)
Employee
Benefits
.10-.19
(3)
Professional Fees
(4)
Total
Compensation
Line
No
.20
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
Definitive Observation
6150
40
45
Medical/Surgical Acute
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
75
6420
80
6440
80
85
6470
85
90
6510
90
95
Nursery Acute
6530
95
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
70
$97,838
$97,838
75
145
$97,838
$97,838
150
AMBULATORY SERVICES
160 Emergency Services
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
220
225
12/31/2013
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(5)
Research
Supported by
Hospital
(6)
Medical
Education
Supported by
Hospital (NonInservice)
(7)
General
Administration
and Hospital
Committees
(8)
Nursing and
Paramedical Care Line
of Hospital
No
Patients
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
Definitive Observation
6150
40
45
Medical/Surgical Acute
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
6510
90
95
Nursery Acute
6530
95
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
145
150
AMBULATORY SERVICES
160 Emergency Services
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
220
225
12/31/2013
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(9)
Physician and
Intern/Resident
Care of Hospital
Patients
(10)
(13)
Supervision and
Allocation of
Other Functions
Page 16, Column Line
of the Cost Center (9), to Revenue
No
Centers (See
Instructions)
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
Definitive Observation
6150
40
45
Medical/Surgical Acute
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
75
6420
80
6440
80
85
6470
85
90
6510
90
95
Nursery Acute
6530
95
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
70
$97,838
75
145
$97,838
150
AMBULATORY SERVICES
160 Emergency Services
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
220
225
12/31/2013
COMPENSATION
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
(1)
Salaries
and Wages
No
.07
(2)
Employee
Benefits
.10-.19
(3)
Professional
Fees
(4)
Total
Compensation
Line
No
.20
ANCILLARY SERVICES
230 Labor and Delivery Services
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
290 Electromyography
7610
290
295 Electroencephalography
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405
12/31/2013
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(5)
Research
Supported by
Hospital
(6)
Medical
Education
Supported by
Hospital (NonInservice)
(7)
General
Administration
and Hospital
Committees
(8)
Nursing and
Paramedical Care Line
of Hospital
No
Patients
ANCILLARY SERVICES
230 Labor and Delivery Services
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
290 Electromyography
7610
290
295 Electroencephalography
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405
12/31/2013
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(9)
Physician and
Intern/Resident
Care of Hospital
Patients
(10)
(13)
Supervision and
Allocation of
Other Functions
Page 16, Column Line
of the Cost Center (9), to Revenue
No
Centers (See
Instructions)
ANCILLARY SERVICES
230 Labor and Delivery Services
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
290 Electromyography
7610
290
295 Electroencephalography
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405
12/31/2013
COMPENSATION
Line
No
Account
No
(1)
Salaries
and Wages
(2)
Employee
Benefits
(3)
Professional
Fees
(4)
Total
Compensation
Line
No
.07,.09
.10-.19
.20
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
ADMINISTRATIVE SERVICES
205 Hospital Administration
8610
8620
210
8630
215
8640
220
225 Personnel
8650
225
8660
230
8670
235
8680
240
8690
245
8700
250
8710
255
8720
260
8730
265
8740
270
8750
8760
8790
$39,143
$39,143
205
275
$58,700
$58,700
280
$97,843
$97,843
300
$195,681
$195,681
305
295
TOTAL
305 TOTAL PAGES 15 AND 16
12/31/2013
Line
No
(5)
Research
Supported by
Hospital
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(6)
Medical
Education
Supported by
Hospital (NonInservice)
(7)
General
Administration
and Hospital
Committees
(8)
Nursing and
Paramedical Care Line
of Hospital
No
Patients
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
ADMINISTRATIVE SERVICES
205 Hospital Administration
8610
205
8620
210
8630
215
8640
220
225 Personnel
8650
225
8660
230
8670
235
8680
240
8690
245
8700
250
8710
255
8720
260
8730
265
8740
270
8750
275
8760
280
8790
295
300
TOTAL
305 TOTAL PAGES 15 AND 16
305
TOTAL LINE 305
LINES 15-50
TOTAL LINE 305
TO PAGE 18,
PAGE 16,TO
TO PAGE 18,
COLUMN(3), LINE SAME LINES ON COLUMN(3) LINE
5
PAGE 18, COL.(3);
295
OTHERS TO
PAGE 18,
COLUMN(3), LINE
15
LINE ITEMS TO
PAGE 17,
COLUMN(3)
LINES AS
APPROPRIATE
(SEE
INSTRUCTIONS)
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(9)
Physician and
Intern/Resident
Care of Hospital
Patients
(10)
Supervision and
Other Functions Line
of the Cost Center No
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
ADMINISTRATIVE SERVICES
205 Hospital Administration
8610
8620
$39,143
205
210
8630
215
8640
220
225 Personnel
8650
225
8660
230
8670
235
8680
240
8690
245
8700
250
8710
255
8720
260
8730
265
8740
270
8750
8760
8790
275
$58,700
280
295
$97,843
300
$97,838
$97,843
305
LINE 50 TO PAGE
15, COLUMN(13)
(SEE
INSTRUCTIONS)
LINE ITEMS TO
PAGES 17 & 18,
COLUMN(3),
LINES AS
APPROPRIATE
(SEE
INSTRUCTIONS)
TOTAL
305 TOTAL PAGES 15 AND 16
12/31/2013
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(1)
Salaries
and Wages
.00-.06,.08,
.09,.91,.95
(2)
Employee
Benefits
.10-.19,.92-.96
12/31/2013
(3)
Reclassified
Physician and
Student
Compensation
Pages 15 &16,
Cols. (8) & (10)
(4)
Professional Fees
.07,.10-.19,.20
.21-.29
Line
No
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
Definitive Observation
6150
40
45
Medical/Surgical Acute
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
75
6420
80
6440
80
85
6470
85
90
6510
90
95
Nursery Acute
6530
95
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
70
$1,969,739
$898,213
$572,021
75
145
$1,969,739
$898,213
$572,021
150
AMBULATORY SERVICES
160 Emergency Services
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
7220
7230
195
7260
200
7290
205
7310
210
7320
215
7390
185
$30,046
$15,496
190
220
$30,046
$15,496
225
Line
No
PATIENT
REVENUE PRODUCING CENTERS
(5)
Supplies
Account
No
.31-.50,.93,.97
(6)
Purchased
Services
.61-.69
(7)
Depreciation
.71-.74
12/31/2013
(8)
Leases
and Rentals
Line
No
.75-.76
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
Definitive Observation
6150
40
45
Medical/Surgical Acute
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
75
6420
80
6440
80
85
6470
85
90
6510
90
95
Nursery Acute
6530
95
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
70
$130,271
$11,976
$2,959
$2,352
75
145
$130,271
$11,976
$2,959
$2,352
150
AMBULATORY SERVICES
160 Emergency Services
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
220
225
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
Natural Classification Code
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
12/31/2013
(12) (Optional)
Adjusted Direct
Expenses [Cols. Line
(10) minus (11)] to No
Page 20, Column
(1)
.77-.90,.94-.98
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
Definitive Observation
6150
40
45
Medical/Surgical Acute
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
75
6420
80
6440
80
85
6470
85
90
6510
90
95
Nursery Acute
6530
95
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
70
$213,195
$3,800,726
$506,259
$3,294,467
75
145
$213,195
$3,800,726
$506,259
$3,294,467
150
AMBULATORY SERVICES
160 Emergency Services
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
7220
7230
195
7260
200
7290
205
7310
210
7320
215
7390
185
$45,542
$45,542
190
220
$45,542
$45,542
225
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(13) (Optional)
Units of Service
from Page 4,
Columns (4) + (5)
or Col(1)
Line
No
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
Definitive Observation
6150
40
45
Medical/Surgical Acute
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
75
6420
80
6440
80
85
6470
85
90
6510
90
95
Nursery Acute
6530
95
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
145
70
13,406
$245.75
75
150
AMBULATORY SERVICES
160 Emergency Services
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
7220
7230
195
7260
200
7290
205
7310
210
7320
215
7390
220
185
293
$155.43
190
225
12/31/2013
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(1)
Salaries
and Wages
.00-.06,.08,
.09,.91,.95
(2)
Employee
Benefits
.10-.19,.92-.96
12/31/2013
(3)
Reclassified
Physician and
Student
Compensation
Pages 15 &16,
Cols. (8) & (10)
(4)
Professional
Fees
.07,.10-.19,.20
.21-.29
Line
No
ANCILLARY SERVICES
230 Labor and Delivery Services
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
290 Electromyography
7610
290
295 Electroencephalography
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405
7900
7950
410
411
$1,999,785
$913,709
$572,021
415
Line
No
PATIENT
REVENUE PRODUCING CENTERS
(5)
Supplies
Account
No
.31-.50,.93,.97
(6)
Purchased
Services
.61-.69
(7)
Depreciation
.71-.74
12/31/2013
(8)
Leases
and Rentals
Line
No
.75-.76
ANCILLARY SERVICES
230 Labor and Delivery Services
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
290 Electromyography
7610
290
295 Electroencephalography
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405
7900
7950
410
411
$130,271
$11,976
$2,959
$2,352
415
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
Natural Classification Code
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
12/31/2013
(12) (Optional)
Adjusted Direct
Expenses [Cols. Line
(10) minus (11)] to No
Page 20, Column
(1)
.77-.90,.94-.98
ANCILLARY SERVICES
230 Labor and Delivery Services
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
290 Electromyography
7610
290
295 Electroencephalography
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405
7900
7950
410
411
$213,195
$3,846,268
$506,259
$3,340,009
415
Line
No
PATIENT
REVENUE PRODUCING CENTERS
Account
No
(13) (Optional)
Units of Service
from Page 4,
Columns (4) + (5)
or Col(1)
Line
No
ANCILLARY SERVICES
230 Labor and Delivery Services
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
290 Electromyography
7610
290
295 Electroencephalography
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405
7900
7950
410
411
415
12/31/2013
NON-REVENUE
PRODUCING CENTERS
Line
No
Account
No
(1)
Salaries
and Wages
.00-.06,.08,
.09,.91,.95
(2)
Employee
Benefits
.10-.19,.92-.96
12/31/2013
(3)
Reclassified
Physician and
Student
Compensation
Pages 15 &16,
Cols. (5),(6),(7),
(8)& (10)
(4)
Professional
Fees
.07,.10-.19,.20
.21-.29
Line
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
8310
55
60
Kitchen
8320
60
65
8330
70
Dietary
8340
75
8350
75
80
8360
80
85
Central Transportation
8370
85
90
8380
90
95
Pharmacy
8390
95
8400
100
105 Grounds
8410
105
110 Security
8420
110
115 Parking
8430
120 Housekeeping
8440
8450
8460
135 Communications
8470
135
8480
140
8490
65
$144,058
$71,445
$14,777
70
115
$49,580
$22,806
$547
$0
$0
$2,878
120
125
130
145
$193,638
$94,251
$18,202
$81,721
$38,678
$7,694
$193,294
$87,391
150
FISCAL SERVICES
155 General Accounting
8510
8530
8550
170 Admitting
8560
8570
8590
155
160
165
170
175
195
$275,015
$126,069
$7,694
200
NON-REVENUE
PRODUCING CENTERS
Line
No
(5)
Supplies
Account
No
.31-.50,.93,.97
(6)
Purchased
Services
.61-.69
(7)
Depreciation
.71-.74
12/31/2013
(8)
Leases and
Rentals
Line
No
.75-.76
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
8310
55
60
Kitchen
8320
60
65
8330
70
Dietary
8340
$155,892
75
8350
$5,240
80
8360
80
85
Central Transportation
8370
85
90
8380
90
95
Pharmacy
8390
95
8400
100
105 Grounds
8410
105
110 Security
8420
110
115 Parking
8430
120 Housekeeping
8440
8450
8460
135 Communications
8470
8480
8490
65
$60
70
75
115
$2,520
$29,749
$13,262
$156,532
120
125
130
135
$29,887
140
145
$176,914
$216,228
150
FISCAL SERVICES
155 General Accounting
8510
$14,329
155
8530
$13,265
160
8550
$15,374
165
170 Admitting
8560
$751
170
8570
8590
$910
175
195
$910
$43,719
200
NON REVENUE
PRODUCING CENTERS
Line
No
Account
No
Natural Classification Code
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
12/31/2013
(12) (Optional)
Adjusted Direct
Expenses [Cols. Line
(10) minus (11)] to No
Page 20, Column
(1)
.77-.90,.94-.98
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
8310
55
60
Kitchen
8320
60
65
8330
70
Dietary
8340
75
8350
80
8360
80
85
Central Transportation
8370
85
90
8380
90
95
Pharmacy
8390
95
8400
100
105 Grounds
8410
105
110 Security
8420
110
115 Parking
8430
120 Housekeeping
8440
$102
$105,304
$105,304
120
8450
$116,365
$116,365
$116,365
125
8460
$539
$173,211
$173,211
130
135 Communications
8470
8480
$29,887
$29,887
8490
$117,518
$816,751
$816,751
150
$14,329
$14,329
155
$532
$141,890
$141,890
160
$15,374
$15,374
165
$285,894
$285,894
170
65
$512
$386,744
$386,744
70
$5,240
$5,240
75
115
135
140
145
FISCAL SERVICES
155 General Accounting
8510
8530
8550
170 Admitting
8560
8570
8590
$3,548
175
195
$4,080
$457,487
$457,487
200
NON REVENUE
PRODUCING CENTERS
Line
No
(13)
Units of Service
Account
No
Line
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
8310
55
60
Kitchen
8320
60
65
8330
70
Dietary
8340
31,905
$12.12
70
75
8350
28,748
$0.18
75
80
8360
80
85
Central Transportation
8370
85
90
8380
90
95
Pharmacy
8390
95
8400
100
105 Grounds
8410
105
110 Security
8420
110
115 Parking
8430
120 Housekeeping
8440
22,727
$4.63
120
8450
24,424
$4.76
125
8460
24,424
$7.09
130
135 Communications
8470
8480
6,120
$4.88
8490
65
115
135
140
145
150
FISCAL SERVICES
155 General Accounting
8510
73
$196.29
155
8530
6,120
$23.18
160
8550
6,120
$2.51
165
170 Admitting
8560
185
$1,545.37
170
8570
175
8590
195
200
12/31/2013
NON REVENUE
PRODUCING CENTERS
Line
No
Account
No
(1)
Salaries
and Wages
(2)
Employee
Benefits
12/31/2013
(3)
Reclassified
Physician and
Student
Compensation
Pages 15 & 16,
Cols. (5),(6),(7),(8)
& (10)
(4)
Professional
Fees
Line
No
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
.07,.10-.19,.20
.21-.29
$306,587
$130,602
$39,143
$86,277
ADMINISTRATIVE SERVICES
205 Hospital Administration
8610
8620
210
8630
215
8640
220
225 Personnel
8650
225
8660
230
8670
235
8680
240
8690
245
8700
250
8710
255
8720
260
8730
265
8740
270
8750
8770
8790
205
275
$74,005
$36,672
$58,700
$400
$380,592
$167,274
$97,843
$86,677
280
295
300
UNASSIGNED COSTS
305 Depreciation and Amortization
8810
305
8820
310
8830
315
8840
320
8850
325
8860
330
8870
345
8880
350
8890
355
360
TOTAL
365 TOTAL OPERATING COSTS (17 & 18)
$2,849,030
$1,301,303
$97,843
$684,594
$2,849,030
$1,301,303
$97,843
$684,594
365
370
375
NON REVENUE
PRODUCING CENTERS
Line
No
(5)
Supplies
Account
No
(6)
Purchased
Services
.31-.50,.93,.97
.61-.69
$27,885
$154,860
(7)
Depreciation
.71-.74
12/31/2013
(8)
Leases and
Rentals
Line
No
.75-.76
ADMINISTRATIVE SERVICES
205 Hospital Administration
8610
8620
210
8630
215
8640
225 Personnel
8650
$21,411
225
8660
$8,536
230
8670
235
8680
240
8690
245
8700
250
8710
255
8720
260
8730
8740
8750
8770
8790
$3,094
205
220
265
$355
270
275
$3,108
280
295
$30,993
$185,162
$3,094
300
UNASSIGNED COSTS
305 Depreciation and Amortization
8810
8820
$116,078
305
8830
315
8840
320
8850
325
8860
330
8870
8880
8890
$162,240
310
345
$5,720
350
355
$5,720
$116,078
$162,240
360
$339,088
$462,805
$119,037
$167,686
365
$339,088
$462,805
$119,037
$167,686
TOTAL
365 TOTAL OPERATING COSTS (17 & 18)
370 Non-Operating Cost Centers
375 TOTAL COSTS
370
375
NON REVENUE
PRODUCING CENTERS
Line
No
Account
No
Natural Classification Code
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
12/31/2013
(12) (Optional)
Adjusted Direct
Expenses [Cols. Line
(10) minus (11)] to No
Page 20, Column
(1)
.77-.90,.94-.98
ADMINISTRATIVE SERVICES
205 Hospital Administration
8610
8620
210
8630
215
8640
225 Personnel
8650
$21,411
$21,411
225
8660
$8,536
$8,536
230
8670
235
8680
240
8690
245
8700
250
8710
255
8720
260
8730
8740
8750
8770
8790
$47,572
$796,020
$796,020
205
220
265
$3,209
$3,564
$3,564
270
$11,074
$183,959
$183,959
$61,855
$1,013,490
$1,013,490
300
275
280
295
UNASSIGNED COSTS
305 Depreciation and Amortization
8810
$116,078
$116,078
305
8820
$162,240
$162,240
310
8830
$35,460
$35,460
$35,460
315
8840
$25,038
$25,038
$25,038
320
8850
$16,672
$16,672
$16,672
325
8860
8870
8880
8890
330
345
$5,720
$5,720
350
$77,170
$361,208
$361,208
360
$473,818
$6,495,204
$506,259
$5,988,945
365
$473,818
$6,495,204
$506,259
$5,988,945
355
TOTAL
365 TOTAL OPERATING COSTS (17 & 18)
370 Non-Operating Cost Centers
375 TOTAL COSTS
370
375
NON REVENUE
PRODUCING CENTERS
Line
No
(13)
Units of Service
Account
No
Line
No
ADMINISTRATIVE SERVICES
205 Hospital Administration
8610
8620
73
$10,904.38
205
210
8630
215
8640
225 Personnel
8650
73
$293.30
225
8660
73
$116.93
230
8670
235
8680
240
8690
245
8700
250
8710
255
8720
260
8730
8740
8750
8770
8790
220
265
15
$237.60
1,150
$159.96
270
275
280
295
300
UNASSIGNED COSTS
305 Depreciation and Amortization
8810
24,424
$4.75
305
8820
24,424
$6.64
310
8830
6,120
$5.79
315
8840
24,424
$1.03
320
8850
24,424
$0.68
325
8860
8870
8880
8890
330
345
73
$78.36
350
355
360
TOTAL
365 TOTAL OPERATING COSTS (17 & 18)
365
370
375
12/31/2013
(4) Accumulated
Costs
Line
No
LINES BEING ALLOCATED
5-25
30-80
85-100
(7) Square
Feet Serviced
105
110
Line
No
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
35
Hospital Administration
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
65
General Accounting
70
Communications
70
75
75
80
85
Personnel
$21,411
85
90
$8,536
90
95
$5,720
30
831
35
60
341
65
80
95
100
105
100
$106,638
1.38
$2,520
110
115 Grounds
115
120 Security
120
125 Parking
130 Plant Operations
125
165
$118,565
165
$173,211
$13,262
135
140
1,041
$400,626
468
$11,481
214
$144,744
130
2.77
$155,892
1,041
145
$5,240
468
150
214
155
1.86
$29,887
175
160
$17,708
175
165
170
175
180
185
190
195
200
$35,460
334
$290,348
205
2.57
$910
334
210
215
220
225
$3,564
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
145
150
155-215
Line
No
220
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
1,041
145
468
150
214
155
160
175
165
170
175
180
185
190
195
200
205
334
210
215
220
225
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
(13)Nursing
FTE's
(14) Central
Service and
Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
225-230
235
240
Line
No
250-255
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160
165
170
175
180
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
(19) Nursing
Student
Departmental
Assignment
260-265
(20) Paramedic
Student
Departmental
Assignment
270-275
Line
No
280
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160
165
170
175
180
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
(4) Accumulated
Costs
Line
No
LINES BEING ALLOCATED
5-25
30-80
85-100
(7) Square
Feet Serviced
105
110
Line
No
505
510
515
520
525
530
535
540
545
550
555
560
565
570
20,330
$3,565,569
51.32
$130,271
20,330
575
580
585
590
595
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
660 Emergency Services
660
665
670
675 Clinics
675
680
685
$45,542
.64
690
695
700
705
710
715
720
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
145
150
155-215
Line
No
220
505
510
515
520
525
530
535
540
545
550
555
560
565
570
20,330
31,905
28,748
$6,029,839
575
580
585
590
595
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
660 Emergency Services
660
665
670
675 Clinics
675
680
685
$90,499
$90,499
690
695
700
705
710
715
720
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
(13)Nursing
FTE's
(14) Central
Service and
Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
225-230
235
240
Line
No
250-255
505
510
515
520
525
530
535
540
545
550
555
560
565
570
40.45
$6,029,839
575
580
585
590
595
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
660 Emergency Services
660
665
670
675 Clinics
675
680
685
.64
$90,499
690
695
700
705
710
715
720
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
(19) Nursing
Student
Departmental
Assignment
260-265
(20) Paramedic
Student
Department
Assignment
270-275
Line
No
280
505
510
515
520
525
530
535
540
545
550
555
560
565
570
575
580
585
590
595
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
660 Emergency Services
660
665
670
675 Clinics
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
(4) Accumulated
Costs
Line
No
LINES BEING ALLOCATED
5-25
30-80
85-100
(7) Square
Feet Serviced
105
110
Line
No
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
23,999
$4,979,008
60.54
22,727
920
$320,028
$1,009,937
$42,901
$129,242
925
$308,095
$112
930
$320,028
$1,009,825
$42,901
$129,242
935
$13.3351
$0.2028
$708.6207
$5.6867
940
145
150
155-215
Line
No
220
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
22,562
31,905
28,748
$6,120,338
$351,892.00
$506,000.00
$23,770.00
$641,761.00
$351,892.00
$506,000.00
$23,770.00
$641,761.00
935
16
16
$0.1049
940
$90,499
920
925
930
(13)Nursing
FTE's
(14) Central
Service and
Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
225-230
235
240
Line
No
250-255
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
41.09
$4,287
$6,120,338
920
925
930
$4,287
935
$104.3319
940
(19) Nursing
Student
Departmental
Assignment
260-265
(20) Paramedic
Student
Departmental
Assignment
270-275
Line
No
280
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
920
925
930
935
940
COST ALLOCATION
(2)Square Feet
12/31/2013
(3)Subtotal
Line
No
5-25
Interest - Other
8870
10
Insurance - Other
8840
15
20
25
5
$25,038
10
8850
$16,672
15
8810
$116,078
8820
$162,240
($320,028)
30
8860
35
Hospital Administration
8610
$796,020
$11,081
40
8620
40
45
Public Relations
8630
45
50
Management Engineering
8640
55
8770
60
8790
65
General Accounting
8510
70
Communications
8470
70
75
8590
75
80
8310
85
Personnel
8650
$21,411
$21,411
85
90
8660
$8,536
$8,536
90
95
8880
$5,720
$5,720
20
25
30
$807,101
35
50
$183,959
$183,959
55
60
$14,329
$4,547
$18,876
65
80
95
8330
8400
110 Housekeeping
8440
115 Grounds
8410
115
120 Security
8420
120
125 Parking
8430
8450
$116,365
8460
$173,211
8490
145 Dietary
8340
$386,744
$13,882
$400,626
145
8350
$5,240
$6,241
$11,481
150
8530
$141,890
$2,854
$144,744
155
8480
$29,887
$29,887
160
8550
$15,374
$17,708
165
8670
170
8680
175
8690
180
8700
185
8710
190
8360
195
8750
8830
$35,460
210 Admitting
8560
$285,894
8890
215
8570
220
8720
8740
8380
235
240 Pharmacy
8390
240
8010
245
8210
250
8260
255
8230
260
8220
265
8250
270
8290
275
8260
100
105
$105,304
$1,334
$106,638
110
125
$2,200
$118,565
130
$173,211
135
140
$2,334
200
$4,454
$35,460
205
$290,348
210
225
$3,564
$3,564
230
280
$2,648,936
$2,377,834
285
COST ALLOCATION
(4)Accumulated
Costs
30-80
105
12/31/2013
(7)Square Feet
Serviced
Line
No
110
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
80
85
75
($1,009,937)
80
Personnel
$4,343
85
90
$1,731
90
95
$1,160
95
($42,901)
100
105
$21,628
$977
($129,242)
110
115 Grounds
115
120 Security
120
125 Parking
125
$24,047
$35,130
$938
130
135
140
145 Dietary
$81,253
$2,328
$29,356
$6,062
$3,591
$1,965
$1,319
$5,920
145
$2,661
150
$1,217
155
160
$995
165
170
175
180
185
190
195
200
$7,192
210 Admitting
$58,887
205
$1,819
$1,899
210
215
220
225
$723
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
COST ALLOCATION
(8)Square Feet
from Column (2)
(9)Meals Served
(10)Dry Pounds
Processed
115-140
145
150
12/31/2013
(11)Gross Patient
Line
Revenue from Page No
12, Column 23
155-215
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
($351,892)
145 Dietary
$16,236
$7,299
$3,338
140
($506,000)
145
($23,770)
150
155
160
$2,729
165
170
175
180
185
190
195
200
205
$5,209
210
($641,761)
215
220
225
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
COST ALLOCATION
12/31/2013
(12)Gross
Outpatient Revenue
from Page
12,Column 22
(13)Nursing
FTE's
(14)Central Service
and Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
Line
No
220
225-230
235
240
No
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160
165
170
175
180
185
190
195
200
205
210 Admitting
210
215
220
225
($4,287)
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
COST ALLOCATION
(16)Subtotal
12/31/2013
(17)Gross Patient
Revenue from
Column (11)
(18) Students in
All Approved
Programs
(19)Nursing Student
Departmental
Assignment
245
250-255
260-265
Line
No
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160
165
170
175
180
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
280
285
COST ALLOCATION
(20)Paramedic Student
Departmental
Assignment
(21)Medical
Postgraduate
Departmental
Assignment
270-275
280
12/31/2013
(22)Transfers
for Operating
Costs
(23)Total
Line
No
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160
165
170
175
180
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255
260
265
270
275
COST ALLOCATION
(2)Square Feet
12/31/2013
(3)Subtotal
Line
No
5-25
5320
350
5340
355
5350
360
5370
365
5380
370
5390
375
5430
380
5440
385
5480
390
5700
395
5740
400
5782
5770
5781
411
5790
415
5780
420
5780
425
5780
430
5780
405
($112)
($112)
410
435
($112)
($112)
440
445
6010
505
6030
510
6050
515
6070
520
6090
525
6110
530
6130
535
6150
540
6170
545
6290
550
6340
555
6360
560
6380
565
6400
6420
6440
580
6470
585
6510
590
6530
595
6560
600
6570
601
6580
605
6610
610
6630
615
6680
620
6780
625
6900
570
$3,294,467
$271,102
$3,565,569
575
645
$3,294,467
$271,102
$3,565,569
650
AMBULATORY SERVICES
660 Emergency Services
7010
660
7040
665
7060
670
COST ALLOCATION
(4)Accumulated
Costs
30-80
105
12/31/2013
(7)Square Feet
Serviced
Line
No
110
350
355
360
365
370
375
380
385
390
395
400
405
$112
410
411
415
420
425
430
435
$112
440
445
505
510
515
520
525
530
535
540
545
550
555
560
565
570
$723,156
$36,367
$115,611
575
580
585
590
595
600
601
605
610
615
620
625
645
$723,156
$36,367
$115,611
650
AMBULATORY SERVICES
660 Emergency Services
660
665
670
COST ALLOCATION
(8)Square Feet
from Column (2)
(9)Meals Served
(10)Dry Pounds
Processed
115-140
145
150
12/31/2013
(11)Gross Patient
Line
Revenue from Page No
12, Column 23
155-215
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
440
445
505
510
515
520
525
530
535
540
545
550
555
560
565
570
$317,080
$506,000
$23,770
$632,272
575
580
585
590
595
600
601
605
610
615
620
625
645
$317,080
$506,000
$23,770
$632,272
650
AMBULATORY SERVICES
660 Emergency Services
660
665
670
COST ALLOCATION
Line
No
12/31/2013
(12)Gross
Outpatient Revenue
from Page
12,Column 22
(13)Nursing
FTE's
(14)Central Service
and Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
Line
No
220
225-230
235
240
No
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
440
445
505
510
515
520
525
530
535
540
545
550
555
560
565
570
$4,220
575
580
585
590
595
600
601
605
610
615
620
625
645
$4,220
650
AMBULATORY SERVICES
660 Emergency Services
660
665
670
COST ALLOCATION
Line
No
(16)Subtotal
12/31/2013
(17)Gross Patient
Revenue from
Column (11)
(18) Students in
All Approved
Programs
(19)Nursing Student
Departmental
Assignment
245
250-255
260-265
Line
No
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
440
445
505
510
515
520
525
530
535
540
545
550
555
560
565
570
$5,924,045
575
580
585
590
595
600
601
605
610
615
620
625
645
$5,924,045
650
AMBULATORY SERVICES
660 Emergency Services
660
665
670
COST ALLOCATION
(20)Paramedic Student
Departmental
Assignment
(21)Medical
Postgraduate
Departmental
Assignment
270-275
280
12/31/2013
(22)Transfers
for Operating
Costs
(23)Total
Line
No
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
440
445
505
510
515
520
525
530
535
540
545
550
555
560
565
570
$5,924,045
575
580
585
590
595
600
601
605
610
615
620
625
645
$5,924,045
650
AMBULATORY SERVICES
660 Emergency Services
660
665
670
COST ALLOCATION
Line
No
(2)Square Feet
12/31/2013
(3)Subtotal
Line
No
5-25
675 Clinics
7070
675
7180
680
7200
7220
7230
695
7260
700
7290
705
7310
710
7320
715
7390
685
$45,542
$45,542
690
720
$45,542
$45,542
725
ANCILLARY SERVICES
730 Labor and Delivery Services
7400
7420
735
7430
740
745 Anesthesiology
7450
745
7470
750
7480
755
7500
760
7520
765
7540
770
775 Echocardiology
7560
775
7570
780
7590
785
790 Electromyography
7610
790
795 Electroencephalography
7620
795
7630
800
7640
805
7650
810
7660
815
820 Ultrasonography
7670
820
7680
825
7710
830
7720
835
7730
840
7740
845
850 Lithotripsy
7750
850
7760
855
7770
860
7780
865
7790
870
7800
875
7820
880
7830
885
7840
890
7860
895
7870
900
730
905
7900
7950
910
911
915
$5,988,833
-0-
$5,988,833
920
COST ALLOCATION
(4)Accumulated
Costs
30-80
105
12/31/2013
(7)Square Feet
Serviced
Line
No
110
675 Clinics
675
680
685
$9,237
$453
690
695
700
705
710
715
720
$9,237
$453
725
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
905
910
911
915
920 TOTAL
-0-
-0-
-0-
-0-
920
COST ALLOCATION
(8)Square Feet
from Column (2)
(9)Meals Served
(10)Dry Pounds
Processed
115-140
145
150
12/31/2013
(11)Gross Patient
Line
Revenue from Page No
12, Column 23
155-215
675 Clinics
675
680
685
$9,489
690
695
700
705
710
715
720
$9,489
725
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
905
910
911
915
920 TOTAL
-0-
-0-
-0-
-0-
920
COST ALLOCATION
12/31/2013
(12)Gross Patient
Revenue from Page
12,Column 22
(13)Nursing
FTE's
(14)Central Service
and Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
220
225-230
235
240
Line
No
No
675 Clinics
675
680
685
$67
690
695
700
705
710
715
720
$67
725
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
905
910
911
915
920 TOTAL
-0-
-0-
-0-
-0-
920
COST ALLOCATION
(16)Subtotal
12/31/2013
(17)Gross Patient
Revenue from
Column (11)
(18) Students in
All Approved
Programs
(19)Nursing Student
Departmental
Assignment
245
250-255
260-265
Line
No
675 Clinics
675
680
685
$64,788
690
695
700
705
710
715
720
$64,788
725
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
905
910
911
915
920 TOTAL
$5,988,833
-0-
-0-
-0-
920
COST ALLOCATION
(20)Paramedic Student
Departmental
Assignment
(21)Medical
Postgraduate
Departmental
Assignment
270-275
280
12/31/2013
(22)Transfers
for Operating
Costs
(23)Total
Line
No
675 Clinics
675
680
685
$64,788
690
695
700
705
710
715
720
$64,788
725
ANCILLARY SERVICES
730 Labor and Delivery Services
730
735
740
745 Anesthesiology
745
750
755
760
765
770
775 Echocardiology
775
780
785
790 Electromyography
790
795 Electroencephalography
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
905
910
911
915
920 TOTAL
-0-
-0-
-0-
$5,988,833
920
Line
No
(2)Other Operating
Revenue Page
14,Col(1), Line 200
12/31/2013
(4)Other Operating
Revenue Page 14, Col Line
(1),Line 210
No
Cost Recovery
Interest - Other
1
5
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160
165
170
175
180
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
Line
No
(2)Other Operating
Revenue Page
14,Col(1), Line 200
12/31/2013
(4)Other Operating
Revenue Page 14, Col Line
(1),Line 210
No
255
260
265
270
275
280
-0-
-0-
-0-
-0-
285
Line
No
Cost Recovery
Interest - Other
1
5
10
Insurance - Other
10
15
15
20
20
25
25
30
30
35
Hospital Administration
35
40
40
45
Public Relations
45
50
Management Engineering
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160
165
170
175
180
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
12/31/2013
Line
No
255
260
265
270
275
280
-0-
-0-
285
12/31/2013
Line
No
Account No
(7)Transfers for
Operations (Revenue
Line
Centers) Page
No
14,Column (1), Line 270
500
6010
505
6030
510
6050
515
6070
520
6090
525
6110
530
6130
535
6150
540
6170
545
6290
550
6340
555
6360
560
6380
565
6400
570
6420
575
6440
580
6470
585
6510
590
6530
595
6560
600
6570
601
6580
605
6610
610
6630
615
6680
620
6780
625
6900
645
650
AMBULATORY SERVICES
660 Emergency Services
7010
660
7040
665
7060
670
675 Clinics
7070
675
7180
680
7200
685
7220
690
7230
695
7260
700
7290
705
7310
710
7320
715
7390
720
725
12/31/2013
Line
No
Account No
(7)Transfers for
Operations
(Revenue
Centers) Page
14,Column (1),
Line 270
Line
No
ANCILLARY SERVICES
730 Labor and Delivery Services
7400
730
7420
735
7430
740
745 Anesthesiology
7450
745
7470
750
7480
755
7500
760
7520
765
7540
770
775 Echocardiology
7560
775
7570
780
7590
785
790 Electromyography
7610
790
795 Electroencephalography
7620
795
7630
800
7640
805
7650
810
7660
815
820 Ultrasonography
7670
820
7680
825
7710
830
7720
835
7730
840
7740
845
850 Lithotripsy
7750
850
7760
855
7770
860
7780
865
7790
870
7800
875
7820
880
7830
885
7840
890
7860
895
7870
900
905
-0-
920
12/31/2013
CLASSIFICATION DESCRIPTION
Line
No
(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
Average
Hourly Rate
12/31/2013
(5)
(6)
Registered
Nurses
.01
Productive
Hours
Average
Hourly Rate
.02
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
70
$33.65
6,935
$22.40
10,229
$25.73
10,838
75
95
100
101
105
110
115
120
125
145
$33.65
6,935
$22.40
10,229
$25.73
10,838
150
AMBULATORY SERVICES
160 Emergency Services
160
165
170
175 Clinics
175
180
185
190
195
200
205
210
215
220
225
CLASSIFICATION DESCRIPTION
Line
No
(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
Average
Hourly Rate
12/31/2013
(11)
.04
Productive
Hours
Average
Hourly Rate
(12)
.05
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
70
$16.01
73,296
$20.21
5,450
75
95
100
101
105
110
115
120
125
145
$16.01
73,296
$20.21
5,450
150
AMBULATORY SERVICES
160 Emergency Services
160
165
170
175 Clinics
175
180
185
$23.18
1,330
190
195
200
205
210
215
220
$23.18
1,330
225
CLASSIFICATION DESCRIPTION
Line
No
(14)
Environmental and
Food Service
(15)
(16)
Productive
Hours
(17)
(18)
Physicians
(Salaried)
Non-Physicians Medical
Practitioners
.07
.08
.06
Average
Hourly Rate
12/31/2013
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
75
80
80
85
85
90
90
95
Nursery Acute
95
100
101
105
110
115
120
125
145
150
AMBULATORY SERVICES
160 Emergency Services
160
165
170
175 Clinics
175
180
185
190
195
200
205
210
215
220
225
CLASSIFICATION DESCRIPTION
Line
No
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Average Hourly
Rate
Line
Productive
Hours
No
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
95
100
Sub-Acute Care
100
101
101
105
105
110
110
115
Intermediate Care
115
120
Residential Care
120
125
125
145
150
70
$19.28
75
145
$19.28
150
AMBULATORY SERVICES
160
Emergency Services
160
165
165
170
170
175
Clinics
175
180
Satellite Clinics
180
185
190
195
Observation Care
195
200
200
205
205
210
210
215
215
220
225
185
$23.18
190
220
$23.18
225
12/31/2013
(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Total Paid
Hours
12/31/2013
Line
No
Column (22)
2080
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
70
106,748
10,380
117,128
51.32
75
95
100
101
105
110
115
120
125
145
106,748
10,380
117,128
51.32
150
AMBULATORY SERVICES
160 Emergency Services
160
165
170
175 Clinics
175
180
185
1,330
290
1,620
.64
190
195
200
205
210
215
220
1,330
290
1,620
.64
225
CLASSIFICATION DESCRIPTION
Line
No
(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
Average
Hourly Rate
12/31/2013
(5)
(6)
Registered
Nurses
.01
Productive
Hours
Average
Hourly Rate
.02
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
ANCILLARY SERVICES
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
CLASSIFICATION DESCRIPTION
Line
No
(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
Average
Hourly Rate
12/31/2013
(11)
.04
Productive
Hours
Average
Hourly Rate
(12)
.05
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
ANCILLARY SERVICES
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
CLASSIFICATION DESCRIPTION
Line
No
(14)
Environmental and
Food Service
(15)
(16)
Productive
Hours
(17)
(18)
Physicians
(Salaried)
Non-Physicians Medical
Practitioners
.07
.08
.06
Average
Hourly Rate
12/31/2013
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
ANCILLARY SERVICES
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
CLASSIFICATION DESCRIPTION
Line
No
(20)
Other Salaries
and Wages
.09
Average Hourly
Rate
(21)
Cost Center
Average Hourly
Rate
Line
Productive
Hours
No
ANCILLARY SERVICES
230
230
235
235
240
240
245
Anesthesiology
245
250
250
255
255
260
260
265
265
270
Blood Bank
270
275
Echocardiology
275
280
280
285
Cardiology Services
285
290
Electromyography
290
295
Electroencephalography
295
300
Radiology - Diagnostic
300
305
Radiology - Therapeutic
305
310
Nuclear Medicine
310
315
315
320
Ultrasonography
320
325
325
330
330
335
Respiratory Therapy
335
340
340
345
Renal Dialysis
345
350
Lithotripsy
350
355
Gastro-Intestinal Services
355
360
Physical Therapy
360
365
Speech-Language Pathology
365
370
Occupational Therapy
370
375
375
380
Electroconvulsive Therapy
380
385
Psychiatric/Psychological Testing
385
390
390
395
Organ Acquisition
395
400
400
405
405
12/31/2013
(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Total Paid
Hours
12/31/2013
Line
No
Column (22)
2080
ANCILLARY SERVICES
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
(2)
(3)
12/31/2013
(4)
CLASSIFICATION DESCRIPTION
Registry Nursing
Personnel
Other Contracted
Services
.25
.21, .26
(5)
Total Contracted
Hours
Line
No
Line
REVENUE PRODUCING CENTERS
Average Hourly
Rate
Productive Hours
Average Hourly
Rate
Productive Hours
No
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
Definitive Observation
40
45
Medical/Surgical Acute
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
75
80
80
85
85
90
90
95
Nursery Acute
70
$28.67
19,952
19,952
75
95
100
101
105
110
115
120
125
145
$28.67
19,952
19,952
150
AMBULATORY SERVICES
160 Emergency Services
160
165
170
175 Clinics
175
180
185
190
195
200
205
210
215
220
225
(2)
(3)
12/31/2013
(4)
CLASSIFICATION DESCRIPTION
Registry Nursing
Personnel
Other Contracted
Services
.25
.21, .26
Line
No
(5)
Total Contracted
Hours
Line
Average Hourly
Rate
Productive Hours
Average Hourly
Rate
Productive Hours
No
ANCILLARY SERVICES
230 Labor and Delivery Services
230
235
240
245 Anesthesiology
245
250
255
260
265
270
275 Echocardiology
275
280
285
290 Electromyography
290
295 Electroencephalography
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
CLASSIFICATION DESCRIPTION
Line
No
(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
Average
Hourly Rate
12/31/2013
(5)
(6)
Registered
Nurses
.01
Productive
Hours
Average
Hourly Rate
.02
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
Paramedical Education
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
70
Dietary
75
75
80
80
85
Central Transportation
85
90
90
95
Pharmacy
65
$32.59
1,830
70
95
100
105 Grounds
105
110 Security
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
135
140
145
$32.59
1,830
150
FISCAL SERVICES
155 General Accounting
155
160
165
$42.10
2,016
$24.42
1,936
175
170
195
$42.10
2,016
$24.42
1,936
200
CLASSIFICATION DESCRIPTION
Line
No
(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
12/31/2013
(5)
(6)
Registered
Nurses
.01
.02
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$51.60
4,207
$21.74
50
Average
Hourly Rate
Line
Productive
Hours
No
ADMINISTRATIVE SERVICES
205 Hospital Administration
205
210
215
220
225 Personnel
225
230
235
240
245
250
255
260
265
270
275
$30.34
1,825
$30.11
1,875
280
295
$51.60
4,207
300
350
370
CLASSIFICATION DESCRIPTION
Line
No
(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
Average
Hourly Rate
12/31/2013
(11)
.04
Productive
Hours
Average
Hourly Rate
(12)
.05
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
Paramedical Education
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
75
80
80
85
Central Transportation
85
90
90
95
Pharmacy
95
100
105 Grounds
105
110 Security
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
135
140
145
150
FISCAL SERVICES
155 General Accounting
160 Patient Accounting
155
$21.78
3,873
$48.24
1,388
165
170
175
160
195
$28.76
5,261
200
CLASSIFICATION DESCRIPTION
Line
No
(8)
Licensed
Vocational Nurses
(9)
(10)
Productive
Hours
(11)
(12)
Aides and
Orderlies
.04
.05
.03
Average
Hourly Rate
12/31/2013
Average
Hourly Rate
Productive
Hours
Line
Average
Hourly Rate
Productive
Hours
No
$23.21
4,240
205
ADMINISTRATIVE SERVICES
205 Hospital Administration
210 Governing Board Expense
210
215
220
225 Personnel
225
230
235
240
245
250
255
260
265
270
275
$20.60
980
$22.72
5,220
280
295
300
350
370
(14)
(15)
(16)
12/31/2013
(17)
(18)
CLASSIFICATION DESCRIPTION
Environmental and
Food Service
Physicians
(Salaried)
Non-Physician Medical
Practitioners
Line
.06
.07
.08
No
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
Paramedical Education
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
70
Dietary
75
75
80
80
85
Central Transportation
85
90
90
95
Pharmacy
65
$22.76
3,937
70
95
100
105 Grounds
105
110 Security
110
115 Parking
120 Housekeeping
115
$17.73
2,868
120
125
$0.00
130
135 Communications
135
140
145
$20.64
6,805
150
FISCAL SERVICES
155 General Accounting
155
160
165
170 Admitting
170
175
195
200
CLASSIFICATION DESCRIPTION
Line
No
(14)
Environmental and
Food Service
(15)
(16)
Physicians
(Salaried)
.06
12/31/2013
(17)
.07
Average
Hourly Rate
Productive
Hours
$17.00
Average
Hourly Rate
(18)
Non-Physician Medical
Practitioners
.08
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
ADMINISTRATIVE SERVICES
205 Hospital Administration
205
210
215
220
225 Personnel
225
230
235
240
245
250
255
260
265
270
275
280
295
$17.00
300
350
370
CLASSIFICATION DESCRIPTION
Line
No
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Average Hourly
Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
Paramedical Education
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
70
Dietary
75
75
80
80
85
Central Transportation
85
90
90
95
Pharmacy
95
100
100
105
Grounds
105
110
Security
110
115
Parking
120
Housekeeping
125
Plant Operations
130
Plant Maintenance
135
Communications
135
140
Data Processing
140
145
150
65
$27.72
70
115
$18.99
120
125
$0.00
130
145
$24.88
150
FISCAL SERVICES
155
General Accounting
160
Patient Accounting
165
170
Admitting
175
Outpatient Registration
195
200
155
$21.72
160
165
$36.79
170
175
195
$30.40
200
12/31/2013
(20)
CLASSIFICATION DESCRIPTION
Other Salaries
and Wages
Line
.09
No
Average Hourly
Rate
(21)
Cost Center
Average Hourly
Rate
Line
Productive
Hours
No
ADMINISTRATIVE SERVICES
205
Hospital Administration
210
$39.40
205
210
215
Public Relations
215
220
Management Engineering
220
225
Personnel
225
230
230
235
Auxiliary Groups
235
240
Chaplaincy Services
240
245
Medical Library
245
250
Medical Records
250
255
255
260
Nursing Administration
260
265
265
270
270
275
Utilization Management
280
295
300
350
350
370
370
275
$26.98
280
295
$36.05
300
12/31/2013
(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Total Paid
Hours
12/31/2013
Line
No
Column (22)
2080
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
Paramedical Education
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
70
Dietary
75
75
80
80
85
Central Transportation
85
90
90
95
Pharmacy
65
5,767
758
6,525
2.77
70
95
100
105 Grounds
105
110 Security
110
115 Parking
120 Housekeeping
115
2,868
275
3,143
1.38
120
125
130
135 Communications
135
140
145
8,635
1,033
9,668
4.15
3,873
476
4,349
1.86
5,340
568
5,908
2.57
150
FISCAL SERVICES
155 General Accounting
160 Patient Accounting
155
165
170
175
160
195
9,213
1,044
10,257
4.43
200
(23)
(24)
HOURS SUMMARY
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
12/31/2013
Productive
Hours
NonProductive
Hours
Total Paid
Hours
Column (22)
2080
8,501
396
8,897
4.09
Line
No
ADMINISTRATIVE SERVICES
205 Hospital Administration
205
210
215
220
225 Personnel
225
230
235
240
245
250
255
260
265
270
275
2,805
483
3,288
1.35
11,306
879
12,185
5.44
280
295
300
350
370
CLASSIFICATION DESCRIPTION
Line
No
(4)
Other Contracted
Services
.26
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
Paramedical Education
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
70
Dietary
75
75
80
80
85
Central Transportation
85
90
90
95
Pharmacy
65
$28.69
515
70
95
100
105 Grounds
105
110 Security
110
115 Parking
115
120 Housekeeping
120
125
$28.77
105
130
135 Communications
135
140
145
$28.70
620
150
FISCAL SERVICES
155 General Accounting
155
160
$28.71
268
165
170 Admitting
170
175
195
$28.71
268
200
12/31/2013
CLASSIFICATION DESCRIPTION
Line
No
(4)
Other Contracted
Services
.26
Line
Average
Hourly Rate
Productive
Hours
No
$28.68
1,443
205
ADMINISTRATIVE SERVICES
205 Hospital Administration
210 Governing Board Expense
210
215
220
225 Personnel
225
230
235
240
245
250
255
260
265
270
275
$28.57
14
$28.68
1,457
280
295
300
350
370
12/31/2013