OSHPD Reports

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT
USING DATA SUBMITTED BY FACILITY

FACILITY NO:106190762
ST. VINCENT MEDICAL CENTER
2131 WEST THIRD STREET
LOS ANGELES
CA
PHONE NO:
OWNER:
90057
GENERAL INFORMATION
TYPE OF CONTROL:
TYPE OF CARE:
Null
LICENSED BEDS*
67
ACUTE
272
LONG-TERM
27
TOTAL
OCCUPANCY RATE
Los Angeles
11
HFPA NO:
0925
EMERGENCY SERVICES
INTENSIVE
67
ACUTE
366
35.90%
*EXCLUDES BEDS IN SUSPENSE
FINANCIAL AND UTILIZATION DATA BY PAYER

Patient (Census) Days
Hospital Discharges (Excluding Nursery)
Average Length of Stay (Including L-T Care)
Average Length of Stay (Excluding L-T Care)
Outpatient Visits (Incl. ER Visits)
Outpatient Emergency Services Visits
Gross Inpatient Revenue
Gross Outpatient Revenue
Deductions From Revenue
Net Inpatient Revenue
Net Outpatient Revenue
Net Inpatient Revenue Per Day
Net Inpatient Revenue Per Discharge
Net Outpatient Revenue Per Visit
Adjusted Patient Days
Net Revenue Per Adj Patient Day
Purchased Inpatient Days
243
LONG-TERM
27
TRAUMA CENTER DESIGNATION

OBSERVATION
ORTHOPEDIC
337
PSYCHIATRIC
39.00%
HELICOPTER
TOTAL
OCCUPANCY RATE
EMERGENCY ROOM
OTHER
OTHER
NO. BASSINETS
TOTAL
MEDICARE
TRADITIONAL
29,833
4,356
6.8
5.9
29,491
2,623
$413,257,330
$145,319,884
$474,144,018
$62,466,989
$21,966,207
$2,094
$14,340
$745
MEDICARE
MANAGED CARE
6,271
1,352
4.6
4.1
9,850
1,046
$75,128,220
$42,290,753
$99,594,489
$17,915,416
$10,084,844
$2,857
$13,251
$1,024
MEDI-CAL
TRADITIONAL
2,959
514
5.8
5.7
4,302
1,091
$50,660,098
$22,404,647
$60,180,079
$8,933,699
$3,950,967
$3,019
$17,381
$918
MEDI-CAL
MANAGED CARE
2,462
523
4.7
4.7
9,931
3,248
$46,060,852
$31,495,663
$70,211,568
$4,362,168
$2,982,779
$1,772
$8,341
$300
CO. INDIGENT
TRADITIONAL
CO. INDIGENT
MANAGED CARE
THIRD PARTY
TRADITIONAL
849
185
4.6
4.6
566
327
$5,893,413
$1,662,580
$5,932,393
$1,266,351
$357,249
$1,492
$6,845
$631
THIRD PARTY
MANAGED CARE
5,259
OTHER
INDIGENT
5
OTHER
PAYERS
304
1,250
4.2
2
2.5
63
4.8
2.5
4.8
22,258
36
1,911
47,942
8,245
5.8
5.2
78,345
11,759
$703,560,224
$337,002,302
$867,548,503
$121,760,836
$61,428,963
$2,540
$14,768
$784
70,906
$2,584
1,886
36
1,502
$112,117,974
$44,342
$397,995

$92,255,108
$155,525,091
$211,020
$255,362
$1,362,647
$1,705,503
$26,797,745
$18,468
$22,050,246
$36,671

6/24/2015
1 OF 5
07/01/2013
06/30/2014
(213)484-7111
DAUGHTERS OF CHARITY HEALTH SYSTEM
COUNTY:
HSA NO:
AVAILABLE BEDS
INTENSIVE
DATE PREPARED:
PAGE:
REPORT PERIOD:
THRU
$5,096
$61
$21,438
$293
$991
$19
LIVE BIRTH SUMMARY
NATURAL BIRTHS
CESAREAN SECTIONS
TOTAL LIVE BIRTHS
SUMMARY STATEMENT OF INCOME

GROSS PATIENT REVENUE
PROVISION FOR BAD DEBT
MEDICARE TRAD. CONTRACTUAL ADJ
MEDICARE MANAGED CONTRACTUAL ADJ
MEDI-CAL TRAD. CONTRACTUAL ADJ
MEDI-CAL MANAGED CONTRACTUAL ADJ
DISPROPORTIONATE SHARE FUNDS REC'D
CO. INDIGENT TRAD. CONTRACTUAL ADJ
CO. INDIGENT MANAGED CONTRACTUAL ADJ
THIRD PARTY TRAD. CONTRACTUAL ADJ
THIRD PARTY MANAGED CONTRACTUAL ADJ
CHARITY OTHER
ALL OTHER DEDUCTIONS
TOTAL DEDUCTIONS FROM REVENUE
CAPITATION PREMIUM REVENUE
NET PATIENT REVENUE
OTHER OPERATING REVENUE
TOTAL OPERATING EXPENSES
NET FROM OPERATIONS
NON-OPERATING REVENUE
+
NON-OPERATING EXPENSES
PROVISION FOR INCOME TAXES
EXTRAORDINARY ITEMS
NET INCOME
OPERATING EXPENSES BY CLASSIFICATION
SALARIES AND WAGES
EMPLOYEE BENEFITS
PHYSICIANS PROFESSIONAL FEES
OTHER PROFESSIONAL FEES
SUPPLIES
PURCHASED SERVICES
DEPRECIATION
LEASES AND RENTALS
INTEREST
ALL OTHER EXPENSES
ADJUSTED PATIENT REVENUE
ADJUSTED INPATIENT REVENUE
REVENUE PER DAY
REVENUE PER DISCHARGE
ADJUSTED OUTPATIENT REVENUE
REVENUE PER VISIT
OPERATING EXPENSES BY COST CENTER GROUP
DAILY HOSPITAL SERVICES
AMBULATORY SERVICES
ANCILLARY SERVICES
PURCHASED INPATIENT SERVICES
PURCHASED OUTPATIENT SERVICES
RESEARCH
EDUCATION
GENERAL SERVICES
FISCAL SERVICES
ADMINISTRATIVE SERVICES
UNASSIGNED COSTS
ADJUSTED PATIENT EXPENSES
ADJUSTED INPATIENT EXPENSES
EXPENSES PER DAY
EXPENSES PER DISCHARGE
ADJUSTED OUTPATIENT EXPENSES
EXPENSES PER VISIT
DATE PREPARED: 6/24/2015

PAGE:
2 OF 5
REPORT PERIOD: 07/01/2013
THRU 06/30/2014
GROSS PATIENT REVENUE BY REVENUE CENTER

AMBULATORY SERVICES
ANCILLARY SERVICES
TOTAL GROSS PATIENT REVENUE
$1,040,562,526
$5,530,363
$470,903,610
$98,936,943
$60,148,911
$70,178,483
$5,890,080
$153,946,285
$642,527
$1,371,301
$867,548,503
$10,175,776
$183,189,799
$3,657,799
$229,806,233
($42,958,635)
$14,404,651
$2,780,284
($31,334,268)
$64,681,581
$37,526,591
$5,955,807
$2,696,371
$42,169,027
$44,723,314
$12,400,434
$1,557,711
$3,378,550
$14,716,847
$229,806,233
$39,318,697
$9,212,616
$85,328,183
$3,900,966
$852,534
$897,434
$37,020,189
$4,598,464
$34,567,021
$14,110,129
$229,806,233
$217,169,490
$80,818,794
$742,574,242
$1,040,562,526
PERCENT OF TOTAL
20.9
7.8
71.4
100.0


PAGE:
BALANCE SHEET SUMMARY

TOTAL CURRENT ASSETS
LIMITED USE ASSETS
NET PROPERTY, PLANT, AND EQUIPMENT
CONSTRUCTION-IN-PROGRESS
OTHER ASSETS
INTANGIBLE ASSETS
TOTAL ASSETS
3 OF 5

THRU 06/30/2014
$51,904,462
$4,998,382
$77,064,908
$2,582,507
$1,104,854
TOTAL CURRENT LIABILITIES

DEFERRED INCOME
NET LONG-TERM DEBT
TOTAL LIABILITIES
$107,490,077
$126,029,267
$233,519,344
EQUITY
TOTAL LIABILITIES AND EQUITY
$137,655,113
($95,864,231)
$137,655,113
FINANCIAL RATIO FORMULAS

LIQUIDITY RATIOS
FORMULAS
CURRENT RATIO
.53 (TOTAL CURRENT ASSETS + BOARD DESIG. CASH + BOARD DESIG.

INVESTMENTS) / TOTAL CURRENT LIABILITIES
ACID TEST RATIO
.07 (CASH + MARKETABLE SECURITIES + BOARD DESIG. CASH + BOARD DESIG.

INVESTMENTS) / TOTAL CURRENT LIABILITIES
DAYS IN ACCOUNTS RECEIVABLE
46.71 NET ACCOUNTS RECEIVABLE / (NET PATIENT REVENUE / DAYS IN REPORT

PERIOD)
BAD DEBT RATE
0.53% (PROVISION FOR BAD DEBTS / TOTAL GROSS PATIENT REVENUE) X 100
DEBT, RISK, AND LEVERAGE RATIOS

LONG-TERM DEBT TO ASSETS RATE
91.55% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100
DEBT SERVICE COVERAGE RATIO
( .48) (NET INCOME + INTEREST-WORKING CAPITAL + INTEREST-OTHER +

DEPRECIATION EXPENSE) / PRINCIPAL PAYMENTS ON SHORT-TERM AND
LONG-TERM DEBT, NOTES, AND LOANS + INTEREST-WORKING CAPITAL +
INTEREST-OTHER)
INTEREST EXPENSE AS A PERCENTAGE

OF OPERATING EXPENSE
1.47% ((INTEREST-WORKING CAPITAL + INTEREST-OTHER) / TOTAL OPERATING

EXPENSE) X 100
PROFITABILITY RATIOS
NET RETURN ON OPERATING ASSETS
NET RETURN ON EQUITY

OPERATING MARGIN
TURNOVER ON OPERATING ASSETS
( 30.69%) ((NET FROM OPERATIONS + INTEREST-WORKING CAPITAL + INTERESTOTHER) / (TOTAL CURRENT ASSETS + NET PROPERTY, PLANT AND
EQUIPMENT)) X 100
32.69% (NET INCOME / EQUITY) X 100
( 22.99%) (NET FROM OPERATIONS / TOTAL OPERATING REVENUE) X 100
1.45 TOTAL OPERATING REVENUE / (TOTAL CURRENT ASSETS + NET PROPERTY,
PLANT, AMD EQUIPMENT)
FIXED ASSET RATIOS

FIXED ASSET GROWTH RATE
AVERAGE AGE OF PLANT

NET PPE ASSETS PER BED
13.81% ((CURRENT YEAR GROSS PROPERTY, PLANT AND EQUIPMENT +

CONSTRUCTION-IN-PROGRESS) - (PRIOR YEAR GROSS PROPERTY, PLANT,
AND EQUIPMENT + CONSTRUCTION-IN-PROGRESS)) / (PRIOR YEAR NET
PROPERTY, PLANT, AND EQUIPMENT + CONSTRUCTION-IN-PROGRESS) X 100
19.71 ACCUMULATED DEPRECIATION / DEPRECIATION EXPENSE
217,616 (NET PROPERTY, PLANT, AND EQUIPMENT + CONSTRUCTION-IN-PROGRESS)
/ LICENSED BEDS (END OF PERIOD)
SUMMARY OF FINANCIAL AND UTILIZATION DATA FOR SELECTED COST CENTERS

REVENUE-PRODUCING COST CENTERS
MEDICAL/SURGICAL INTENSIVE CARE
UNITS OF
SERVICE
UNIT
CODE
GROSS REV
PER UNIT
3,506
$10,497.78
$2,261.24
$4,506.89
$801.13
CORONARY CARE
BURN CARE
DEFINITIVE OBSERVATION
MEDICAL/SURGICAL ACUTE
1
1
PSYCHIATRIC ACUTE - ADULT
OBSTETRICS ACUTE
ALTERNATE BIRTHING CENTER
CHEMICAL DEPENDENCY SERVICES

TOTAL PATIENT CARE SERVICES
1
8,288
$2,656.09
$356.94
47,942
$4,529.84
$820.13
NURSERY ACUTE
AMBULATORY SERVICES
EMERGENCY SERVICES
CLINICS
ADJ DIRECT
EXP PER UNIT
1
31,128
PEDIATRIC ACUTE
SKILLED NURSING CARE
ADJ REV
PER UNIT
3
15,941
$3,159.47
$255.15
26,955
$1,129.79
$190.59
OBSERVATION CARE
HOME HEALTH CARE SERVICES
ADJ TOTAL
EXP PER UNIT
PROFIT/LOSS
PER UNIT

REVENUE-PRODUCING COST CENTERS
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
UNITS OF
SERVICE
UNIT
CODE
795,922
55,638
364,616
11,921
46,557
2,199
9,223
55,309
49,015
162,057
7
8
9
10
11
11
11
11
14
12
11
27
GROSS REV
PER UNIT
ADJ REV
PER UNIT
$262.22
$57.87
$238.13
$5,654.59
$1,459.36
$6,979.18
$3,218.10
$1,283.09
$519.37
$15.28
$388.87
$19.16
$670.49
$141.19
$375.58
$63.41
$109.46
$47.68
$288.92
$16.29
NON-REVENUE PRODUCING COST CENTERS

COST CENTER
DIETARY
LAUNDRY AND LINEN
SOCIAL WORK SERVICES
HOUSEKEEPING
PLANT OPERATIONS & MAINTENANCE
PATIENT ACCOUNTING
ADMITTING
COST CENTER
HOSPITAL ADMINISTRATION
MEDICAL RECORDS
NURSING ADMINISTRATION
UTILIZATION MANAGEMENT
COMMUNITY HEALTH EDUCATION
INSURANCE - MALPRACTICE
INTEREST - OTHER
UNITS OF
SERVICE
143,826
928,708
1,974
618,435
703,754
1,040,563
7,797
UNIT
CODE
16
17
18
19
20
21
22
ADJ DIRECT
EXP PER UNIT
$10.07
$0.52
$258.06
$5.48
$17.17
$1.10
$228.92
UNITS OF
SERVICE
937
70,906
304
7,797
3,386
1,040,563
UNIT
CODE*
23
24
25
22
26
21
20
ADJ DIRECT
EXP PER UNIT
$19,808.06
$26.24
$5,519.20
$551.29
$241.97
$1.69
UNIT CODE DESCRIPTIONS

UNIT CODE
1
2
3
4
5
6
7
8
9
10
11
12
14
16
17
18
19
20
21
22
23
24
25
26
27

PAGE:
4 OF 5
THRU 06/30/2014
ADJ DIRECT
ADJ TOTAL
PROFIT/LOSS
EXP PER UNIT EXP PER UNIT
PER UNIT
<-----------------STANDARD UNIT OF MEASURE ------------------>

NUMBER OF PATIENT DAYS
TOTAL PATIENT DAYS (EXCLUDING NEWBORN)
NUMBER OF NEWBORN DAYS
NUMBER OF VISITS
NUMBER OF OBSERVATION HOURS
NUMBER OF HOME HEALTH CARE VISITS
NUMBER OF DELIVERIES
NUMBER OF OPERATING MINUTES
NUMBER OF CS & S ADJUSTED INPATIENT DAYS
NUMBER OF TESTS
NUMBER OF PROCEDURES
NUMBER OF RESPIRATORY THERAPY ADJUSTED INPATIENT DAYS
NUMBER OF PHARMACY ADJUSTED INPATIENT DAYS
NUMBER OF PATIENT MEALS
NUMBER OF DRY AND CLEAN POUNDS PROCESSED
NUMBER OF PERSONAL CONTACTS
NUMBER OF SQUARE FEET SERVICED
NUMBER OF GROSS SQUARE FEET
$ 1,000 OF GROSS PATIENT REVENUE
NUMBER OF ADMISSIONS
NUMBER OF HOSPITAL FULL-TIME EQUIVALENT (FTE) EMPLOYEES
NUMBER OF ADJUSTED INPATIENT DAYS
NUMBER OF NURSING SERVICE FULL-TIME EQUIVALENT PERSONNEL
NUMBER OF PARTICIPANTS
NUMBER OF SESSIONS

DATE PREPARED:
PAGE:
REPORT PERIOD:
THRU
6/24/2015
5 OF 5
07/01/2013
06/30/2014
PERCENTAGE OF HOURS AND AVERAGE HOURLY RATE BY EMPLOYEE CLASSIFICATION

COST CENTER GROUP
AMBULATORY SERVICES
ANCILLARY SERVICES
RESEARCH
EDUCATION
GENERAL SERVICES
FISCAL SERVICES
TOTAL OPERATING COST CTRS
NON-OPERATING COST CENTERS
AVERAGE HOURLY RATE
MANAGEMENT
AND
SUPERVISION
1.59%
6.38%
7.30%
4.59%
TECHNICAL
AND
SPECIALIST
1.79%
16.49%
47.41%
22.72%
REGISTERED
NURSES
65.02%
21.91%
20.71%
40.98%
LICENSED
VOCATIONAL
NURSES
3.77%
0.72%
0.05%
1.83%
AIDES
AND
ORDERLIES
16.64%
0.06%
3.58%
9.06%
7.20%
%
9.65%
10.01%
24.89%
22.93%
50.98%
51.10%
5.01%
32.64%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
7.83%
2.98%
25.76%
%
28.94%
%
1.29%
%
6.40%
%
$0.00
$0.00
$0.00
$0.00
$0.00
ENVIRON.
AND
FOOD SERV.
%
%
%
%
%
%
16.33%
%
%
CLERICAL
AND OTHER
EMPLOYEES
10.29%
52.82%
20.17%
19.89%
69.86%
49.02%
22.92%
84.98%
42.48%
REGISTRY
AND
TEMP HELP
0.90%
1.63%
0.78%
0.94%
%
%
0.50%
0.40%
1.35%
TOTAL
PRODUCTIVE
HOURS
543,679
154,145
499,869
1,197,693
25,697
12,545
156,600
91,438
208,198
TOTAL
PAID
HOURS
638,081
176,837
575,026
1,389,944
30,528
13,712
178,975
104,703
241,384
TOTAL OPERATING COST CTRS

NON-OPERATING COST CENTERS
1.51%
%
27.38%
97.02%
0.90%
%
1,696,120
5,208
1,959,246
5,621
AVERAGE HOURLY RATE
$0.00
$0.00
$0.00
COST CENTER GROUP

AMBULATORY SERVICES
ANCILLARY SERVICES
RESEARCH
EDUCATION
GENERAL SERVICES
FISCAL SERVICES
HOSPITAL PERSONNEL PROFILE

TOTAL NUMBER OF PRODUCTIVE HOSPITAL FTE'S*
NUMBER OF NURSING REGISTRY AND TEMP HELP FTE'S
* EXCLUDES REGISTRY NURSES AND TEMPORARY HELP

**INCLUDES NURSING REGISTRY
811
6
TOTAL NUMBER OF NURSING FTE'S**

NUMBER OF NURSING REGISTRY FTE'S
304
5
HOSPITAL DISCLOSURE REPORT FACSIMILE
Date Prepared: 6/24/2015
GENERAL INFORMATION AND CERTIFICATION
( Page 0 Submitted Data )
1.Health Care Institution(Legal Name):

2. OSHPD Facility Number:

106190762
3. D. B.A. (Doing Business As) Name:

4. Hospital Business Phone:

(213) 484-7111
5.Medi-Cal Contract Provider Number:

HSC30502H
6. Medi-Cal Non-Contract Provider Number:
7.Medicare Provider Number:

05-0502
8. Street Address:
2131 WEST THIRD STREET
9. City:
LOS ANGELES
10.Zip Code:
90057
11. Mailing Address (if different) - Street or P.O. Box:
12. City:
13. Zip Code:

00000
14. Chief Executive Officer:

CATHY FICKES
15. Title:
CEO
16. Hospital Web Site Address:

17. Name of Owner:
DAUGHTERS OF CHARITY HEALTH SYSTEM
18.Previous Name of Institution if Changed Since Previous Report:
23. Person Completing Report:
JEFF CLARK
24. Organization Name:

CLARK KOORTBOJIAN AND ASSOC
25. Phone Number:

(916) 673-2020 Ext: 28. Mailing Address - Street or P.O. Box:
1120 IRON POINT ROAD STE 150
26. FAX Phone Number:

(916) 673-2025
29. City:
FOLSOM
30. State :
CA
36. Report Period:

From: 07/01/2013
37.
Through:
06/30/2014
38. Medi-Cal Contract Period:

From: 07/01/2013
39.
Through:
06/30/2014
31. Zip Code:

95630
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

1.
HOSPITAL DESCRIPTION
Facility D.B.A. Name :

Line
No
( Page 1 (1 of 2) Submitted Data )
MISC INFORMATION
(1)
Report Period End:
TYPE OF CONTROL
(2)
06/30/2014
TYPE OF CARE
(3)
Line
No
Licensed Beds (End of Period)
366
Church
Short-Term - General
10
Available Beds
337
Non-Profit Corporation
Short-Term - Childrens
10
15
Staffed Beds (Average)
192
Non-Profit Other
Short-Term - Psychiatric
15
20
HSA No
Investor - Individual
Short-Term - Specialty
20
25
If Designated Trauma Center
Investor - Partnership
Long-Term - General
25
30
Indicate Level (1,2 or 3)
Investor - Corporation
Long-Term - Childrens
30
35
If CCS approved NICU,
State
Long-Term - Psychiatric
35
40
indicate the standard below:
County
Long-Term - Specialty
40
45
Regional
City/County
45
50
Community
City
50
55
Intermediate
District
Line
No
11
GOVERNMENT PROGRAMS
(1)
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
Parent Organization Based
Psychiatric ER
65
70
Children's Medical Services
State Contracts
Physician
70
75
Short-Doyle
Federal Contracts
Pharmacist
75
80
CHAMPUS
Medical Foundation Contracts
Operating Room
80
85
County Indigent
Commercial Plan Contracts
Laboratory Services
85
90
Other (Specify)
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)
NON-HOSPITAL BASED
Other
(3)
Board
Certified
(4)
Board
Eligible
(5)
Other
(6)
RESIDENTS/FELLOWS
(Enter FTEs)
Residents
(7)
110 Aerospace Medicine
115
7
125 Cardiovascular Diseases
120
21
125
130 Child Psychiatry
130
135 Colon and Rectal Surgery
135
140 Dental
140
145 Dermatology
150 Diagnostic Radiology
Fellows
(8)
110
115 Allergy and Immunology

120 Anesthesiology
Line
No
145
1
150
155 Forensic Pathology
155
160 Gastroenterology
12
160
165 General/Family Practice
165
175 General Surgery
180 Internal Medicine
15
185 Neurological Surgery
190 Neurology
170 General Preventive Medicine
195 Nuclear Medicine
170
0.75
175
180
185
190
195
200 Obstetrics and Gynecology
200
205 Occupational Medicine
205
210 Oncology
210
215 Ophthalmology
215
220 Oral Surgery
220

1.
HOSPITAL DESCRIPTION

Line
No

CLINICAL SPECIALTY
Report Period End:
HOSPITAL BASED
Board
Certified
(1)
Board
Eligible
(2)
NON-HOSPITAL BASED
Other
(3)
Board
Certified
(4)
225 Orthopaedic Surgery
230 Otolaryngology
235 Pathology
Board
Eligible
(5)
Other
(6)
06/30/2014
RESIDENTS/FELLOWS
(Enter FTEs)
Residents
(7)
Fellows
(8)
0.66
4.00
Line
No
225
230
235
240 Pediatric-Allergy
240
245 Pediatric-Cardiology
245
250 Pediatric-Surgery
250
255 Pediatrics
255
260 Physical Medicine/Rehabilitation
260
265 Plastic Surgery
265
270 Podiatry
275 Psychiatry
270
275
280 Public Health
280
285 Pulmonary Disease

290 Radiology
285
290
295 Therapeutic Radiology
295
300 Thoracic Surgery
300
305 Urology
310 Vascular Surgery
315 Other Specialties
46
163
32
320 TOTAL
11
0.50
305
310
315
1.91
4.00
320

2.
SERVICES INVENTORY
Line
No
(1)Co
de
INTENSIVE CARE SERVICES
10
Burn
15
Coronary
20
Report Period End:
06/30/2014
(2)
Code
(3)Co
de
Microbiology
Dental
Necropsy
Dermatology
Serology
Diabetes
Medical
Surgical Pathology
Drug Abuse
25
Neonatal
DIAGNOSTIC IMAGING SERVICES
Family Therapy
30
Neurosurgical
Computed Tomography
Group Therapy
35
Pediatric
Cystoscopy
Hypertension
40
Pulmonary
Magnetic Resonance Imaging
Metabolic
45
Surgical
Positron Emission Tomography
Neurology
50
Definitive Observation Care
Ultrasonography
Neonatal
55
ACUTE CARE SERVICES
X-Ray - Radiology
Obesity
60
Alternate Birthing Center (Licensed Beds)
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
Transitional Inpatient Care (Acute Beds)
110
NEWBORN CARE SERVICES
Endoscopy
Rural Health
Surgery
115
Developmentally Disabled Nursery Care
Gastro-Intestinal Laboratory
120
Newborn Nursery Care
Hyperbaric Chamber Services
125
Premature Nursery Care
Lithotripsy
HOME CARE SERVICES
130
Hospice Care
Nuclear Medicine
Home Health Aide Services
135
Inpatient Care Under Custody (Jail)
Occupational Therapy
Home Nursing Care (Visiting Nurse)
140
LONG-TERM CARE
Physical Therapy
Home Physical Medicine Care
145
Behavioral Disorder Care
Peripheral Vascular Laboratory
Home Social Service Care
150
Developmentally Disabled Care
Pulmonary Function Services
Home Dialysis Training
155
Intermediate Care
Radiation Therapy
Home Hospice Care
160
Residential/Self Care
Radium Therapy
Home IV Therapy Services
165
Self Care
Radioactive Implants
Jail Care
170
Skilled Nursing Care
Recreational Therapy
Psychiatric Foster Home Care
175
Sub-Acute Care
Respiratory Therapy Services
177
Sub-Acute Care-Pediatric
179
Transitional Inpatient Care (SNF Beds)
180
CHEMICAL DEPENDENCY - DETOX
Speech-Language Pathology
AMBULATORY SERVICES
185
Alcohol
Spotcare Medicine
Adult Day Health Care Center
190
Drug
Stress Testing
Ambulatory Surgery Services
195
CHEMICAL DEPENDENCY - REHAB
Therapeutic Radioisotope
Comprehensive Outpatient Rehab

Facility
200
Alcohol
X-Ray Radiology Therapy
Observation (Short Stay) Care
205
Drug
PSYCHIATRIC SERVICES
Satellite Ambulatory Surgery Center
CODE
1- Service is available at the hospital.
3 - Service not available.
2- Service is available through arrangement at

another health care entity.
4 - Clinic services are commonly provided in the emergency suite to

non-emergency outpatients by hospital-based physicians or residents. *
* Code 4 used only for Clinic Services.

2.
SERVICES INVENTORY
Line
No
(1)Co
de
Report Period End:
06/30/2014
(2)
Code
(3)Co
de
210
PSYCHIATRIC SERVICES
Clinic Psychologist Services
215
Psychiatric Acute- Adult
Child Care Services
220
Psychiatric - Adolescent and Child
Electroconvulsive Therapy (Shock)
OTHER SERVICES
225
Psychiatric Intensive (Isolation) Care
Milieu Therapy
Diabetic Training class
230
Psychiatric Long-Term Care
Night Care
Dietetic Counseling
Psychiatric Therapy
Drug Reaction Information
Psychopharmacological Therapy
Family Planning
Genetic Counseling
235
Satellite Clinic Services
240
OBSTETRIC SERVICES
245
Abortion Services
Sheltered Workshop
250
Combined Labor/Delivery Birthing Room
RENAL DIALYSIS
Medical Research
255
Delivery Room Services
Hemodialysis
Parent Training Class
260
Infertility Services
Home Dialysis Support Services
Patient Representative
265
Labor Room Services
Peritoneal
Public Health Class
270
SURGERY SERVICES
Self-Dialysis Training
Social Work Services
275
Dental
Organ Acquisition
Toxicology/Antidote Information
280
General
Blood Bank
Vocational Services
285
Gynecological
Extracorporeal Membrane Oxygenation
290
Heart
Pharmacy
295
Kidney
300
Neurosurgical
EMERGENCY SERVICES
305
Open Heart
Emergency Communications Systems
310
Ophthalmologic
315
Organ Transplant
320
325
MEDICAL EDUCATION PROGRAMS

Approved Residency
Approved Fellowship
Non-Approved Residency
Emergency Helicopter Service
Associate Records Technician
Emergency Observation Service
Diagnostic Radiologic Technologist
Orthopedic
Emergency Room Service
Dietetic Intern Program
Otolaryngologic
Heliport
Hospital Administration Program
330
Pediatric
Medical Transportation
Hospital Administration Program
335
Plastic
Mobile Cardiac Care Services
Licensed Vocational Nurse
340
Podiatry
Orthopedic Emergency Services
Medical Technologist Program
345
Thoracic
Psychiatric Emergency Services
Medical Records Administrator
350
Urologic
Radioisotope Decontamination Room
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
Social Worker Program
400
Histocompatibility
Child Treatment
405
Immunology
Communicable Disease
CODE
1- Service is available at the hospital.
3 - Service not available.
2- Service is available through arrangement at

another health care entity.
4 - Clinic services are commonly provided in the emergency suite to

non-emergency outpatients by hospital-based physicians or residents. *
* Code 4 used only for Clinic Services.

3.1
RELATED HOSPITAL INFORMATION
( Page 3.1 Submitted Data )
Report Period End:
06/30/2014
A. Are any costs included which are a result of transactions with a related organizations as defined in 42 CFR 413.17?
1.
Yes
No (If "Yes", complete item C.)
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
No (If "Yes", complete item C.)
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)
Name of Individual (Complete for Codes C- G)

(2)
Percent
Ownership of
Hospital (3)
Related Organizations
Name
(4)
Percent
Ownership(5)
Type of Business
(6)
3
4
5
6
7
8
9
10
11
12
Expense Included on
Line
Nature of Service or Supply
Amount
No
(7)
(8)
Page
(9)
Column (10)
3
4
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.
Line (11)

3.2

D.
Report Period End:
06/30/2014
STATEMENT OF COMPENSATION OF OWNERS AND THEIR RELATIVES

Sole Pro-
Partners
Corporation Officers
prietorship
Line
No
Name
(1)
Title and Function

(2)
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
No If "Yes", what is the total amount ?
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
Hospital Cost Center

(1)
23
Clinical and Pathological Laboratory Services
24
Radiology - Diagnostic and Therapeutic
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)

3.3

Report Period End:
06/30/2014
G. HOSPITAL OWNERS AND GOVERNMENT BOARD MEMBERS
Line
No
Name
Occupation
(2)
(1)
Check if
Owner
(3)
Percentage of Check if
Hospital
Board
Ownership
Member
(4)
(5)
Compensation*
(6)
37
SISTER MARION BILL, DC
VP, MISSION INTEGRATION
$0
38
ROBERT ISSAI
PRESIDENT/CEO, DOCHS
$0
39
SISTER MARK SANDY, DC
ST. VINCENT'S SISTERS' HOME
$0
40
SISTER CAROL PADILLA, DC
HEALTH COUNCILOR
$0
41
SISTER SILVIA PARKS, DC
$0
42
SISTER MARIANNE OLIVES, DC
ST. VINCENT'S SCHOOL
$0
43
FREDERICK MCKNIGHT, VICE CHAIR
JONES DAY, REAVIS AND POGUE
$0
44
WILLIAM R. BARRETT, JR
PRESIDENT/CEO , FIDUCIARY TRUS
$0
45
SISTER JUDITH SCHOMISCH, DC
$0
46
RANDAL P. ARASE, MD
PHYSICIAN
$0
47
ARMAND BOUZAGLOU, MD
CANCER TREATMENT CENTER
$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.

3.4

I.

Report Period End:
06/30/2014
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
(This excludes related parties, e.g, management by a parent corporation.)

No.
(If "Yes", complete lines 81 through 102.)
81. Name of the management firm:

82. Address:
83. City:
84. State:
85. ZIP Code:
86. Amount paid to the management firm for the reporting period:
K. Does the hospital administrator work for the management firm ?

87.
Yes
No
L. List the services provided by the management firm.

88
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.
(If "No", complete lines 99 through 102.)
Please explain why amounts paid to the management firm are not functionally accounted and reported.
99
100
101
102

4
PATIENT UTILIZATION STATISTICS
Report Period End:
BEDS
Line
No
PATIENT (CENSUS) DAYS
(1)
Licensed
(End of
Period)
(2)
Available
(Average)
(3)
Staffed
(Average)
(4)
Adult
67
67
20
3,506
(5)
Pediatric
06/30/2014
DISCHARGES
(11)
Service
(12)
Total
731
Line
No
Medical/Surgical Intensive Care
10
Coronary Care
10
15
Pediatric Intensive Care
15
20
Neonatal Intensive Care
20
25
Psychiatric Intensive ( Isolation ) Care
25
30
Burn Care
30
35
Other Intensive Care
35
40
Definitive Observation
45
Medical/Surgical Acute
50
Pediatric Acute
50
55
Psychiatric Acute - Adult
55
60
Psychiatric Acute - Adolescent & Child
60
65
Obstetrics Acute
65
70
Alternate Birthing Center
70
75
Chemical Dependency Services
80
Physical Rehabilitation Care
85
Hospice - Inpatient Care
90
Other Acute Care
40
253
224
131
31,128
6,492
45
75
19
19
19
5,020
416
80
85
90
100 Sub-Acute Care
100
101 Sub-Acute Care - Pediatric

105 Skilled Nursing Care
101
27
27
22
8,288
606
110 Psychiatric Long-Term Care
105
110
115 Intermediate Care
115
120 Residential Care
120
125 Other Long-Term Care Services
125
145 Other Daily Hospital Services

150 Total
155 Nursery Acute
145
366
337
192
47,942
8,245
150
155

4

Line
No

ACCOUNT DESCRIPTION
STANDARD UNIT OF MEASURE
Report Period End:
06/30/2014
(1)
Total Units of
Service [Sum of
columns (7) and
(13)]
(7)
Total Inpatient Units
of Service
(13)
Total Outpatient
Units of Service
Line
No.
15,941
4,182
11,759
160
AMBULATORY SERVICES
160 Emergency Services
Visits
165 Medical Transportation Services
Occasions of Service
170 Psychiatric Emergency Rooms
Visits
175 Clinics
Visits
180 Satellite Clinics
Visits
180
185 Satellite Ambulatory Surgery Center
Operating Minutes
185
190 Outpatient Chemical Dependency Svcs
Visits
190
195 Observation Care
Observation Hours
195
200 Partial Hospitalization - Psychiatric
Day-Night Care Days
200
205 Home Health Care Services
Home Health Visits
205
210 Hospice - Outpatient
Visits
210
215 Adult Day Health Care
Visits
215
ANCILLARY SERVICES
230 Labor and Delivery Services
Deliveries
235 Surgery and Recovery Services
Operating Minutes
240 Ambulatory Surgery Services
Operating Minutes
245 Anesthesiology
165
170
26,955
26,955
175
230
795,922
503,785
292,137
235
Anesthesia Minutes
818,349
523,371
294,978
250 Medical Supplies Sold to Patients
CS & S Adj. Inpatient Days
55,638
255 Durable Medical Equipment
Adjusted Inpatient Days
260 Clinical Laboratory Services
Tests
364,616
245,423
119,193
260
265 Pathological Laboratory Services
Tests
16,151
8,076
8,075
265
270 Blood Bank
Units of Blood Issued
4,367
3,763
604
270
275 Echocardiology
Procedures
280 Cardiac Catheterization Services
Procedures
11,921
4,820
7,101
280
285 Cardiology Services
Procedures
15,256
9,210
6,046
285
290 Electromyography
Procedures
295 Electroencephalography
Procedures
428
243
185
295
300 Radiology - Diagnostic
Procedures
46,557
16,363
30,194
300
305 Radiology - Therapeutic
Procedures
Procedures
4,531
2,362
2,169
310
315 Magnetic Resonance Imaging
Procedures
2,199
928
1,271
315
320 Ultrasonography
Procedures
6,042
2,681
3,361
320
325 Computed Tomographic Scanner
Procedures
9,223
4,663
4,560
325
330 Drugs Sold to Patients
Pharmacy Adj. Inpatient Days
55,309
330
335 Respiratory Therapy
Respiratory Therapy Adj. Inpatient

Days
49,015
335
340 Pulmonary Function Services
Procedures
6,133
5,142
345 Renal Dialysis
Hours of Treatment
21,248
21,248
350 Lithotripsy
Procedures
355 Gastro-Intestinal Services
Procedures
4,677
1,609
3,068
355
360 Physical Therapy
Sessions
162,057
112,601
49,456
360
365 Speech-Language Pathology
Sessions
365
370 Occupational Therapy
Sessions
370
380 Electroconvulsive Therapy
Treatments
380
385 Psychiatric/Psychological Testing
Sessions
385
390 Psychiatric Individual/Group Therapy
Sessions
395 Organ Acquisition
Organs acquired
240
245
250
255
275
290
305
991
340
345
350
390
41
41
395

4
Report Period End:
OTHER STATISTICS
(1)
Total Units of
Service
(7)
Inpatient Units of
Service
06/30/2014
(13)
Outpatient Units of
Service
Surgeries
Satellite Operating Rooms
505
Surgeries
Open Heart Surgery Minutes
Open Heart Surgeries
Inpatient Operating Rooms
530
Surgeries
535
Outpatient Operating Rooms
540
510
9,566
2,107
98
98
7,459
515
520
525
545 Observation Care Days
545
550 Renal Dialysis Care Visits
550
555 Referred Visits
32,172
32,172
555
560 Total Outpatient Visits(a)
78,345
78,345
560
LIVE BIRTH SUMMARY
(1)
Total Births [Sum of
columns (7) and
(13)]
(7)
Natural Births
(13)
Cesarean Sections
600
605
610 Alternate Birthing Services
610
615 Obstetrics Acute
615
620 Emergency Services and other areas within the hospital
620
625 Total Births (Sum of Lines 600 through 620)
625
(a) Sum of column 13, lines 160,170,175,180,190,200,205,210,215,505,515,535,545,550, and 555.

4.1
PATIENT UTILIZATION STATISTICS BY PAYER
( Page 4.1 (1 of 2) Submitted Data )
Report Period End:
06/30/2014
PATIENT (CENSUS ) DAYS

TYPE OF CARE
Line
No
(1)
Medicare Traditional
(2)
Medicare Managed Care
(3)
Medi-Cal Traditional
(4)
Medi-CalManaged Care
18,846
4,954
2,914
2,421
(5)
County
Indigent
Programs Traditional
(6)
Line
County
No
Indigent
Programs Managed Care
Acute Care
10
Psychiatric Care
15
Chemical Dependency Care
20
Rehabilitation Care
4,429
116
21
20
25
Long-Term Care
6,558
1,201
24
33
25
30
Other Care
35
Total
29,833
6,271
2,959
2,462
40
Nursery Acute
40
45
Purchased Inpatient Services
45
10
15
30
35
PATIENT (CENSUS ) DAYS

TYPE OF CARE
Line
No
(7)
Other Third
Parties
Traditional
631
(8)
(9)
Other Third
Other Indigent
Parties
Managed Care
4,559
(10)
Other Payors
(11)
Total Patient
Days
304
34,634
Line
No
Acute Care
10
Psychiatric Care
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
40
45
45
10
15
210
236
5,020
20
464
8,288
25
849
5,259
30
5
304
47,942
35
DISCHARGES
TYPE OF CARE
Line
No
(12)
(13)
(14)
(15)
3,569
1,210
512
518
(16)
County
Indigent
(17)
County
Line
Indigent
No
Programs Managed Care
Acute Care
10
Psychiatric Care
15
20
Rehabilitation Care
364
12
25
Long-Term Care
423
130
30
Other Care
35
Total
4,356
1,352
514
523
40
Nursery Acute
40
45
45
10
15
20
25
30
35
DISCHARGES
TYPE OF CARE
Line
No
(18)
Other Third
Parties
Traditional
170
(19)
(20)
Other Third
Other Indigent
Parties
Managed Care
1,179
(21)
Other Payors
63
(22)
Total
Discharges
Line
No
Acute Care
10
Psychiatric Care
7,223
15
20
Rehabilitation Care
14
25
416
20
25
Long-Term Care
46
606
25
30
Other Care
35
Total
185
1,250
40
Nursery Acute
40
45
45
10
15
30
2
63
8,245
35

4.1
PATIENT UTILIZATION STATISTICS BY PAYER
Report Period End:
06/30/2014
OUTPATIENT VISITS
TYPE OF OUTPATIENT VISIT
(1)
(2)
(3)
(4)
(5)
County
Indigent
(6)
County
Indigent
Line
Programs No
Managed Care
Line
No
60
Emergency Svcs. (incl. Psych ER)
2,623
1,046
1,091
3,248
60
65
Clinic (incl. Satellite Clinics)
10,559
4,054
126
3,180
65
70
Observation Care Days
70
75
Psychiatric Day-Night Care Days
75
80
Home Health Care Services
80
85
Hospice - Outpatient
90
Outpatient Surgeries
2,436
713
946
496
95
Private Referred
13,873
4,037
2,139
3,007
85
90
95
100 Other *
100
105 Total
29,491
9,850
4,302
9,931
105
OUTPATIENT VISITS
TYPE OF OUTPATIENT VISIT
(7)
Other Third
Parties Traditional
(8)
Other Third
Parties Managed Care
(9)
Other Indigent
36
(10)
Other Payors
(11)
Total
OutPatient
Visits
Line
No
1,502
11,759
60
233
26,955
65
Line
No
60
Emergency Svcs. (incl. Psych ER)
327
1,886
65
Clinic (incl. Satellite Clinics)
46
8,757
70
Observation Care Days
70
75
Psychiatric Day-Night Care Days
75
80
80
85
Hospice - Outpatient
90
Outpatient Surgeries
34
2,808
26
7,459
95
Private Referred
159
8,807
150
32,172
85
100 Other *
105 Total
90
95
100
566
22,258
Includes Chemical Dependency Services, Adult Day Health Care, & Renal Dialysis Visits
36
1,911
78,345
105

5
BALANCE SHEET - UNRESTRICTED FUND

Line
No
ASSETS
Report Period End:
06/30/2014
Account No
(1) Current Year
(2) Prior Year
$2,822,131
$3,434,861
Line
No
CURRENT ASSETS
5
Cash
1000
10
Marketable securities
1010
15
Accounts and notes receivable
1020
$186,022,557
$177,123,700
15
20
Less allowance for uncollectible receivables and thrid-party contractual withholds
1040
($162,581,475)
($153,116,568)
20
25
Receivables from third-party payors
1050
$4,631,947
$5,251,680
25
30
Pledges and other receivables
1060
$1,615,885
$6,647,697
30
35
Due from restricted funds
1070
40
Inventory
1080
$5,469,897
$4,904,693
40
45
Intercompany receivables
1090
$13,266,103
$12,162,759
45
50
Prepaid expenses and other current assets
1100
$657,417
$1,452,142
50
55
TOTAL CURRENT ASSETS (Sum of lines 5 through 50)
$51,904,462
$57,860,964
55
$4,998,382
$4,337,679
60
10
35
ASSETS WHOSE USE IS LIMITED

60
Limited use cash
1110
65
Limited use investments
1120
70
Limited use other assets
1130
75
TOTAL ASSETS WHOSE USE IS LIMITED (Sum of lines 60 through 70)
65
70
$4,998,382
$4,337,679
75
PROPERTY, PLANT AND EQUIPMENT - AT COST

80
Land
1200
$13,856,934
$14,347,434
80
85
Land improvements
1210
$2,699,277
$2,699,277
85
90
Buildings and improvements
1220
$102,043,236
$98,139,992
90
95
Leasehold improvements
1230
$66,446,596
$62,083,129
95
1240
$136,381,815
$128,385,142
100
$321,427,858
$305,654,974
105
1260
($244,362,950)
($231,998,968)
195
$77,064,908
$73,656,006
200
$2,582,507
$7,188,211
205
100 Equipment
105 TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 80 through 100)
195 Less accumulated depreciation and amortization
200 NET TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 105 & 195)
205 Construction in progress
1250
INVESTMENTS AND OTHER ASSETS

210 Investments in property, plant and equipment
1310
215 Less accumulated depreciation - investments in plant and equipment
1320
220 Other Investments
1330
225 Intercompany receivables
1340
230 Other Assets
1350
235 TOTAL INVESTMENTS IN OTHER ASSETS (Sum of lines 210 through 230)
210
215
$1,104,854
$1,246,173
220
225
230
$1,104,854
$1,246,173
235
INTANGIBLE ASSETS
245 Goodwill
1360
245
250 Unamortized loan costs
1370
250
255 Preopening and other organization costs
1380
255
260 Other Intangible assets
1390
260
265 TOTAL INTANGIBLE ASSETS (Sum of lines 245 through 260)
265
TOTAL
270 TOTAL ASSETS (Sum of lines 55, 75,200,205,235 , and 265)
Line
No
OTHER INFORMATION
$137,655,113
$144,289,033
270
(1) Current Year
(2) Prior Year
Line
No
405 Current market value - current assets marketable securities (Line 10)
405
410 Current market value - limited use investments (Line 65)
410
415 Current market value - other investments (Line 220)
$1,104,854
$1,246,173
415
420 Total cost to complete construction in progress (Line 205)
$2,582,507
$7,188,211
420

5
BALANCE SHEET - UNRESTRICTED FUND
Line
No
LIABILITIES AND EQUITY

Account No
(3) Current Year
(4)Prior Year
Line
No
$6,450,447
10
CURRENT LIABILITIES
5
Notes and loans payable
2010
10
Accounts payable
2020
$9,926,526
15
Accrued compensation and related liabilities
2030
$8,961,439
$9,602,805
15
20
Other accrued expenses
2040
$8,698,587
$12,232,231
20
25
Advances from third-party payors
2050
30
Payable to third-party payors
2060
$7,171,692
$9,163,216
35
Due to restricted funds
2070
40
Income Taxes payable
2080
45
Intercompany payables
2090
50
Current maturities of long-term debt (Must agree with line 125)
55
Other current liabilities
60
TOTAL CURRENT LIABILITIES (Sum of lines 5 through 55)
2100
25
30
35
40
$71,971,860
$47,795,761
45
$674,565
$1,044,237
50
$85,408
$57,209
55
$107,490,077
$86,345,906
60
DEFERRED CREDITS
65
Deferred income taxes
2110
65
70
Deferred third-party income
2120
70
75
Other deferred credits
2130
75
80
TOTAL DEFERRED CREDITS (Sum of lines 65 through 75)
80
LONG-TERM DEBT Unpaid Principal(a)

85
Mortgages payable
2210
85
90
Construction loans
2220
90
95
Notes under revolving credit
2230
95
100 Capital lease obligations
2240
100
105 Bonds payable
2250
110 Intercompany payables
2260
115 Other non-current liabilities
2270
120 TOTAL LONG-TERM DEBT (Sum of lines 85 through 115)

125 Less amount shown as current maturities (Must agree with line 50)
$57,219,777
$85,873,221
105
$69,484,055
$69,627,298
115
$126,703,832
$155,500,519
120
110
($674,565)
($1,044,237)
125
130 NET TOTAL LONG-TERM DEBT(Sum of lines 120 and 125)
$126,029,267
$154,456,282
130
135 TOTAL LIABILITIES (Sum of lines 60,80 and 130)
$233,519,344
$240,802,188
135
($95,864,231)
($96,513,155)
140
EQUITY (Non Profit)

140 Unrestricted Fund Balance
2310
EQUITY (Investor-Owned - Corporation)

145 Preferred stock
2310
145
150 Common stock
2320
150
155 Additional paid-in-capital
2330
155
160 Retained earnings
2340
160
165 Less Treasury stock
2350
165
170 Capital - unrestricted
2310
170
175 Less Partner's draw
2320
175
180 Preferred Stock
2710
180
185 Common Stock
2720
185
190 Additional paid-in-capital
2730
190
195 Division equity - unrestricted
2740
195
200 Less Treasury stock
2750
EQUITY (Investor-Owned - Partnership)
EQUITY (Investor-Owned - Division of a Corporation)
205 TOTAL EQUITY(Sum of lines 140 through 200)
200
($95,864,231)
($96,513,155)
205
$137,655,113
$144,289,033
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.

5.1
SUPPLEMENTAL LONG - TERM DEBT INFORMATION
Line
No
(5) Detail For Page 5,

column(3), Line No
(6)Date Obligation
Incurred (Year Only*)
(7) Due Date

(Year Only*)
105
1995
2015
10
115
2012

Report Period End:

(8) Interest
Rate (a)
5.00
(9) Unpaid Principal

Balance at Year End
06/30/2014
Line
No
$57,219,777
$69,484,055
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
*Do not report month and day. Report year only.

(a) If more than one due date or interest rate, list each with related unpaid principal amount.

5.1
SUPPLEMENTAL LONG - TERM DEBT INFORMATION

Line
No
(5) Detail For Page 5,

column(3), Line No
(6)Date Obligation
Incurred (Year Only*)
(7) Due Date

(Year Only*)

Report Period End:

(8) Interest
Rate (a)
(9) Unpaid Principal

Balance at Year End
06/30/2014
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
*Do not report month and day. Report year only.

(a) If more than one due date or interest rate, list each with related unpaid principal amount.

5.2
STATEMENT OF CHANGES IN PROPERTY, PLANT AND EQUIPMENT

(1)

Report Period End:
(2)
(3)
(4)
(5)
06/30/2014
(6)
Additions
Line
Line
No
Description
Beginning
Balance(a)
Purchase
Donation
Transfers
Disposals and
Retirements
Ending
Balance (b)
No
($490,500)
$13,856,934
$2,699,277
10
Land
$14,347,434
10
Land Improvements
$2,699,277
15
Buildings and Improvements
$98,139,992
$3,903,244
$102,043,236
15
20
Leasehold Improvements
$62,083,129
$4,363,467
$66,446,596
20
25
Equipment
$128,385,142
$3,390,969
$136,381,815
25
30
Construction-in-progress
$2,582,507
30
35
TOTAL
$324,010,365
35
$7,188,211
$312,843,185
$4,605,704
($4,605,704)
$11,657,680
(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.
($490,500)

6
BALANCE SHEET - RESTRICTED FUND
Line
No
ASSETS

Report Period End:

Account
No
(1)
Current Year
06/30/2014
(2)
Prior Year
Line
No
SPECIFIC PURPOSE FUNDS

5
Cash
1510
10
Investments Marketable Securities
1521
10
15
Other Investments
1529
15
20
Receivables
1530
20
25
Due from other funds
1540
25
30
Other assets
1550
30
75
TOTAL SPECIFIC PURPOSE FUND ASSETS (Sum of lines 5 through 30)
75
PLANT REPLACEMENT AND EXPANSION FUNDS

105
Cash
1410
105
110
1421
110
115
Mortgages investments
1422
115
120
Real property (net of accumulated depreciation)
1423
1424
120
125
Other Investments
1429
125
130
Receivables
1430
130
135
1440
135
140
Other assets
1450
140
170
TOTAL PLANT REPLACEMENT AND EXPANSION FUND ASSETS (Sum

of lines 105 through 140)
170
ENDOWMENT FUNDS
205
Cash
1610
210
1621
210
215
Mortgages
1622
215
220
Real property (net of accumulated depreciation)
1623
1624
220
225
Other investments
1629
225
230
Receivables
1630
230
235
1640
235
240
Other assets
1650
275
TOTAL ENDOWMENT FUND ASSETS (Sum of lines 205 through 240)
Line
No
OTHER INFORMATION
$3,065,243
$4,929,813
205
240
$3,065,243
$4,929,813
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
Current market value - endowment funds marketable securities (line 210)
415

6
BALANCE SHEET - RESTRICTED FUND

Line
No
LIABILITIES AND FUND BALANCES
Report Period End:

Account
No
(3)
Current Year
06/30/2014
(4)
Prior Year
Line
No
SPECIFIC PURPOSE FUNDS

5
Due to unrestricted fund
2510
10
Due to plant replacement and expansion fund
2520
10
15
Due to endowment fund
2530
15
70
Fund balance
2570
70
75
TOTAL SPECIFIC PURPOSE FUND LIABILITIES AND FUND BALANCE

(Sum of lines 5 through 70)
75
PLANT REPLACEMENT AND EXPANSION FUNDS

105
2410
105
110
Due to specific purpose fund
2420
110
115
Due to endowment fund
2430
115
165
Fund balance
2470
165
170
TOTAL PLANT REPLACEMENT AND EXPANSION FUND LIABILITIES

AND FUND BALANCE (Sum of lines 105 through 165)
170
ENDOWMENT FUNDS
205
Mortgages
2610
205
210
Other non-current liabilities
2620
210
215
2630
215
220
Due to plant replacement and expansion fund
2640
220
225
Due to specific purpose fund
2650
270
Fund balance
2670
275
TOTAL ENDOWMENT FUND LIABILITIES AND FUND BALANCE (Sum of

lines 205 through 270)
225
$3,065,243
$4,929,813
270
$3,065,243
$4,929,813
275

7
STATEMENT OF CHANGES IN EQUITY

Report Period End:
06/30/2014
RESTRICTED FUNDS
Line
No
ASSETS
BALANCE AT BEGINNING OF YEAR, AS

PREVIOUSLY REPORTED
10
Prior period audit adjustment
15
Restatement (describe)
(1) Funds
Unrestricted
($96,513,155)
(2) Specific Purpose (3) Plant Replacement

(a)
and Expansion
(4) Endowment
$4,929,813
$31,983,192
Line
No
5
10
15
20
PRIOR PERIOD TEMP RSTD FUNDS
20
25
PRIOR PERIOD PERM RSTD FUNDS
25
30
AUDITORS ADJ TO PRIOR PERIOD
30
35
35
40
40
45
45
50
BALANCE AT BEGINNING OF YEAR, AS

RESTATED
($64,529,963)
55
ADDITIONS (DEDUCTIONS):
Net Income (Loss)
($31,334,268)
60
Acquisitions of pooled companies
60
65
Proceeds from sale of stock
65
70
Stock options exercised
70
75
Restricted contributions and grants
75
80
Restricted investment income
80
85
Expenditures for specific purposes
85
90
Dividends declared
90
95
Donated property, plant and equipment
95
100
Intercompany transfers
100
105
Dispo. Share funds transferred to public entity
105
110
Other (Describe)
110
115
DCHS PENSION
120
OTHER ADJUSTMENTS
$4,929,813
50
55
115
($31,334,268)
($1,864,570)
120
($1,864,570)
125
125
TOTAL ADDITIONS (DEDUCTIONS)
130
TRANSFERS:
Property and equipment additions
130
135
Principal payments on long-term debt
135
140
Other (Describe)
140
145
145
150
150
155
155
160
160
165
165
170
170
175
TOTAL TRANSFERS (Sum of columns (1)

through (4) must equal 0)
185
BALANCE AT END OF YEAR (Sum of lines

50,125 and 175)
(a) District Hospitals. Include bond interest and redemption.
175
($95,864,231)
$3,065,243
185

8
STATEMENT OF INCOME- UNRESTRICTED FUND
Line SECTION I
No
Report Period End:

(1)
Current Year
06/30/2014
(2)
Prior Year
Line
No
OPERATING REVENUES:
Daily hospital services
$217,169,490
$236,461,501
10
Ambulatory services
$80,818,794
$88,051,124
10
15
Ancillary services
15
30
GROSS PATIENT REVENUE (Sum of lines 5 through 15)
105
DEDUCTIONS FROM REVENUE (From line 395) (a)
107
CAPITATION PREMIUM REVENUE (From line 450) (b)
110
NET PATIENT REVENUE (Line 30 minus line 105 plus line 107)
135
TOTAL OTHER OPERATING REVENUE
140
$742,574,242
$829,482,920
$1,040,562,526
$1,153,995,545
30
$867,548,503
$963,268,362
105
$10,175,776
$8,593,085
107
$183,189,799
$199,320,268
110
$3,657,799
$1,871,745
135
TOTAL OPERATING REVENUE (Sum of lines 110 and 135)
$186,847,598
$201,192,013
140
146
OPERATING EXPENSES:
Daily Hospital Services
$39,318,697
$39,682,664
146
151
Ambulatory Services
$9,212,616
$9,946,157
151
156
Ancillary Services
$85,328,183
$91,017,045
156
161
Research Costs
$852,534
$1,083,383
161
166
Education Costs
$897,434
$784,567
166
171
General Services
$37,020,189
$32,003,758
171
176
Fiscal Services
$4,598,464
$4,455,579
176
181
Administrative Services
$34,567,021
$47,512,694
181
186
Unassigned Costs
$14,110,129
$13,288,239
186
190
$3,900,966
195
Purchased Outpatient Services
200
TOTAL OPERATING EXPENSES (Sum of Lines 146 through 195)
$229,806,233
$239,774,086
200
205
NET FROM OPERATIONS (Line 140 minus line 200)
($42,958,635)
($38,582,073)
205
210
NET NON-OPERATING REVENUE AND EXPENSE (From Line 700) (c)
$11,624,367
$3,469,002
210
215
NET INCOME BEFORE TAXES AND EXTRAORDINARY ITEMS: (Sum of lines

205 and 210)
($31,334,268)
($35,113,071)
215
220
PROVISION FOR INCOME TAXES:

Current
220
225
Deferred
225
230
NET INCOME BEFORE EXTRAORDINARY ITEMS: (Line 215 minus 220 and
225)
190
195
($31,334,268)
($35,113,071)
230
EXTRAORDINARY ITEMS:(Specify)
235
235
240
245
240
NET INCOME (Line 230 minus lines 235 and 240)
($31,334,268)
(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.
($35,113,071)
245

8

(DEDUCTIONS FROM REVENUE AND CAPITATION PREMIUM REVENUE)
Line SECTION II
No

Report Period End:

(1)
Current Year
06/30/2014
(2)
Prior Year
Line
No
300
DEDUCTIONS FROM REVENUE:

Provision for bad debt
$5,530,363
$6,049,547
300
305
Contractual adjustments - Medicare - traditional
$470,903,610
$574,569,811
305
310
Contractual adjustments - Medicare - managed care
$98,936,943
$84,273,312
310
315
Contractual adjustments - Medi-Cal - traditional
$60,148,911
$59,361,556
315
320
Contractual adjustments - Medi-Cal - managed care
$70,178,483
$55,456,012
320
325
Disproportionate share payments for Medi-Cal patient days (SB 855) (credit bal)
(d)
325
330
Contractual adjustments - County indigent programs - traditional
330
335
Contractual adjustments - County indigent programs - managed care
340
Contractual adjustments - Other third parties - traditional
345
Contractual adjustments - Other third parties - managed care
350
Charity discounts - Hill Burton
355
Charity discounts - other
360
Restricted donations and subsidies for indigent care (credit balance)
360
365
Teaching allowances (Teaching Hospitals only)
365
370
Support for clinical teaching (credit balance (Teaching Hospitals only)
375
Policy discounts
$314,219
380
Administrative adjustments
$63,336
385
Other deductions from revenue
$993,746
$2,650,873
385
395
TOTAL DEDUCTIONS FROM REVENUE (Sum of lines 300 thru 385)
$867,548,503
$963,268,362
395
430
CAPITATION PREMIUM REVENUE:

Capitation Premium Revenue - Medicare
$10,175,776
$8,593,085
430
435
Capitation Premium Revenue - Medi-Cal
435
440
Capitation Premium Revenue - County indigent programs
440
445
Capitation Premium Revenue - Other third parties
450
TOTAL CAPITATION PREMIUM REVENUE (Sum of lines 430 thru 445)
335
$5,890,080
$5,095,921
340
$153,946,285
$174,634,160
345
$642,527
$1,177,170
350
355
370
375
380
445
$10,175,776
(d) Disproportionate share funds transferred back to a related public entity must be reported on page 7, column(1), line 105.
$8,593,085
450

8

(NON-OPERATING REVENUE AND EXPENSE)
Line SECTION III

No

Report Period End:
06/30/2014
Account
No
(1)
Current Year
(2)
Prior Year
$8,142,613
$136,465
$2,563,203
$2,767,738
Line
No
500
NON-OPERATING REVENUES:
Gains on sale of hospital property
9010
505
Maintenance of restricted funds revenue
9030
510
Unrestricted contributions
9040
515
Donated services
9050
515
520
Income, gains and losses from unrestricted investments
9060
520
525
Unrestricted income from endowment funds
9070
525
530
Unrestricted income from other restricted funds
9080
530
535
Term endowment funds becoming unrestricted
9090
535
540
Transfers from restricted funds for non-operating expenses
9100
540
545
Assessment revenue (e)
9150
545
550
County allocation of taxes revenue (e)
9160
550
555
Special district augmentation revenue (e)
9170
555
560
Debt service taxes revenue (e)
9180
560
565
State homeowner's property tax relief (e)
9190
565
570
State appropriation
9200
570
575
County appropriation - Realignment funds
9210
575
580
County appropriation - County general funds
9220
580
585
County appropriation - Other county funds
9230
590
Physician's offices and other rentals - revenue
9250
$425,578
$733,871
590
595
Medical office building revenue
9260
$2,581,190
$2,583,040
595
600
Child care services revenue (non-employee)
9270
605
Family housing revenue
9280
610
Retail operations revenue
9290
$585,604
615
Other non-operating revenue
9400
$106,463
$420,834
615
625
TOTAL NON-OPERATING REVENUE (Sum of lines 500 thru 615)
$14,404,651
$6,641,948
625
640
NON-OPERATING EXPENSES:
Loses on sale of hospital property
9020
645
Maintenance of restricted funds expense
9030
650
Physician's offices and other rentals expense
9510
$659,098
$790,064
650
655
Medical office building expense
9520
$1,933,091
$2,120,328
655
660
Child care services expense (non-employee)
9530
665
Family housing expense
9540
670
Retail operations expense
9550
$145,935
675
Other non-operating expense
9800
$42,160
$262,554
675
685
TOTAL NON-OPERATING EXPENSE (Sum of lines 640 thru 675)
$2,780,284
$3,172,946
685
700
NET NON-OPERATING REVENUE AND EXPENSE (Line 625

minus line 685)
$11,624,367
$3,469,002
700
705
Interest on long-term debt (e)
(e) District Hospital only.
500
505
510
585
600
605
610
640
645
660
665
670
705

9
STATEMENT OF CASH FLOWS - UNRESTRICTED FUND
Line
No
5
CASH FLOW FROM OPERATING ACTIVITIES AND NON-OPERATING REVENUE:

Net income (loss)
15
Adjustments to reconcile net income to net cash provided by (used for) operating activities and
non-operating revenue :
Depreciation and amortization
17
Amortization of intangible assets
20
Change in marketable securities
30
Change in accounts and notes receivable, net of allowance for uncollectible receivables and
third-party contractual withholds
35
Change in receivables from third-party payors
40
Change in pledges and other receivables
45
Change in due from restricted funds
50
Change in inventory
55
Change in intercompany receivables
57
Change in Prepaid expenses and other current assets
60

Report Period End:
06/30/2014
(1) Current Year
(2) Prior Year
Line
No
($31,334,268)
($35,113,071)
$12,442,595
$9,881,657
15
17
20
$566,050
$1,905,800
30
$619,733
$2,538,030
35
$5,031,812
$3,683,039
40
($565,204)
($1,049,043)
50
($1,103,344)
($2,671,047)
55
$794,725
($335,917)
57
Change in accounts payable
$3,476,079
$2,257,167
60
65
Change in accrued compensation and related liabilities
($641,366)
$914,278
65
70
Change in other accrued expenses
($3,533,644)
($6,151,828)
70
75
Change in advances from third-party payors
80
Change in payable to third-party payors
($1,991,524)
$3,819,668
85
Change in due to restricted funds
87
Change in income taxes payable
90
Change in intercompany payables
$24,176,099
$20,859,528
95
Change in other current liabilities
$28,199
($106)
45
75
80
85
87
90
95
100 Change in deferred credits
100
102 Other (Describe): DONATED PROPERTY, PLANT, AND E
102
103 Other (Describe): DCHS PENSION
103
104 Other (Describe): PRIOR PERIOD ADJUSTMENT
$31,983,192
$9,231,895
104
105 TOTAL ADJUSTMENTS (Sum of lines 15 through 104)
$71,283,402
$44,883,121
105
115 NET CASH PROVIDED BY (USED FOR) OPERATING ACTIVITIES (Sum of lines 5 and 105)
$39,949,134
$9,770,050
115
CASH FLOW FROM INVESTING ACTIVITIES:

130 Change in assets whose use is limited
($660,703)
$4,072,453
130
($11,657,680)
($11,574,299)
135
140 Other (Describe): PPE DEPREC ADJ.
($78,613)
($3,030,972)
140
141 Other (Describe): PPE DISPOSALS
$490,500
$1,776,424
141
142 Other (Describe): CHANGES IN OTHER INVESTMENTS
$141,319
135 Purchase of plant, property and equipment and construction-in-progress
NET CASH PROVIDED BY (USED FOR) INVESTING ACTIVITIES (Sum of lines 130 through
145 142)
142
($11,765,177)
($8,756,394)
($28,796,687)
($6,036,721)
CASH FLOW FROM FINANCING ACTIVITIES:

160 Proceeds from issuance of long-term debt
165 Principal payments on long-term debt
145
160
165
170 Proceeds from issuance of short-term notes and loans
170
175 Principal payments on short-term notes and loans
175
180 Dividends paid
180
185 Proceeds from issuance of common stock
185
190 Other (Describe): OTHER CHANGES IN FUND BALANCE
190
191 Other (Describe): MISC ADJUSTMENT
191
192 Other (Describe): CHANGE IN OTHER ASSETS

NET CASH PROVIDED BY (USED FOR) FINANCING ACTIVITIES (Sum of lines 160 through
195 192)
($544,370)
192
($28,796,687)
($6,581,091)
195
205 NET INCREASE (DECREASE) IN CASH (Sum of lines 115, 145 and 195)
($612,730)
($5,567,435)
205
215 CASH AT BEGINNING OF YEAR
$3,434,861
$9,002,296
215
225 CASH AT END OF YEAR (Sum of lines 205 and 215)
$2,822,131
$3,434,861
225

10
(OPTIONAL) SUMMARY OF REVENUES AND COSTS

Line
No
REVENUE PRODUCING CENTERS
(1)Units of
Service
from Page 17,
Column (13)

Report Period End:

(2)Adjusted
Direct Expenses
from Page 20,
Column (1)
(3)Allocated
Costs
Column
(4) minus (2)
(4)Total Patient
Care Costs from
Page 20, Column
(16),Lines 505 - 915
06/30/2014
(5)Average Unit
Patient Care
Costs, Column
(4) (1)
Line
No
DAILY HOSPITAL SERVICES:

10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
40
45
45
50
Pediatric Acute
50
55
55
60
Psychiatric Acute - Adol & Child
60
65
Obstetrics Acute
65
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
150 TOTAL DAILY HOSPITAL SERVICES
150
AMBULATORY SERVICES:
160
165
170
175 Clinics
175
180
185
190
195
200
205
210 Hospice - Outpatient Services
210
215 Adult Day Health Care Services
215
220 Other Ambulatory Services
220
225 TOTAL AMBULATORY SERVICES
225

10

Line
No

Report Period End:
06/30/2014
(6) Reallocated (7) Reallocated (8) Transfers for

(9) Net Costs as
(10) Average Unit Line
Net Research
Net Education
Operating
Reallocated Column Cost Column (9)
No
Costs from
Costs from
Costs from
(4) + (6) +(7) - (8)
(1)
Page 20, Col.
Page 20, Cols.
Page 20,
(17), Lines 505- (18) + (19) + (20) Column (22),
915
+(21), Lines 505 Lines 505 - 915
- 915

10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
40
45
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
150
160
165
170
175 Clinics
175
180
185
190
195
200
205
210
215
220
225

10

Line
No
(11) Gross
Revenue from
Page 12,
Columns (21) +
(22)

Report Period End:

(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)
06/30/2014
(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
40
45
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
150
160
165
170
175 Clinics
175
180
185
190
195
200
205
210
215
220
225

10

Line
No

5 Medical/Surgical Intensive Care

Report Period End:
(16) Net
(17) Average Line
Revenue Minus
Unit Net
No
Net Costs
Column (16)
Column (14)
(1)
minus (9)
5
10 Coronary Care
10
15 Pediatric Intensive Care
15
20 Neonatal Intensive Care
20
25 Psychiatric Intensive (Isolation) Care
25
30 Burn Care
30
35 Other Intensive Care
35
40 Definitive Observation
40
45 Medical/Surgical Acute
45
50 Pediatric Acute
50
55 Psychiatric Acute - Adult
55
60 Psychiatric Acute - Adol & Child
60
65 Obstetrics Acute
65
70 Alternate Birthing Center
70
75 Chemical Dependency Services
75
80 Physical Rehabilitation Care
80
85 Hospice - Inpatient Care
85
90 Other Acute Care
90
95 Nursery Acute
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
150
160
165
170
175 Clinics
175
180
185
190
195
200
205
210
215
220
225
06/30/2014

10

Line
No
(1)Units of
Service
from Page 17,
Column (13)

Report Period End:

(2)Adjusted
Direct Expenses
from Page 20,
Column (1)
(3)Allocated
Costs
Column
(4) minus (2)
06/30/2014
(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
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375 Other Physical Medicine
375
380
385
390
395
400 Other Ancillary Services
400
405 TOTAL ANCILLARY SERVICES
405
410 Purchased Inpatient Services
410
411 Purchased Outpatient Services
411
415 TOTAL OPERATING REV. & EXP. (A)
415
420 Non-Operating Cost Centers/Revenue
420
425 Provision for Income Taxes
425
430 Extraordinary Items
430
435 TOTALS/NET PROFIT (LOSS) (B)
435
(A) Sum of lines 150, 225, 405, and 410.

(B) Column (16), Line 435 must agree with Page 8, Column 1, Line 245.

10

Line
No

Report Period End:
06/30/2014
(6) Reallocated (7) Reallocated (8) Transfers for

(9) Net Costs as
Net Research
Net Education
Operating
Reallocated Column Cost Column (9)
No
Costs from
Costs from
Costs from
(4) + (6) +(7) - (8)
(1)
Page 20, Col.
Page 20, Cols.
Page 20,
(17), Lines 505- (18) + (19) + (20) Column (22),
915
+(21), Lines 505 Lines 505 - 915
- 915
ANCILLARY SERVICES:
230
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
(A) Sum of lines 150, 225, 405, and 410.


10

Line
No
(11) Gross
Revenue from
Page 12,
Columns (21) +
(22)

Report Period End:

(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)
06/30/2014
(15)Average Unit Line
Net Revenue
No
Column (14) (1)
ANCILLARY SERVICES:
230
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
(A) Sum of lines 150, 225, 405, and 410.


10

Line
No

Report Period End:
(16) Net
Revenue Minus Net Column (16) No
Net Costs
(1)
Column (14)
minus (9)
ANCILLARY SERVICES:
230
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
(A) Sum of lines 150, 225, 405, and 410.

06/30/2014

12
SUPPLEMENTAL PATIENT REVENUE INFORMATION
Report Period End:
06/30/2014
MEDICARE
Traditional
(1) Gross
Inpatient Revenue
Line
No
PATIENT
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
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
Psychiatric Acute - Adolescent and Child
3360
60
65
Obstetrics Acute
3380
65
70
3400
70
75
3420
80
3440
85
Hospice - Inpatient Services
3470
85
90
Other Acute Care
3510
90
95
Nursery Acute
3530
95
100 Sub-Acute Care
3560
100
3570
3580
110 Psychiatric - Long Term Care
3610
3630
115
3680
120
3780
125
3900
$18,697,778
$4,548,257
40
$82,077,196
$15,342,627
45
75
$16,097,371
$491,430
80
101
$18,355,921
$2,299,857
105
110
145
$135,228,266
$22,682,171
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
190 Outpatient Chemical Dependency Services
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$10,677,197
$8,433,354
$2,101,786
$2,435,524
160
165
170
$400,636
$11,549,232
$135,522
$4,434,350
175
220
$11,077,833
$19,982,586
$2,237,308
$6,869,874
225

12

Report Period End:
06/30/2014
MEDI-CAL
Traditional
(5) Gross
Inpatient Revenue
Line
No
PATIENT
Managed Care
(6) Gross
Outpatient
Revenue
(7) Gross
Inpatient Revenue
(8) Gross
Outpatient
Revenue
Account
No
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
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
70
75
3420
80
3440
85
3470
85
90
Other Acute Care
3510
90
95
Nursery Acute
3530
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
$4,311,154
$2,794,851
40
$12,555,381
$10,948,574
45
75
$75,329
80
145
$16,941,864
$13,743,425
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$1,912,784
$2,512,846
$2,102,803
$8,524,907
160
165
170
$179,329
$137,663
$3,477,516
175
220
$2,092,113
$2,650,509
$2,102,803
$12,002,423
225

12

Report Period End:
06/30/2014
COUNTY INDIGENT PROGRAMS

Traditional
(9) Gross
Inpatient Revenue
Line
No
PATIENT
Managed Care
(10) Gross
Outpatient
Revenue
(11) Gross
Inpatient Revenue
(12) Gross
Outpatient
Revenue
Account
No
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
3150
40
45
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
Other Acute Care
3510
90
95
Nursery Acute
3530
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
150
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

Report Period End:
06/30/2014
OTHER THIRD PARTIES

Traditional
(13) Gross
Inpatient Revenue
Line
No
PATIENT
Managed Care
(14) Gross
Outpatient
Revenue
(15) Gross
Inpatient Revenue
(16) Gross
Outpatient
Revenue
Account
No
Line
.02, .03, .06
.42, .43, .46
.12,.13,.16
.52, .53, .56
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
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
70
75
3420
80
3440
85
3470
85
90
Other Acute Care
3510
90
95
Nursery Acute
3530
95
100 Sub-Acute Care
3560
100
3570
3580
3610
3630
115
3680
120
3780
125
3900
$132,992
$6,309,089
40
$631,025
$18,678,852
45
75
$555,997
$839,921
80
101
$45,621
$1,312,287
105
110
145
$1,365,635
$27,140,149
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$7,556
$215,198
$2,159,349
$9,067,980
160
165
170
$50,745
$257,139
$9,577,171
175
220
$7,556
$265,943
$2,416,488
$18,645,151
225

12

Report Period End:
OTHER INDIGENT
(17) Gross
Inpatient Revenue
Line
No
PATIENT
(18) Gross
Outpatient
Revenue
06/30/2014
OTHER PAYORS
(19) Gross
Inpatient Revenue
(20) Gross
Outpatient
Revenue
Account
No
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
3150
45
3170
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
Other Acute Care
3510
90
95
Nursery Acute
3530
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
$10,758
$325
40
$18,355
$38,542
45
145
$29,113
$38,867
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$105,029
$4,021
$104,847
160
165
170
$254,310
175
220
$105,029
$4,021
$359,157
225

12

Report Period End:
06/30/2014
TOTAL
(21) Gross
Inpatient Revenue
Line
No
PATIENT
(22) Gross
Outpatient
Revenue
(23) Gross Patient

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
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
70
75
3420
80
3440
85
3470
85
90
Other Acute Care
3510
90
95
Nursery Acute
3530
95
100 Sub-Acute Care
3560
100
3570
3580
3610
3630
115
3680
120
3780
125
3900
$36,805,204
$36,805,204
40
$140,290,552
$140,290,552
45
75
$18,060,048
$18,060,048
80
101
$22,013,686
$22,013,686
105
110
145
$217,169,490
$217,169,490
150
$50,365,181
160
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$18,965,496
$31,399,685
165
170
$972,626
$29,480,987
$30,453,613
175
220
$19,938,122
$60,880,672
$80,818,794
225

12

Report Period End:
06/30/2014
MEDICARE
Traditional
Line
No
PATIENT
(1) Gross
Inpatient Revenue
(3) Gross
Inpatient Revenue
.04
.44
.14
.54
$60,121,235
$26,480,605
$11,977,284
$7,564,770
Account
No
Managed Care
(2) Gross
Outpatient
Revenue
(4) Gross
Outpatient
Revenue
Line
No
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
4450
$4,289,900
$1,771,500
$1,405,880
$704,340
245
250 Medical Supplies sold to Patients
4470
$2,108,606
$91,689
$96,203
$29,428
250
4480
4500
$35,496,046
$17,696,429
$6,171,263
$1,689,880
260
4520
$1,140,184
$1,202,280
$320,951
$351,536
265
270 Blood Bank
4540
$2,123,748
$347,602
$429,553
$60,378
270
275 Echocardiology
4560
4570
$11,518,376
$23,754,820
$5,590,895
$8,759,169
280
4590
$7,850,086
$2,794,601
$2,374,814
$1,449,632
285
4610
4620
$170,714
$117,673
$53,088
$14,286
295
4630
$19,908,812
$18,263,765
$4,912,649
$4,636,454
300
4640
4650
$2,440,586
$2,274,759
$932,269
$1,004,603
310
4660
$3,076,643
$4,054,261
$775,342
$1,771,121
315
320 Ultrasonography
4670
$3,027,301
$2,339,854
$555,229
$748,208
320
4680
$7,776,079
$7,209,533
$1,730,096
$1,922,641
325
4710
$38,051,725
$4,184,167
$5,800,376
$1,039,241
330
4720
$15,597,295
$175,017
$2,627,988
$68,925
335
4730
$1,718,400
$372,288
$533,572
$141,352
340
345 Renal Dialysis
4740
$9,852,727
$477,723
$519,704
$34,955
345
350 Lithotripsy
4750
4760
$2,968,001
$5,566,404
$703,477
$1,153,687
355
4770
$28,900,870
$4,943,004
$2,698,108
$2,244,701
360
365 Speech- Language Pathology
4780
365
4790
370
4800
375
4820
380
4830
385
4840
4860
4870
230
240
255
275
290
305
350
390
$8,813,897
$1,219,324
$266,951,231
$125,337,298
415 TOTAL PATIENT REVENUE
$413,257,330
$145,319,884
MEDICARE
Traditional
Inpatient
Outpatient
DEDUCTIONS FROM REVENUE

420 Provision for Bad Debts
425 Contractual Adjustments (exclude capitation revenue)
235
$31,572
395
400
$50,208,741
$35,420,879
405
$75,128,220
MEDICARE
Managed Care
Total
$42,290,753
415
$2,397,381
$843,027
$657,546
420
$348,392,960
$122,510,650
$98,936,943
425
Disproportionate share payments for Medi-Cal patient days

426 (SB 855) (Credit Balance)
426
430 Charity
430
435 Restricted Donations and Subsidies for Indigent Care

(Credit Balance)
435
440 Teaching Allowances
440
445 Support for Clinical Teaching (Credit Balance)
445
450 Other Deductions

455 TOTAL DEDUCTIONS FROM REVENUE
450
$350,790,341
$123,353,677
457 CAPITATION PREMIUM REVENUE

460 NET PATIENT REVENUE (Line 415 - 455 + 457)
$62,466,989
$21,966,207
$99,594,489
455
$10,175,776
457
$28,000,260
460

12

Report Period End:
06/30/2014
MEDI-CAL
Traditional
Line
No
PATIENT
(6) Gross
Outpatient
Revenue
(7) Gross
Inpatient Revenue
(8) Gross
Outpatient
Revenue
.05
.45
.15
.55
$4,411,327
$10,690,316
$6,593,022
$5,358,685
Account
No
Managed Care
(5) Gross
Inpatient Revenue
Line
No
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
4450
$400,900
$287,700
$626,580
$388,920
245
4470
$233,592
$255,502
$87,497
$22,848
250
4480
4500
$4,925,515
$568
$4,292,284
$2,652,810
260
4520
$183,417
$1,473,097
$165,007
$265,214
265
270 Blood Bank
4540
$293,895
$297,604
$283,167
$32,348
270
275 Echocardiology
4560
4570
$3,117,575
$22,877
$3,869,172
$1,801,359
280
4590
$1,338,494
$90,415
$1,286,327
$557,118
285
4610
4620
$2,333,090
$283,374
$14,804
$9,919
295
4630
$735,574
$2,361,641
$2,944,249
$3,523,401
300
4640
4650
$434,855
$363,069
$363,021
$150,831
310
4660
$451,281
$88,228
$513,373
$116,571
315
320 Ultrasonography
4670
$515,511
$724,436
$498,666
$409,458
320
4680
$1,336,409
$1,076,898
$1,011,675
$1,509,642
325
4710
$4,411,796
$423,495
$3,714,144
$924,776
330
4720
$3,080,192
$18,423
$1,471,937
$63,348
335
4730
$444,108
$13,569
$399,369
$12,493
340
345 Renal Dialysis
4740
$1,515,804
$17,478
$1,261,366
$17,478
345
350 Lithotripsy
4750
4760
$602,837
$1,106,334
$335,255
$1,505,847
355
4770
$699,545
$87,990
$483,709
$53,821
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
4860
4870
230
235
240
255
275
290
305
350
390
$160,404
$71,124
$31,626,121
$19,754,138
$30,214,624
$19,493,240
405
$50,660,098
$22,404,647
$46,060,852
$31,495,663
415
$116,353
400
MEDI-CAL
Traditional
Total
MEDI-CAL
Managed Care
Total
$60,148,911
$70,178,483
$31,168
$33,085

420

430 Charity
395
425
426
430

(Credit Balance)
435
440
445

450
$60,180,079
$70,211,568
$12,884,666
$7,344,947

455
457
460

12

Report Period End:
06/30/2014

Traditional
Line
No
PATIENT
Account
No
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:
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
270 Blood Bank
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
4610
290
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
345 Renal Dialysis
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
Traditional
Inpatient
Outpatient
CO. INDIGENT
PROGRAMS
Managed Care
Total
420
425

426
430 Charity
430

(Credit Balance)
435
440
445
450
455
457
460

12

Report Period End:
06/30/2014
OTHER THIRD PARTIES

Traditional
Line
No
PATIENT
Account
No
Managed Care
(13) Gross
Inpatient Revenue
(14) Gross
Outpatient
Revenue
(15) Gross
Inpatient Revenue
(16) Gross
Outpatient
Revenue
.02, .03, .06
.42, .43, .46
.12,.13,.16
.52, .53, .56
$2,474,694
$190,711
$41,686,499
$30,652,609
Line
No
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
4450
$582,620
$207,560
$3,144,360
$1,922,200
245
4470
$40,004
$228
$203,910
$45,484
250
4480
4500
$208,903
$143,043
$6,984,585
$6,213,928
260
4520
$12,255
$3,218
$531,201
$559,179
265
270 Blood Bank
4540
$35,364
$6,556
$531,347
$417,796
270
275 Echocardiology
4560
4570
$97,454
$3,697,450
$5,176,281
280
4590
$279,053
$1,753,885
$2,260,393
285
4610
4620
$2,961
$40,399
$41,768
295
4630
$109,189
$3,163,705
$7,060,989
300
4640
4650
$727,278
$1,366,651
310
4660
$22,920
$46,426
$1,086,459
$3,337,087
315
320 Ultrasonography
4670
$7,460
$613
$651,040
$2,672,501
320
4680
$40,191
$28,245
$2,049,210
$3,905,158
325
4710
$374,862
$35,274
$9,128,482
$2,814,921
330
4720
$29,550
$2,092,546
$222,322
335
4730
$2,029
$464,910
$167,071
340
345 Renal Dialysis
4740
$557,599
$40,781
345
350 Lithotripsy
4750
4760
$734,999
$1,314,811
355
4770
$3,331,473
$2,676,153
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
4860
4870
230
240
255
275
$3,858
290
$250,149
305
350
$573,362
$108,107
390
$741,874
$4,520,222
$5,893,413
$1,662,580
OTHER THIRD PARTIES
Traditional
Inpatient

395
400
235
$1,396,637
Outpatient
$82,561,337
$112,117,974
OTHER THIRD
PARTIES
Managed Care
Total
$73,609,957
405
$92,255,108
415
$33,003
$9,310
$1,578,806
420
$4,594,059
$1,296,021
$153,946,285
425

426
430 Charity
430

(Credit Balance)
435
440
445

450
$4,627,062
$1,305,331
$155,525,091
$1,266,351
$357,249
$48,847,991

455
457
460

12

Report Period End:
OTHER INDIGENT
Line
No
PATIENT
Account
No
06/30/2014
OTHER PAYORS
(17) Gross
Inpatient Revenue
(18) Gross
Outpatient
Revenue
(19) Gross
Inpatient Revenue
(20) Gross
Outpatient
Revenue
.08
.48
.00, .09
.40, .49
$222,207
$279,916
$17,180
$17,340
245
$16
$4,651
$166
250
$36,676
$27,562
$287,752
260
$2,533
$651
265
$1,869
$1,062
270
Line
No
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
4450
4470
4480
4500
4520
270 Blood Bank
4540
275 Echocardiology
4560
4570
4590
4610
4620
4630
4640
4650
4660
320 Ultrasonography
4670
$6,671
$570
$266,096
320
4680
$28,003
$7,312
$49,408
325
4710
$14,381
$32,882
$15,875
330
4720
$3,141
$6,019
335
4730
340
345 Renal Dialysis
4740
345
350 Lithotripsy
4750
4760
4770
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
230
240
255
$1,610
275
$13,619
$9,451
$2,980
280
$39
285
290
295
$7,652
$11,109
$53,977
$7,501
310
315
350
$19,731
$15,195
355
$323
360
400
$15,229
$105,991
$1,003,490
405
$44,342
$211,020
OTHER INDIGENT
$397,995
$1,362,647
OTHER PAYORS
415
Inpatient
Inpatient
Outpatient
$3,781
$7,509
Outpatient
$355,107
420
425

430 Charity
300
305
$6,691

235
426
$44,342
$211,020
$149,312
$173,600
430

(Credit Balance)
435
440
445

$44,342
$211,020
$226,434
$1,144,867
450
$379,527
$1,325,976
455
$18,468
$36,671

457
460

12

Report Period End:
06/30/2014
TOTAL
Line
No
PATIENT
Account
No
(21) Gross
Inpatient Revenue
(22) Gross
Outpatient
Revenue
(23) Gross patient

Revenue
Line
No
$127,486,268
$81,217,612
$208,703,880
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
4450
$10,467,420
$5,299,560
$15,766,980
245
4470
$2,774,463
$445,361
$3,219,824
250
4480
4500
$58,106,158
$28,721,086
$86,827,244
260
4520
$2,355,548
$3,855,175
$6,210,723
265
270 Blood Bank
4540
$3,700,553
$1,163,346
$4,863,899
270
275 Echocardiology
4560
4570
$27,793,468
$39,614,940
$67,408,408
280
4590
$14,621,083
$7,440,702
$22,061,785
285
4610
4620
$2,615,056
$467,020
$3,082,076
295
4630
$31,785,287
$36,158,028
$67,943,315
300
4640
4650
$4,898,009
$5,166,604
$10,064,613
310
4660
$5,933,519
$9,413,694
$15,347,213
315
320 Ultrasonography
4670
$5,255,777
$7,167,837
$12,423,614
320
4680
$13,950,972
$15,729,528
$29,680,500
325
4710
$61,514,267
$9,452,130
$70,966,397
330
4720
$24,899,508
$557,195
$25,456,703
335
4730
$3,562,388
$706,773
$4,269,161
340
345 Renal Dialysis
4740
$13,707,200
$588,415
$14,295,615
345
350 Lithotripsy
4750
4760
$5,344,569
$10,662,278
$16,006,847
355
4770
$36,706,798
$10,114,099
$46,820,897
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
4860
4870
230
235
240
255
275
290
305
350
390
$8,974,301
$2,180,247
$11,154,548
$466,452,612
$276,121,630
$742,574,242
405

$703,560,224
$337,002,302
$1,040,562,526
415
Total Inpatient
Total Outpatient

400
Total
$5,530,363
420
$860,004,312
425

430 Charity
395
426
$642,527
430

(Credit Balance)
435
440

445
$1,371,301
450
$867,548,503
455
$10,175,776
457
$183,189,799
460

14
SUPPLEMENTAL OTHER OPERATING REVENUE INFORMATION

Line
No
SUPPLEMENTAL OTHER OPERATING REVENUE INFORMATION

Report Period End:

Account
No.
(1)
06/30/2014
Other Operating
Revenue
Line
No
PART I: COST REDUCTIONS DISTRIBUTED TO SEVERAL COST CENTERS

Donated Commodities
5650
10
Cash Discounts of Purchases
5660
$4,736
10
15
Sale of Scrap and Waste
5670
$7,058
15
20
Rebates and Refunds
5680
$5,295
20
25
Other Commissions
5710
25
30
Non-Patient Room Rentals
5730
30
35
Other (Specify)
35
40
40
45
45
50
50
65
PART II: MINOR RECOVERIES DISTRIBUTED TO ONE COST CENTER

Telephone and Telegraph Revenue
5470
65
70
Donated Blood
5750
70
75
Vending Machine Commissions
5690
75
80
Television/Radio Rentals
5720
80
85
Finance Charges on Patient Accounts Receivable
5520
85
90
Child Care Services Revenue - Employees
5760
90
95
Other (Specify)
100
95
GRANT REVENUE
100
105
105
110
110
115
115
120
TOTAL PARTS I AND II
130
PART III: OTHER OPERATING REVENUE ALLOCATED

Non-Patient Food Sales
5320
130
135
Laundry and Linen Revenue
5340
135
140
Social Work Services Revenue
5350
140
145
Supplies sold to Non-Patients Revenue
5370
150
Drugs Sold to Non-Patients Revenue
5380
155
Purchasing Services Revenue
5390
160
Parking Revenue
5430
165
Housekeeping & Maintenance Services Revenue
5440
170
Data Processing Services Revenue
5480
$30,801
170
175
Medical Records Abstracts Sales
5700
$19,273
175
180
Management Services Revenue
5740
180
185
Transfers from Restricted Funds for Operations (Non-Revenue Centers)
5790
185
190
Worker's Compensation Refunds
5782
190
195
Community Health Education Revenue
5770
195
196
Reinsurance Recoveries
5781
200
Other (Specify) OTHER OPER REVENUE
205
MEANINGFUL USE REVENUE
210
CASH RECLASS
$17,089
120
145
$81,721
150
155
$456,450
160
165
196
$16,592
200
$2,747,332
205
$288,541
210
215
215
220
TOTAL PART III
$3,640,710
225
PART IV: RESEARCH & EDUCATION REVENUES AND TRANSFERS

Transfers from Restricted Funds for Research Expense
220
5010
225
230
School of Nursing Tuition
5220
230
235
Licensed Vocational Nurse Program Tuition
5230
235
240
Medical Postgraduate Education Tuition
5240
240
245
Paramedical Education Tuition
5250
245
250
Student Housing Revenue
5260
250
255
Other Health Profession Education Revenue
5270
255
260
Transfers from Restricted Funds for Education Expense
5280
260
270
Transfers from Restricted Funds for Operations (Revenue Centers)
5790
270
275
TOTAL PART IV
280
TOTAL OTHER OPERATING REVENUE (Sum of Lines 120,220 and 275)
275
$3,657,799
280

15
RECLASSIFICATION WORKSHEET- PHYSICIAN AND STUDENT

COMPENSATION -PATIENT REVENUE PRODUCING CENTERS

Report Period End:
06/30/2014
COMPENSATION
Line
No
PATIENT
Account
(1)
Salaries
and Wages
Natural Classification Code
No
.07
(2)
Employee
Benefits
.10-.19
(3)
Professional Fees
(4)
Total
Compensation
Line
No
.20

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
80
6440
85
6470
85
90
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
6580
6610
6630
115
6680
120
6780
125
6900
$129,290
$129,290
75
$2,242,196
$2,242,196
80
101
$6,938
$6,938
105
110
145
$2,378,424
$2,378,424
150
$8,000
$8,000
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
190 Outpatient Chemical Dependency Svcs.
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
$446,727
$446,727
175
220
$454,727
$454,727
225

15


Report Period End:
06/30/2014
PERCENT OF TIME SPENT BY FUNCTION
Line
No
PATIENT
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

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
80
6440
85
6470
85
90
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
6580
6610
6630
115
6680
120
6780
125
6900
$129,290
75
$2,242,196
80
101
$6,938
105
110
145
$2,378,424
150
AMBULATORY SERVICES
7010
160
7040
165
7060
175 Clinics
7070
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
170
$446,727
175
220
$446,727
225

15


Report Period End:
06/30/2014
PERCENT OF TIME SPENT BY

FUNCTION
Line
No
PATIENT
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)

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
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
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
145
150
AMBULATORY SERVICES
7010
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
$8,000
160
220
$8,000
225

15


Report Period End:
06/30/2014
COMPENSATION
Line
No
PATIENT
Account
(1)
Salaries
and Wages
No
.07
(2)
Employee
Benefits
.10-.19
(3)
Professional
Fees
(4)
Total
Compensation
Line
No
.20
ANCILLARY SERVICES
7400
7420
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
7520
270 Blood Bank
7540
275 Echocardiology
7560
7570
7590
285
7610
290
7620
7630
7640
7650
7660
315
320 Ultrasonography
7670
320
7680
325
7710
7720
7730
340
345 Renal Dialysis
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
7860
7870
230
$1,642,041
$1,642,041
235
260
$73,603
$73,603
265
270
275
$177,743
$177,743
280
295
$318,950
$318,950
$26,950
$26,950
300
305
310
330
$13,400
$13,400
335
390
$622,133
$622,133
$2,874,820
$2,874,820
395
400
405

15


Report Period End:
06/30/2014
Line
No
PATIENT
Account
No
(5)
Research
Supported by
Hospital
(6)
Medical
Education
Supported by
(7)
General
Administration
and Hospital
Committees
(8)
Nursing and
of Hospital
No
Patients
ANCILLARY SERVICES
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
7520
270 Blood Bank
7540
275 Echocardiology
7560
7570
7590
285
7610
290
7620
7630
7640
7650
7660
315
320 Ultrasonography
7670
320
7680
325
7710
7720
7730
340
345 Renal Dialysis
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
7860
7870
260
$73,603
265
270
275
$101,740
280
295
$169,841
300
305
$26,950
310
330
$13,400
335
390
$361,646
395
400
$747,180
405

15


Report Period End:
06/30/2014

FUNCTION
Line
No
PATIENT
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
7400
7420
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
270 Blood Bank
7540
270
275 Echocardiology
7560
7570
7590
285
7610
290
7620
7630
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
345 Renal Dialysis
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
7860
7870
230
$1,642,041
235
275
$76,003
280
295
$149,109
300
390
$260,487
395
400
$2,127,640
405

16
RECLASSIFICATION WORKSHEET - PHYSICIAN AND STUDENT

COMPENSATION - NON-REVENUE PRODUCING CENTERS

Report Period End:
06/30/2014
COMPENSATION
Line
No
NON-REVENUE PRODUCING CENTERS
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
Research Projects and Administration
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
Education Administration Office
8210
15
20
School of Nursing
8220
20
25
Licensed Vocational Nurse Program
8230
25
30
Medical Postgraduate Education
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
Other Health Profession Education
8290
45
50
TOTAL EDUCATION
50
205 Hospital Administration
8610
210 Governing Board Expense
8620
210
215 Public Relations
8630
215
220 Management Engineering
8640
220
225 Personnel
8650
230 Employee Health Services
8660
235 Auxiliary Groups
8670
235
240 Chaplaincy Services
8680
240
245 Medical Library
8690
245
250 Medical Records
8700
255 Medical Staff Administration
8710
260 Nursing Administration
8720
260
265 Nursing Float Personnel
8730
265
270 Inservice Education - Nursing
8740
275 Utilization Management
8750
$15,925
$15,925
275
280 Community Health Education
8760
$50,000
$50,000
280
295 Other Administrative Services
8790
$247,836
$247,836
300
$5,955,807
$5,955,807
305
300 TOTAL ADMINISTRATIVE SERVICES
$158,841
$158,841
205
225
$70
$70
230
250
$23,000
$23,000
255
270
295
TOTAL
305 TOTAL PAGES 15 AND 16
DO NOT INCLUDE ANY COMPENSATION LISTED ABOVE ON PAGE 17 OR

18, COLUMNS (1), (2) OR (4).

16


Report Period End:
06/30/2014
Line
No
(5)
Research
Supported by
Hospital
PATIENT
Account
No
(6)
Medical
Education
Supported by
(7)
General
Administration
and Hospital
Committees
(8)
Nursing and
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
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
8610
8620
210
8630
215
8640
220
225 Personnel
8650
8660
8670
235
8680
240
245 Medical Library
8690
245
250 Medical Records
8700
8710
8720
260
8730
265
8740
8750
$15,925
275
8760
$50,000
280
8790
$158,841
205
225
$70
230
250
$23,000
255
270
295
$247,836
300
TOTAL
$3,820,167
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
305
LINE ITEMS TO
PAGE 17,
COLUMN(3)
LINES AS
APPROPRIATE
(SEE
INSTRUCTIONS)

16

Report Period End:

FUNCTION
Line
No
PATIENT
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
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
8610
205
8620
210
8630
215
8640
220
225 Personnel
8650
225
8660
230
8670
235
8680
240
245 Medical Library
8690
245
250 Medical Records
8700
250
8710
255
8720
260
8730
265
8740
270
8750
275
8760
280
8790
295
300
TOTAL
$2,135,640
LINE 50 TO PAGE
15, COLUMN(13)
(SEE
INSTRUCTIONS)
305
LINE ITEMS TO
PAGES 17 & 18,
COLUMN(3),
LINES AS
APPROPRIATE
(SEE
INSTRUCTIONS)
06/30/2014

17
TRIAL BALANCE WORKSHEET AND SUPPLEMENTAL EXPENSE

INFORMATION -PATIENT REVENUE PRODUCING CENTERS
Line
No
PATIENT
Account
No

Report Period End:

(1)
Salaries
and Wages
(2)
Employee
Benefits
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
$4,610,807
$2,799,378
06/30/2014
(3)
Reclassified
Physician and
Student
Compensation
Pages 15 &16,
Cols. (8) & (10)
(4)
Professional Fees
.07,.10-.19,.20
.21-.29
Line
No

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
80
6440
85
6470
85
90
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
6580
6610
6630
115
6680
120
6780
125
6900
$175,540
40
$14,779,833
$8,885,636
$91,322
45
75
$2,235,768
$1,135,424
$15,436
80
101
$1,806,784
$918,925
$86,820
105
110
145
$23,433,192
$13,739,363
$369,118
150
$2,229,892
$1,211,418
$195,037
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
$3,071,960
$1,598,125
$3,390
175
220
$5,301,852
$2,809,543
$198,427
225

17

Line
No
PATIENT
Report Period End:

(5)
Supplies
Account
No
.31-.50,.93,.97
(6)
Purchased
Services
.61-.69
(7)
Depreciation
.71-.74
06/30/2014
(8)
Leases
and Rentals
Line
No
.75-.76

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
80
6440
85
6470
85
90
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
6580
6610
6630
115
6680
120
6780
125
6900
$294,552
$47,101
40
$952,657
$225,017
45
75
$107,385
80
101
$138,204
$6,791
105
110
145
$1,492,798
$278,909
150
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
$255,979
$174,166
160
165
170
$115,815
$215,735
$8,830
175
220
$371,794
$389,901
$8,830
225

17

Line
No
Account
No
Report Period End:
(9)
Other Direct
Expenses
PATIENT
(10)
Total Direct
Expenses
Columns (1) thru
(9)
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
06/30/2014
(12) (Optional)
Adjusted Direct
Expenses [Cols. Line
(10) minus (11)] to No
Page 20, Column
(1)
.77-.90,.94-.98

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
80
6440
85
6470
85
90
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
6580
6610
6630
115
6680
120
6780
125
6900
$530
$7,927,908
40
$3,028
$24,937,493
45
75
$957
$3,494,970
80
101
$802
$2,958,326
105
110
145
$5,317
$39,318,697
150
$802
$4,067,294
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
$123,467
$5,137,322
175
220
$124,269
$9,204,616
225

17

Line
No
PATIENT
Account
No
(13) (Optional)
Units of Service
from Page 4,
Columns (4) + (5)
or Col(1)
Report Period End:

(14)(Optional)
Adjusted Direct
Expenses Per
Unit Column (12)
(13)
Line
No

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
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
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
145
150
AMBULATORY 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
06/30/2014

17

Line
No
PATIENT
Account
No

Report Period End:
(1)
Salaries
and Wages
(2)
Employee
Benefits
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
$5,568,881
$3,510,923
$419,163
$264,263
06/30/2014
(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
7400
7420
230
7430
245 Anesthesiology
7450
7470
7480
7500
$2,543,746
$1,394,765
260
7520
$197,051
$103,032
265
270 Blood Bank
7540
275 Echocardiology
7560
7570
$1,421,610
$845,974
$24,010
280
7590
$421,640
$262,044
$1,744
285
7610
7620
7630
7640
$270,521
235
240
245
250
255
270
275
290
$3,450
295
300
$2,463,884
$1,404,823
$170,518
7650
$209,496
$139,171
$8,744
310
7660
$154,353
$96,665
$15,121
315
320 Ultrasonography
7670
$219,423
$101,210
$12,411
320
7680
$194,145
$76,345
7710
7720
$1,420,542
$791,274
7730
345 Renal Dialysis
7740
$1,179,854
$671,912
350 Lithotripsy
7750
7760
$533,539
$413,296
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
7860
7870
305
325
330
$9,753
335
340
345
350
355
390
$2,535,401
$1,551,062
$19,482,728
$11,626,759
395
400
$516,272
405
PATIENT CARE SERVICES

7900
7950
415 TOTAL PATIENT CARE SERVICES
410
411
$48,217,772
$28,175,665
$1,083,817
415

17

Line
No
PATIENT
Report Period End:

(5)
Supplies
Account
No
(6)
Purchased
Services
(7)
Depreciation
06/30/2014
(8)
Leases
and Rentals
.31-.50,.93,.97
.61-.69
.71-.74
.75-.76
$1,129,449
$924,456
$670,880
$11,073
$69,583
Line
No
ANCILLARY SERVICES
7400
7420
7430
245 Anesthesiology
7450
$85,012
7470
$21,647,687
7480
7500
$1,630,351
$1,102,728
$223,977
7520
$25,415
$250,245
$13,607
265
270 Blood Bank
7540
$1,338,669
$770
$18,021
270
275 Echocardiology
7560
7570
$4,710,223
$7,400
$889,484
280
7590
$25,237
$219
$105,503
285
7610
7620
$2,499
7630
$1,728,480
$354,362
$303,445
7640
7650
$139,364
$19,860
$12,808
310
7660
$8,141
$371,213
$144,415
315
320 Ultrasonography
7670
$29,973
$83,401
7680
$71,266
$6,350
7710
$5,943,802
$110,218
7720
$86,920
$702
$24,772
7730
$1,906
$123
$14,829
340
345 Renal Dialysis
7740
$77,199
$7,399
$6,955
345
350 Lithotripsy
7750
7760
$272,390
$41,713
7770
$23,062
$2,616,244
7780
365
7790
370
7800
375
7820
380
7830
385
7840
7860
7870
230
235
240
$833
245
250
255
$67,434
260
275
290
$1,897
295
$99,233
300
305
320
$92,938
325
330
$429
335
350
355
$871
360
390
$60,654
$3,341,403
$1,125
$38,765
$39,037,699
$9,308,389
$2,525,527
$217,767
395
400
405

7900
7950
$3,900,966
410
411
$40,902,291
$13,599,256
$2,813,266
$217,767
415

17

Line
No
Account
No
Report Period End:
(9)
Other Direct
Expenses
PATIENT
(10)
Total Direct
Expenses
Columns (1) thru
(9)
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
06/30/2014
(12) (Optional)
Adjusted Direct
Page 20, Column
(1)
.77-.90,.94-.98
ANCILLARY SERVICES
7400
7420
230
7430
245 Anesthesiology
7450
7470
7480
7500
$21,520
$6,984,521
260
7520
$650
$590,000
265
270 Blood Bank
7540
$4,365
$1,361,825
270
275 Echocardiology
7560
7570
$94,249
$7,992,950
280
7590
$816,387
285
7610
7620
7630
7640
$73,873
$12,160,056
$5,560
$844,414
235
240
$21,647,687
245
$11,794
250
255
275
290
$7,846
295
$48,714
$6,573,459
300
7650
$15,295
$544,738
310
7660
$35,982
$825,890
315
320 Ultrasonography
7670
$446,418
320
7680
$584,807
325
7710
$6,054,020
330
7720
$2,336,830
335
7730
$16,858
340
345 Renal Dialysis
7740
$1,943,319
345
350 Lithotripsy
7750
7760
7770
7780
365
7790
370
7800
375
7820
380
7830
385
7840
7860
7870
305
$143,763
$2,438
350
$3,454
$1,264,392
355
$2,640,177
360
390
$35,539
$7,563,949
$485,402
$83,200,543
395
400
$11,794
405

7900
7950
$3,900,966
410
411
$614,988
$135,624,822
$11,794
415

17

Line
No
PATIENT
Account
No
(13) (Optional)
Units of Service
from Page 4,
Columns (4) + (5)
or Col(1)
Report Period End:

(14)(Optional)
Adjusted Direct
Expenses Per
Unit Column (12)
(13)
Line
No
ANCILLARY SERVICES
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
345 Renal Dialysis
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
06/30/2014

18

INFORMATION NON-REVENUE PRODUCING CENTERS
NON-REVENUE
PRODUCING CENTERS
Line
No
Account
No

Report Period End:
(1)
Salaries
and Wages
(2)
Employee
Benefits
06/30/2014
(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
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
$434,887
$250,944
$434,887
$250,944
10
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
30
8240
35
8250
35
40
Student Housing
8260
40
45
8290
50
TOTAL EDUCATION
25
$496,899
$246,766
30
45
$496,899
$246,766
50
GENERAL SERVICES
55
Printing and Duplicating
8310
55
60
Kitchen
8320
60
65
Non-Patient Food Services
8330
65
70
Dietary
8340
70
75
Laundry and Linen
8350
80
8360
85
Central Transportation
8370
90
Central Services and Supplies
95
Pharmacy
75
$284,491
$153,476
8380
$643,620
$336,281
8390
$2,092,155
$1,416,603
$61,733
80
85
90
$16,468
95
100 Purchasing and Stores
8400
105 Grounds
8410
110 Security
8420
115 Parking
8430
115
120 Housekeeping
8440
120
125 Plant Operations
8450
125
130 Plant Maintenance
8460
135 Communications
8470
$333,167
$186,290
135
140 Data Processing
8480
$637,840
$419,010
140
145 Other General Services
8490
$4,559,218
$2,790,331
$81,225
150
150 TOTAL GENERAL SERVICES
100
105
$567,945
$278,671
$3,024
110
130
145
FISCAL SERVICES
155 General Accounting
8510
$315,952
$227,008
$94,244
155
160 Patient Accounting
8530
$686,482
$388,402
$25,988
160
165 Credit and Collection
8550
170 Admitting
8560
$1,162,766
$576,204
175 Outpatient Registration
8570
195 Other Fiscal Services
8590
200 TOTAL FISCAL SERVICES
165
170
175
195
$2,165,200
$1,191,614
$120,232
200

18

NON-REVENUE
PRODUCING CENTERS
Line
No
Report Period End:

(5)
Supplies
Account
No
(6)
Purchased
Services
(7)
Depreciation
06/30/2014
(8)
Leases and
Rentals
Line
No
.31-.50,.93,.97
.61-.69
.71-.74
.75-.76
$17,170
$85,588
$23,531
$574
$17,170
$85,588
$23,531
$574
10
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
30
8240
35
8250
35
40
Student Housing
8260
40
45
8290
50
TOTAL EDUCATION
25
$15,916
$122,373
30
45
$15,916
$122,373
50
GENERAL SERVICES
55
8310
60
Kitchen
8320
55
65
8330
$22,382
$1,516,074
$13,018
65
70
Dietary
8340
$20,661
$1,399,453
$28,742
70
75
Laundry and Linen
8350
$33,897
$451,074
$2,325
75
80
8360
$2,324
$3,491
$3,199
80
85
8370
90
8380
$494,132
$821,389
$71,479
$479,512
95
Pharmacy
8390
$285,334
$45,866
$413,036
60
85
8400
105 Grounds
8410
110 Security
8420
115 Parking
8430
120 Housekeeping
8440
8450
$7,259,441
$12,325
8460
$32,462
$92,481
$109,137
135 Communications
8470
$5,651
$77,805
$98,158
140 Data Processing
8480
$130,100
$6,674,010
$363,362
$412,835
8490
$1,070,098
$21,667,455
$766,683
$1,336,538
90
95
100
105
$15,080
$17,999
$14,257
110
$28,075
$3,354,238
$4,815
120
115
125
$31,155
130
135
140
145
150
FISCAL SERVICES
8510
$2,005
$10,808
$33,208
155
8530
$10,614
$21,980
$8,878
160
8550
170 Admitting
8560
8570
8590
$833,535
$30,496
$11,394
165
$2,225
170
175
195
$43,115
$877,717
$44,311
200

18

Line
No
Account
No
Report Period End:
(9)
Other Direct
Expenses
NON REVENUE
PRODUCING CENTERS
(10)
Total Direct
Expenses
Columns (1) thru
(9)
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
06/30/2014
(12) (Optional)
Adjusted Direct
Page 20, Column
(1)
.77-.90,.94-.98
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
$39,840
$852,534
$39,840
$852,534
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
30
8240
35
8250
35
40
Student Housing
8260
40
45
8290
50
TOTAL EDUCATION
25
$15,480
$897,434
30
45
$15,480
$897,434
50
GENERAL SERVICES
55
8310
60
Kitchen
8320
65
8330
$1,551,474
65
70
Dietary
8340
$1,448,856
70
75
Laundry and Linen
8350
$487,296
75
80
8360
$696
$509,410
80
85
8370
90
8380
$130,942
$2,977,355
95
Pharmacy
8390
8400
105 Grounds
8410
110 Security
8420
115 Parking
8430
120 Housekeeping
8440
8450
8460
135 Communications
8470
140 Data Processing
8480
8490
55
60
85
$4,269,462
90
95
100
105
$3,603
$900,579
110
$1,400
$3,388,528
120
$7,271,766
125
$4,812,519
130
$701,071
135
$64,716
$8,701,873
140
$4,748,641
$37,020,189
150
115
$4,547,284
145
FISCAL SERVICES
8510
$837,704
155
8530
$1,142,344
160
8550
$833,535
165
170 Admitting
8560
$1,784,881
170
8570
8590
$154,479
$1,796
175
195
$156,275
$4,598,464
200

18

NON REVENUE
PRODUCING CENTERS
Line
No
Report Period End:
(13)
Units of Service
Account
No
(14)(Optional)
Adjusted Direct
Expenses Per
Unit Column (12)
(13)
Line
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
1,040,563
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
30
8240
35
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
25
6
30
50
GENERAL SERVICES
55
8310
60
Kitchen
8320
65
8330
155,812
65
70
Dietary
8340
143,826
70
75
Laundry and Linen
8350
928,708
75
80
8360
1,974
80
85
8370
90
8380
55,638
95
Pharmacy
8390
55,309
8400
105 Grounds
8410
110 Security
8420
115 Parking
8430
120 Housekeeping
55
60
85
90
95
100
105
937
110
8440
618,435
120
8450
703,754
125
8460
703,754
130
135 Communications
8470
937
135
140 Data Processing
8480
1,040,563
140
8490
115
145
150
FISCAL SERVICES
8510
937
155
8530
1,040,563
160
8550
1,040,563
165
170 Admitting
8560
7,797
170
8570
175
8590
195
200
06/30/2014

18

NON REVENUE
PRODUCING CENTERS
Line
No
Account
No

Report Period End:
(1)
Salaries
and Wages
(2)
Employee
Benefits
06/30/2014
(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
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
$2,141,699
$1,284,263
$660,900
$511,872
$283,068
$47,450
$379,043
8610
8620
8630
8640
225 Personnel
8650
$481,259
$264,133
8660
$209,430
$93,394
8670
8680
$163,564
$95,339
245 Medical Library
8690
$68,482
$36,501
250 Medical Records
8700
$819,321
$458,028
8710
$250,859
$129,175
255
8720
$1,039,352
$603,757
260
8730
8740
8750
$2,638,828
$1,383,331
$237,034
275
8770
$482,939
$240,282
$3,000
280
8790
205
210
215
220
225
230
$1,740
235
240
245
$81,930
250
265
270
$3,820,167
$8,807,605
$4,871,271
$3,820,167
295
$1,411,097
300
UNASSIGNED COSTS
305 Depreciation and Amortization
8810
305
310 Leases and Rentals
8820
310
315 Insurance - Hosp and Prof. Malpractice
8830
315
320 Insurance - Other
8840
320
325 Lic. & Other Taxes (Other than income)
8850
325
330 Interest - Working Capital
8860
330
345 Interest - Other
8870
345
350 Employee Benefits (Non-Payroll Related)
8880
350
355 Other Unassigned costs
8890
355
360 TOTAL UNASSIGNED COSTS
360
TOTAL
365 TOTAL OPERATING COSTS (17 & 18)
370 Non-Operating Cost Centers
375 TOTAL COSTS
$64,681,581
$37,526,591
$80,348
$17,564
$64,761,929
$37,544,155
$3,820,167
$2,696,371
$3,820,167
$2,696,371
365
370
375

18

INFORMATION -NON-REVENUE PRODUCING CENTERS
NON REVENUE
PRODUCING CENTERS
Line
No
Report Period End:

(5)
Supplies
Account
No
(6)
Purchased
Services
(7)
Depreciation
06/30/2014
(8)
Leases and
Rentals
.31-.50,.93,.97
.61-.69
.71-.74
.75-.76
$15,412
$7,773,630
$94,280
$2,832
$14,764
$72,187
Line
No
8610
8620
8630
8640
225 Personnel
8650
$8,410
$21,066
$2,936
225
8660
$1,459
$3,116
$3,814
230
8670
$158
$2,277
$182
235
8680
$2,518
$1,273
240
245 Medical Library
8690
$542
$14,061
$747
245
250 Medical Records
8700
$32,140
$409,719
$54,273
250
8710
$5,288
$18,418
$1,504
255
8720
$11,444
$3,504
$18,686
260
8730
8740
8750
$9,921
$9,173
8770
$18,381
$43,774
8790
$120,437
$8,370,925
205
210
215
220
265
270
$6,746
275
280
295
$184,441
$2,832
300
UNASSIGNED COSTS
8810
8820
$8,568,202
305
310
8830
315
8840
320
8850
325
8860
330
8870
345
8880
350
8890
355
$8,568,202
360
TOTAL
375 TOTAL COSTS
$42,169,027
$44,723,314
$12,400,434
$197,790
$1,457,050
$42,161
$42,366,817
$46,180,364
$12,442,595
$1,557,711
365
370
$1,557,711
375

18

Line
No
(10)
Total Direct
Expenses
Columns (1) thru
(9)
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
$6,592,432
$18,565,448
$5,295
$277,529
$1,206,870
Account
No
Report Period End:
(9)
Other Direct
Expenses
NON REVENUE
PRODUCING CENTERS
06/30/2014
(12) (Optional)
Adjusted Direct
Page 20, Column
(1)
.77-.90,.94-.98
8610
8620
8630
8640
225 Personnel
8650
8660
205
210
215
220
$1,156,847
225
$12,225
$323,438
230
8670
$498
$4,855
235
8680
$1,494
$264,188
240
245 Medical Library
8690
$41,831
$162,164
245
250 Medical Records
8700
$5,234
$1,860,645
250
8710
$1,611
$406,855
255
8720
$1,094
$1,677,837
260
8730
8740
8750
$13,380
$4,298,413
275
8770
$30,918
$819,294
280
8790
265
270
$3,820,167
$6,978,246
$34,567,021
295
$5,295
300
UNASSIGNED COSTS
8810
8820
8830
$1,763,651
$1,763,651
315
8840
$231,883
$231,883
320
8850
$167,843
$167,843
325
8860
$3,378,550
$3,378,550
330
8870
345
8880
350
8890
$8,568,202
305
310
355
$5,541,927
$14,110,129
$18,095,397
$227,670,593
$985,371
$2,780,284
$19,080,768
$230,450,877
360
TOTAL
375 TOTAL COSTS
$17,089
365
370
$17,089
375

18

NON REVENUE
PRODUCING CENTERS
Line
No
Report Period End:
(13)
Units of Service
Account
No
(14)(Optional)
Adjusted Direct
Expenses Per
Unit Column (12)
(13)
Line
No
8610
8620
937
205
8630
8640
225 Personnel
8650
937
225
8660
937
230
8670
267
235
8680
47,942
240
245 Medical Library
8690
211
245
250 Medical Records
8700
70,906
250
8710
211
255
8720
304
260
8730
8740
8750
7,797
275
8770
3,386
280
8790
210
1,044,220
215
220
265
270
295
300
UNASSIGNED COSTS
8810
8820
8830
1,040,563
315
8840
703,754
320
8850
703,754
325
8860
1,040,563
330
8870
345
8880
350
8890
355
703,754
305
310
360
TOTAL
365
370
375 TOTAL COSTS
375
06/30/2014

19
COST ALLOCATION - STATISTICAL BASIS

BASIS OF ALLOCATION
(2) Square Feet
Report Period End: 06/30/2014

(4) Accumulated
Costs
(5) Hospital
FTE's
Line
No
LINES BEING ALLOCATED
5-25
30-80
85-100
(6) Supplies from

Pages 17 & 18
column (5)
(7) Square
Feet Serviced
105
110
Line
No
Interest - Other
10
Insurance - Other
10
15
Licenses and Taxes (Other than on income)
15
20
Depreciation and Amortization
20
25
Leases and Rentals
25
30
Interest - Working Capital
35
Hospital Administration
40
Governing Board Expense
40
45
Public Relations
45
50
Management Engineering
50
55
Community Health Education
60
Other Administrative Services
7,596
60
65
General Accounting
1,605
65
70
Communications
1,294
70
75
Other Fiscal Services
80
85
Personnel
1,127
85
90
Employee Health Services
18,644
90
95
Employee Benefits (Non-Payroll Related)

10,926
100
100 Non-Patient Food Services
30
26,154
35
55
75
80
95

110 Housekeeping
105
2,774
110
115 Grounds
120 Security
115
581
581
49,851
49,851
130
33,360
33,360
135
145 Dietary
5,974
5,974
145
150 Laundry and Linen
3,178
3,178
150
2,462
2,462
155
160 Data Processing
1,652
1,652
160
5,182
5,182
170
4,015
4,015
175
180 Medical Library
1,419
1,419
180
185 Medical Records
4,424
4,424
185
2,221
2,221
190
747
747
195
1,143
1,143
200
5,541
5,541
125 Parking
125
140
195 Social Work Services

165
205 Insurance - Hospital and Professional Malpractice

210 Admitting
205
215 Other Unassigned Costs
210
215

120
220
2,368
2,368
235 Central Services and Supplies
7,779
7,779
235
240 Pharmacy
4,994
4,994
240
245 Research Projects and Administration
2,225
2,225
245
230 Inservice Education-Nursing
225
230
250 Education Administration Office
250
255 Student Housing
255
260 Licensed Vocational Nurse Program
260
265 School of Nursing
265
270 Paramedical Education
270
275 Other Health Profession Education
275
280 Medical Postgraduate Education
280

19

BASIS OF ALLOCATION
Line
No
(8) Square Feet (9)Meals Served (10)Dry Pounds (11)Gross Patient

(12)Gross
from Column
Processed
Revenue from
Outpatient
(2)
Page 12,Column Revenue from Pg
(23)
12,Col(22)
115-140
145
150
155-215
Line
No
220
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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

160 Data Processing
155
16,281
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

19

BASIS OF ALLOCATION
(13)Nursing
FTE's
(14) Central
Service and
Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
225-230
235
240
Line
No
(17)Gross Patient (18) Students in

Revenue from
All Approved
Column (11)
Programs
Line
No
245
250-255
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

19

BASIS OF ALLOCATION
Line
No
(19) Nursing
Student
Departmental
Assignment
260-265

(20) Paramedic
Student
Departmental
Assignment
270-275
(21) Medical
PostGraduate
Departmental
Assignment
Line
No
280
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

19

BASIS OF ALLOCATION
(2) Square Feet

(4) Accumulated
Costs
(5) Hospital
FTE's
Line
No
5-25
16,874
30-80
85-100
(6) Supplies from

Pages 17 & 18
column (5)
(7) Square
Feet Serviced
105
110
Line
No
16,874
505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535

540
59,355
59,355
545
550 Pediatric Acute
550
555
560 Psychiatric Acute - Adolescent & Child
560
565
570

575
9,823
9,823
580
585
590 Other Acute Care
590
595 Nursery Acute
595
600 Sub-Acute Care
600

601
8,970
8,970
605
610
615
620
625
645
AMBULATORY SERVICES
3,365
3,365
665

675 Clinics
660
670
11,641
11,641
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
730
39,628
39,628
735
740
745 Anesthesiology
745
750
755
6,132
6,132
760
3,997
3,997
765
770 Blood Bank
1,617
1,617
770
8,655
8,655
775 Echocardiology
775
780

19

BASIS OF ALLOCATION
Line
No

(12)Gross
from Column
Processed
Revenue from
Outpatient
(2)
(23)
12,Col(22)
115-140
145
150
10,518
72,454
155-215
Line
No
220
505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535

540
93,384
433,053
545
550 Pediatric Acute
550
555
560
565
570

575
15,060
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600

601
24,864
605
610
615
620
625
645
AMBULATORY SERVICES
43,666
665

675 Clinics
660
670
10,698
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
730
257,501
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
14,574
780

19

BASIS OF ALLOCATION
(13)Nursing
FTE's
(14) Central
Service and
Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
225-230
235
240
Line
No

Revenue from
All Approved
Column (11)
Programs
Line
No
245
250-255

505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535
540
545
550 Pediatric Acute
550
555
560
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
660
665
670
675 Clinics
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
730
735
740
745 Anesthesiology
745
$21,647,687
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780

19

BASIS OF ALLOCATION
Line
No
(19) Nursing
Student
Departmental
Assignment
260-265

(20) Paramedic
Student
Department
Assignment
270-275
(21) Medical
PostGraduate
Departmental
Assignment
Line
No
280

505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535

540
5.91
545
550 Pediatric Acute
550
555
560
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
660
665
670
675 Clinics
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
730
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780

19

BASIS OF ALLOCATION
(2) Square Feet

(4) Accumulated
Costs
(5) Hospital
FTE's
Line
No
5-25
30-80
85-100
(6) Supplies from

Pages 17 & 18
column (5)
(7) Square
Feet Serviced
105
110
Line
No
ANCILLARY SERVICES (Continued)

3,954
3,954
135
135
795
16,676
16,676
800
1,407
1,407
810
1,938
1,938
815
3,738
3,738
2,277
2,277
835
753
753
840
7,050
7,050
845
8,615
8,615
855
4,028
4,028
860
790
805
820 Ultrasonography
820

845 Renal Dialysis
785
825
830
850 Lithotripsy
850
865 Speech - Language Pathology
865
870
875
880
885

890
4,483
4,483
895
900
910
911
160,411
160,411
915
920 Total Statistical Units (Lines 5-915)
594,758
524,638
920
925 Operating costs Being Allocated (Page 20)
925
930 Cost Recoveries (Page 20, Lines 440 and 445)
930
935 Net Cost (Line 925 minus 930)
935
940 Unit Multiplier (Line 935 Line 920)
940

19

BASIS OF ALLOCATION
Line
No

(12)Gross
from Column
Processed
Revenue from
OutPatient
(2)
(23)
12,Col(22)
115-140
145
150
155-215
Line
No
220

2,516
785
790
795
26,573
800
805
5,854
810
6,365
815
820 Ultrasonography
820
15,900
825
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
8,838
855
14,435
860
865
870
875
880
885
890
895
900
910
911
915
143,826
928,708
920
925
930
935
940

19

BASIS OF ALLOCATION
(13)Nursing
FTE's
(14) Central
Service and
Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
225-230
235
240
Line
No

Revenue from
All Approved
Column (11)
Programs
Line
No
245
250-255

785
790
795
800
805
810
815
820 Ultrasonography
820
825
$6,054,020
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
$21,647,687
$6,054,020
920
925
930
935
940

19

BASIS OF ALLOCATION
Line
No
(19) Nursing
Student
Departmental
Assignment
260-265

(20) Paramedic
Student
Departmental
Assignment
270-275
(21) Medical
PostGraduate
Departmental
Assignment
Line
No
280

785
790
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
5.91
920
925
930
935
940

20
COST ALLOCATION

Line
No

BASIS OF ALLOCATION

Report Period End:
Account No (1)Adjusted Direct Costs

from Page 17 &
18,Column (12)
(2)Square Feet
06/30/2014
(3)Subtotal
Line
No
5-25
Interest - Other
8870
10
Insurance - Other
8840
10
15
8850
15
20
8810
20
25
Leases and Rentals
8820
25
30
8860
30
35
8610
35
40
8620
40
45
Public Relations
8630
45
50
8640
50
55
8770
55
60
8790
60
65
General Accounting
8510
65
70
Communications
8470
70
75
8590
75
80
8310
80
85
Personnel
8650
85
90
8660
90
95
8880
95
8330
100
8400
105
110 Housekeeping
8440
110
115 Grounds
8410
115
120 Security
8420
120
125 Parking
8430
125
8450
130
8460
135
8490
140
145 Dietary
8340
145
8350
150
8530
155
160 Data Processing
8480
160
8550
165
8670
170
8680
175
180 Medical Library
8690
180
185 Medical Records
8700
185
8710
190
8360
195
8750
200
8830
205
210 Admitting
8560
210
8890
215
8570
220
8720
225
8740
230
8380
235
240 Pharmacy
8390
240
8010
245
8210
250
255 Student Housing
8260
255
8230
260
8220
265
8250
270
8290
275
8260
280
285 TOTAL NON-REVENUE PRODUCING CENTERS
285

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
(4)Accumulated
Costs
30-80
(5)Hospital FTE's (6) Supplies from

Pages 17 & 18,
Column (5)
85-100
105
06/30/2014
(7)Square Feet
Serviced
Line
No
110
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
(8)Square Feet
from Column (2)
(9)Meals Served
(10)Dry Pounds
Processed
115-140
145
150
06/30/2014
(11)Gross Patient
Line
Revenue from Page No
12, Column 23
155-215
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

20
COST ALLOCATION

Line
No

Report Period End:
06/30/2014

BASIS OF ALLOCATION
(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
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

20
COST ALLOCATION

Line
No

BASIS OF ALLOCATION
Report Period End:

(16)Subtotal
06/30/2014
(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
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280
285

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
(20)Paramedic Student
Departmental
Assignment
(21)Medical
Postgraduate
Departmental
Assignment
270-275
280
06/30/2014
(22)Transfers
for Operating
Costs
(23)Total
Line
No
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

20
COST ALLOCATION

Line
No

BASIS OF ALLOCATION

Report Period End:

from Page 17 &
18,Column (12)
(2)Square Feet
06/30/2014
(3)Subtotal
Line
No
5-25
COST RECOVERIES (Page 14, Part III)

350 Non-Patient Food Sales
5320
350
355 Laundry and Linen Revenue
5340
355
360 Social Work Services Revenue
5350
360
365 Supplies Sold to Non-Patients Revenue
5370
365
370 Drugs Sold to Non-Patients Revenue
5380
370
375 Purchasing Services Revenue
5390
375
380 Parking Revenue
5430
380
385 Housekeeping and Maintenance Services Revenue
5440
385
390 Data Processing Services Revenue
5480
390
395 Medical Records Abstracts Sales
5700
395
400 Management Services Revenue
5740
400
405 Worker's Compensation Refunds
5782
405
410 Community Health Education Revenue
5770
410
411 Reinsurance Recoveries
5781
411
415 Transfers from Restricted Funds for Operations (NonRevenue Centers)
5790
415
420 Other (Specify)
5780
420
425 Other (Specify)
5780
425
430 Other (Specify)
5780
430
435 Other (Specify)
5780
435
440 TOTAL COST RECOVERIES
440
445 Research & Education Revenue and Transfers
445

6010
505
510 Coronary Care
6030
510
6050
515
6070
520
6090
525
530 Burn Care
6110
530
6130
535
6150
540
6170
545
550 Pediatric Acute
6290
550
6340
555
6360
560
6380
565
6400
570
6420
575
6440
580
6470
585
6510
590
595 Nursery Acute
6530
595
600 Sub-Acute Care
6560
600
601 Sub-Acute Care Pediatric
6570
601
6580
605
6610
610
6630
615
6680
620
6780
625
6900
645
650
AMBULATORY SERVICES
7010
660
7040
665
7060
670

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
(4)Accumulated
Costs
30-80

Pages 17 & 18,
Column (5)
85-100
105
06/30/2014
(7)Square Feet
Serviced
Line
No
110

350
355
360
365
370
375
380 Parking Revenue
380
385
390
395
400
405
410
411
415
420 Other (Specify)
420
425 Other (Specify)
425
430 Other (Specify)
430
435 Other (Specify)
435
440
445

505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535
540
545
550 Pediatric Acute
550
555
560
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
650
AMBULATORY SERVICES
660
665
670

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
(8)Square Feet
from Column (2)
(9)Meals Served
(10)Dry Pounds
Processed
115-140
145
150
06/30/2014
(11)Gross Patient
Line
12, Column 23
155-215

350
355
360
365
370
375
380 Parking Revenue
380
385
390
395
400
405
410
411
415
420 Other (Specify)
420
425 Other (Specify)
425
430 Other (Specify)
430
435 Other (Specify)
435
440
445

505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535
540
545
550 Pediatric Acute
550
555
560
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
650
AMBULATORY SERVICES
660
665
670

20
COST ALLOCATION

Line
No

Report Period End:
06/30/2014

BASIS OF ALLOCATION
(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 Parking Revenue
380
385
390
395
400
405
410
411
415
420 Other (Specify)
420
425 Other (Specify)
425
430 Other (Specify)
430
435 Other (Specify)
435
440
445

505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535
540
545
550 Pediatric Acute
550
555
560
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
650
AMBULATORY SERVICES
660
665
670

20
COST ALLOCATION

Line
No

BASIS OF ALLOCATION
Report Period End:

(16)Subtotal
06/30/2014
(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 Parking Revenue
380
385
390
395
400
405
410
411
415
420 Other (Specify)
420
425 Other (Specify)
425
430 Other (Specify)
430
435 Other (Specify)
435
440
445

505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535
540
545
550 Pediatric Acute
550
555
560
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
650
AMBULATORY SERVICES
660
665
670

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
Departmental
Assignment
(21)Medical
Postgraduate
Departmental
Assignment
270-275
280
06/30/2014
(22)Transfers
for Operating
Costs
(23)Total
Line
No

350
355
360
365
370
375
380 Parking Revenue
380
385
390
395
400
405
410
411
415
420 Other (Specify)
420
425 Other (Specify)
425
430 Other (Specify)
430
435 Other (Specify)
435
440
445

505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535
540
545
550 Pediatric Acute
550
555
560
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
650
AMBULATORY SERVICES
660
665
670

20
COST ALLOCATION

Line
No

BASIS OF ALLOCATION

Report Period End:

from Page 17 &
18,Column (12)
(2)Square Feet
06/30/2014
(3)Subtotal
Line
No
5-25
675 Clinics
7070
675
7180
680
7200
685
7220
690
7230
695
7260
700
7290
705
7310
710
7320
715
7390
720
725
ANCILLARY SERVICES
7400
7420
735
7430
740
745 Anesthesiology
7450
745
7470
750
7480
755
7500
760
7520
765
770 Blood Bank
7540
770
775 Echocardiology
7560
775
7570
780
7590
785
7610
790
7620
795
7630
800
7640
805
7650
810
7660
815
820 Ultrasonography
7670
820
7680
825
7710
830
7720
835
7730
840
845 Renal Dialysis
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

920 TOTAL
915
-0-
920

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
(4)Accumulated
Costs
30-80

Pages 17 & 18,
Column (5)
85-100
105
06/30/2014
(7)Square Feet
Serviced
Line
No
110
675 Clinics
675
680
685
690
695
700
705
710
715
720
725
ANCILLARY SERVICES
730
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780
785
790
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
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

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
(8)Square Feet
from Column (2)
(9)Meals Served
(10)Dry Pounds
Processed
115-140
145
150
06/30/2014
(11)Gross Patient
Line
12, Column 23
155-215
675 Clinics
675
680
685
690
695
700
705
710
715
720
725
ANCILLARY SERVICES
730
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780
785
790
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
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

20
COST ALLOCATION

Line
No

Report Period End:
06/30/2014

BASIS OF ALLOCATION
(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
690
695
700
705
710
715
720
725
ANCILLARY SERVICES
730
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780
785
790
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
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

20
COST ALLOCATION

Line
No

BASIS OF ALLOCATION
Report Period End:

(16)Subtotal
06/30/2014
(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
690
695
700
705
710
715
720
725
ANCILLARY SERVICES
730
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780
785
790
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
905
910
911
915
920 TOTAL
-0-
-0-
-0-
920

20
COST ALLOCATION

Line
No

Report Period End:

BASIS OF ALLOCATION
Departmental
Assignment
(21)Medical
Postgraduate
Departmental
Assignment
270-275
280
06/30/2014
(22)Transfers
for Operating
Costs
(23)Total
Line
No
675 Clinics
675
680
685
690
695
700
705
710
715
720
725
ANCILLARY SERVICES
730
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780
785
790
795
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
905
910
911
915
920 TOTAL
-0-
-0-
-0-
920

20a.
COST ALLOCATION SHORT FORM

Line
No
COST RECOVERY INFORMATION
(1) Transfers for

Operations NonRevenue Centers Page
14, Col(1), Line 185

( Page 20a (1 of 6) Submitted Data )
Report Period End:
06/30/2014
(2)Other Operating
Revenue Page
14,Col(1), Line 200
(3) Other Operating

Revenue Page 14,
Col (1), Line 205
($16,592)
($2,747,332)
(4)Other Operating
Revenue Page 14, Col Line
(1),Line 210
No
Cost Recovery
Interest - Other
($288,541)
1
5
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
35
40
40
45
Public Relations
45
50
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
30
$16,592
$2,747,332
$288,541
35
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250

20a.
Line
No
(1) Transfers for

Operations NonRevenue Centers Page
14, Col(1), Line 185
Report Period End:

(2)Other Operating
Revenue Page
14,Col(1), Line 200
06/30/2014
(3) Other Operating

Revenue Page 14,
Col (1), Line 205
(4)Other Operating
Revenue Page 14, Col Line
(1),Line 210
No
255 Student Housing
255
260
265
270
275

280
-0-
-0-
-0-
-0-
285

20a.

Line
No
(5)Other Operating Revenue

Page 14, Column (1), Line
215

Report Period End:

(6)Transfers for Education
Page 14,Column (1), Line Line
260
No
Cost Recovery
Interest - Other
1
5
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
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 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
06/30/2014

20a.
Line
No

Report Period End:
(5)Other Operating Revenue

Page 14, Column (1), Line
215
(6)Transfers for Education

Page 14,Column (1), Line Line
260
No
255 Student Housing
255
260
265
270
275

280
-0-
-0-
285
06/30/2014

20a.

Line
No
Account No
500 Transfers for Operations(Revenue Centers) [Page

14, Column(1), Line 270]
505

Report Period End:

(7)Transfers for
Operations (Revenue
Line
Centers) Page
No
14,Column (1), Line 270
500
6010
505
510 Coronary Care
6030
510
6050
515
6070
520
6090
525
530 Burn Care
6110
530
6130
535
6150
540
6170
545
550 Pediatric Acute
6290
550
6340
555
6360
560
6380
565
6400
570
6420
575
6440
580
6470
585
6510
590
595 Nursery Acute
6530
595
600 Sub-Acute Care
6560
600
6570
601
6580
605
6610
610
6630
615
6680
620
6780
625
6900
645
650
AMBULATORY 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
06/30/2014

20a.

Line
No
Account No
Report Period End:

(7)Transfers for
Operations
(Revenue
Centers) Page
14,Column (1),
Line 270
Line
No
ANCILLARY SERVICES
7400
730
7420
735
7430
740
745 Anesthesiology
7450
745
7470
750
7480
755
7500
760
7520
765
770 Blood Bank
7540
770
775 Echocardiology
7560
775
7570
780
7590
785
7610
790
7620
795
7630
800
7640
805
7650
810
7660
815
820 Ultrasonography
7670
820
7680
825
7710
830
7720
835
7730
840
845 Renal Dialysis
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

920 TOTAL
905
-0-
920
06/30/2014

21
DETAIL OF DIRECT PAYROLL COSTS

PATIENT REVENUE PRODUCING CENTERS

(1)
CLASSIFICATION DESCRIPTION
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
.02
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$71.33
1,088
$51.53
218
$62.63
71,050
No

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
$74.85
5,660
$21.43
6,392
$54.66
231,213
45
75
$77.08
1,874
$17.76
29
$55.36
32,384
80
95
100 Sub-Acute Care
100
101
$45.96
3,070
$54.90
18,866
105
110
115
120
125
145
8,622
9,709
353,513
150
32,096
160
AMBULATORY SERVICES
$75.53
1,375
$21.00
4,995
$56.07
165

175 Clinics
170
$40.33
8,455
$52.34
20,422
$39.76
1,684
175
180
185
190
195
200
205
210
215

220
9,830
25,417
33,780
225

21


(7)
Line
No
Report Period End:

(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
06/30/2014
(11)
(12)
Clerical and Other

Administrative
.04
.05
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$25.21
24
$18.48
120
$18.88
3,665
No

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
$26.90
3,546
$15.67
61,951
$17.80
28,924
45
75
$24.99
4,737
$15.21
8,828
$18.34
2,476
80
95
100 Sub-Acute Care
100

101
$24.77
12,214
$16.05
19,596
$23.37
318
105
110
115
120
125
145
20,521
90,495
35,383
150
10,602
160
AMBULATORY SERVICES
$15.36
91
$20.76
165

175 Clinics
170
$19.39
1,104
$18.53
64,162
175
180
185
190
195
200
205
210
215

220
1,104
91
74,764
225

21


(13)
Line
No
"REVENUE PRODUCING CENTERS
Report Period End:

(14)
Environmental and
Food Service
(15)
(16)
Productive
Hours
(17)
(18)
Physicians
(Salaried)
Non-Physicians Medical
Practitioners
.07
.08
.06
Average
Hourly Rate
06/30/2014
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
40
45
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
150
AMBULATORY SERVICES
160
165

175 Clinics
170
$80.32
4,793
175
180
185
190
195
200
205
210
215

220
4,793
225

21

Line
No

Report Period End:
(19)
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Line
Average Hourly
Rate
Productive
Hours
$54.07
3,569
No

5
10
Coronary Care
$59.83
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
80
85
85
90
Other Acute Care
90
95
Nursery Acute
95
100
Sub-Acute Care
100
101
Sub-Acute Care - Pediatric
105
Skilled Nursing Care
110
Psychiatric Long-Term Care
115
Intermediate Care
115
120
Residential Care
120
125
Other Long-Term Care Services
125
145
Other Daily Hospital Services
150
TOTAL DAILY HOSPITAL SERVICES
40
$45.38
14,710
$43.59
45
75
$45.30
1,145
$44.36
80
101
$39.61
1,127
$33.47
105
110
145
20,551
150
AMBULATORY SERVICES
160
Emergency Services
165
Medical Transportation Services
$49.62
1,437
$46.40
160
170
Psychiatric Emergency Rooms
175
Clinics
180
Satellite Clinics
180
185
Satellite Ambulatory Surgery Center
185
190
Outpatient Chemical Dependency Svcs.
190
195
Observation Care
195
200
Partial Hospitalization - Psychiatric
200
205
205
210
Hospice - Outpatient Services
210
215
Adult Day Health Care Services
215
220
Other Ambulatory Services
225
TOTAL AMBULATORY SERVICES
165
170
$48.11
421
$30.74
175
220
1,858
225
06/30/2014

21

(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
Total Paid
Hours
79,734
17,592
97,326
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No

Line
No
Column (22)
2080

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
352,396
61,707
414,103
45
75
51,473
6,380
57,853
80
95
100 Sub-Acute Care
100

101
55,191
8,723
63,914
105
110
115
120
125

145
538,794
94,402
633,196
150
50,596
9,366
59,962
160
AMBULATORY SERVICES
165

175 Clinics
170
101,041
13,326
114,367
175
180
185
190
195
200
205
210
215

220
151,637
22,692
174,329
225

21


(1)
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
.02
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$67.43
7,216
$20.79
22,117
$58.52
62,626
$48.00
8,733
No
ANCILLARY SERVICES
230
240
245 Anesthesiology
245
250

255
$59.67
10,039
$34.04
55,537
260
$31.82
3,632
265
270 Blood Bank
270
275 Echocardiology
275
$63.65
2,003
$43.65
8,419
$33.67
24
$28.47
14,179
$61.44
13,554
280
285
290
235
295
$57.27
8,392
$35.82
39,856
$62.66
3,692
$48.27
4,340
310
$40.96
3,763
315
320 Ultrasonography
$40.08
5,474
320
$33.10
5,464
325
305

330
$66.12
1,417
$34.86
38,066
335
$63.30
1,772
$26.86
$65.72
16,244
$25.50
1,056
$64.15
7,392

345 Renal Dialysis
300
340
350 Lithotripsy
345
350
355
360
365
370
375
380
385

390
$64.17
5,628
$49.58
26,338
395

400
36,491
236,981
103,508
405

21


(7)
Line
No
Report Period End:

(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
Average
Hourly Rate
06/30/2014
(11)
.04
Productive
Hours
(12)
Clerical and Other

Administrative
.05
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$14.04
14,788
$20.22
14,215
No
ANCILLARY SERVICES
230
235
240
245 Anesthesiology
245
250
255
$17.53
3,088
260
$26.20
3,110
265
270 Blood Bank
270
275 Echocardiology
275
$28.45
244
$19.85
1,796
$23.12
2,219
280
$19.50
$21.09
804
285
290
295
$17.52
18,495
300
305
310
$14.00
16
$15.59
851
320 Ultrasonography
315
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
$13.87
1,316
$17.57
806
355
360
365
370
375
380
385
390
$19.29
35,221

395
400
244
17,908
78,825
405

21


(13)
Line
No
Report Period End:

(14)
Environmental and
Food Service
(15)
(16)
Productive
Hours
(17)
(18)
Physicians
(Salaried)
Non-Physicians Medical
Practitioners
.07
.08
.06
Average
Hourly Rate
06/30/2014
Average
Hourly Rate
Productive
Hours
Line
Average
Hourly Rate
Productive
Hours
$94.89
4,567
No
ANCILLARY SERVICES
230
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385

390
$71.57
2,636

395
400
7,203
405

21

Line
No

Report Period End:
(19)
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Line
Average Hourly
Rate
Productive
Hours
$43.34
9,402
No
ANCILLARY SERVICES
230
Labor and Delivery Services
235
Surgery and Recovery Services
230
240
Ambulatory Surgery Services
245
Anesthesiology
250
Medical Supplies Sold to Patients
255
Durable Medical Equipment
260
Clinical Laboratory Services
$46.79
1,904
$37.30
260
265
Pathological Laboratory Services
$41.83
23
$29.55
265
270
Blood Bank
275
Echocardiology
280
Cardiac Catheterization Services
$51.17
446
$54.66
280
285
Cardiology Services
$16.98
124
$29.51
285
290
Electromyography
295
Electroencephalography
300
Radiology - Diagnostic
305
Radiology - Therapeutic
310
$46.15
235
240
$47.95
245
250
255
270
275
290
295
$41.79
1,008
$37.48
300
Nuclear Medicine
$42.20
20
$52.36
310
315
Magnetic Resonance Imaging
$39.87
23
$44.64
315
320
Ultrasonography
$40.99
320
325
Computed Tomographic Scanner
$31.48
325
330
Drugs Sold to Patients
335
Respiratory Therapy
340
345
Renal Dialysis
350
Lithotripsy
355
Gastro-Intestinal Services
360
Physical Therapy
360
365
Speech-Language Pathology
365
370
Occupational Therapy
370
375
Other Physical Medicine
375
380
Electroconvulsive Therapy
380
385
Psychiatric/Psychological Testing
385
390
Psychiatric Individual/Group Therapy
395
Organ Acquisition
400
Other Ancillary Services
405
TOTAL ANCILLARY SERVICES
305
330
$44.08
211
$35.91
$56.42
546
$65.04
$33.50
673
$56.12
335
340
345
350
355
390
$45.87
423
$38.92
395
400
14,803
405
06/30/2014

21


(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
Total Paid
Hours
134,931
23,624
158,555
8,733
10
8,743
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Line
No
Column (22)
2080
ANCILLARY SERVICES
230

245 Anesthesiology
235
240
245
250
255
70,568
9,055
79,623
260
6,765
864
7,629
265
270 Blood Bank
270
275 Echocardiology
275
28,681
3,571
32,252
280
15,139
2,543
17,682
285
290
295
71,443
10,746
82,189
4,360
779
5,139
310
3,802
779
4,581
315
320 Ultrasonography
5,474
724
6,198
320
6,315
343
6,658
325
39,694
7,016
46,710
18,569
2,998
21,567
11,243
1,958
13,201
305

330

345 Renal Dialysis
335
340
350 Lithotripsy
300
345
350
355
360
365
370
375
380
385

390
70,246
10,147
80,393
495,963
75,157
571,120

395
400
405

21.1
DETAIL OF DIRECT CONTRACTED COSTS


Report Period End:
(1)
(2)
(3)
06/30/2014
(4)
Registry Nursing
Personnel
Other Contracted
Services
.25
.21, .26
(5)
Total Contracted
Hours
Line
No
Line
Average Hourly
Rate
Productive Hours
$109.58
1,602
Average Hourly
Rate
Productive Hours
No

5
10
Coronary Care
1,602
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
$64.09
1,425
1,425
45
75
$49.95
309
309
80
95
100 Sub-Acute Care
100

101
$56.05
1,549
1,549
105
110
115
120
125
145
4,885
4,885
150
2,504
2,504
160
AMBULATORY SERVICES
$77.89
165
170
175 Clinics
$50.00
175
180
185
190
195
200
205
210
215

220
2,504
2,508
225

21.1


Report Period End:
(1)
(2)
(3)
06/30/2014
(4)
Registry Nursing
Personnel
Other Contracted
Services
.25
.21, .26
(5)
Total Contracted
Hours
Line
No
Line
Average Hourly
Rate
Productive Hours
$88.16
2,213
Average Hourly
Rate
Productive Hours
No
ANCILLARY SERVICES
230
2,213
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
$102.61
234
234
285
290
280
$118.28
827
$71.88
48
48
295
$89.90
192
1,019
300
305
310
$85.71
156
156
315
320 Ultrasonography
$81.65
152
152
320
325
330
$116.11
84
84
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395

400
3,040
866
3,906
405

22


(1)
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
.02
Average
Hourly Rate
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Productive
Hours
No
$36.48
1,851
$26.32
5,893
5,893
10
RESEARCH COSTS
5
10
TOTAL RESEARCH
1,851
EDUCATION COSTS
15
15
20
School of Nursing
20
25
30
35
35
40
Student Housing
40
45
50
TOTAL EDUCATION
25
$50.03
6,395
30
45
6,395
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
80
85
90
95
75
$48.28
1,844
$35.05
5,577
$49.79
1,795
$18.61
18,431
Pharmacy
$84.68
3,095
$41.04
43,551
85
90
95
100
105 Grounds
110 Security
80
105
$22.60
6,434
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
$42.27
1,932
$29.36
1,965
135
140 Data Processing
$64.29
$59.50
10,491
140
145
15,107
80,015
150
3,497
155
FISCAL SERVICES
$65.51
2,115
$39.63
1,727
$44.65
5,311
$34.84
160

170 Admitting
165
$23.69
1,081
175

170
195
9,153
4,578
200

22


(1)
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
.02
Average
Hourly Rate
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Productive
Hours
No
$156.13
8,994
$41.26
7,080
$47.91
7,765
$36.34
3,034
225 Personnel
$90.14
3,550
$35.56
2,231
225
$55.43
1,863
$48.07
1,212
230
$39.08
798
$26.61
4,974
240
$37.61
1,821
245
$33.34
9,144
250
$53.22
3,183
210
215
220

205
235
245 Medical Library

250 Medical Records
$61.01
2,480
$57.33
1,772
$66.05
9,693
255
260
265
270
$69.57
9,458
$52.31
33,016
275
$24.62
5,446
$19.70
2,251
280
295
51,819

67,946
300
350
$14.37
155
370

22


(7)
Line
No
Report Period End:

(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
Average
Hourly Rate
06/30/2014
(11)
.04
Productive
Hours
Average
Hourly Rate
(12)
Clerical and Other

Administrative
.05
Productive
Hours
Line
Average
Hourly Rate
Productive
Hours
No
$14.02
12,194
12,194
10
RESEARCH COSTS
5
10
TOTAL RESEARCH
EDUCATION COSTS
15
15
20
School of Nursing
20
25
30
35
35
40
Student Housing
40
45
50
TOTAL EDUCATION
25
$29.78
1,916
30
45
1,916
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
75
80
80
85
90
$16.15
13,072
95
Pharmacy
$17.60
2,417
85
90
95
100
105 Grounds
105
110 Security
110
115 Parking
115
120 Housekeeping
120
125

135 Communications
130
$16.36
11,844
140 Data Processing
135
140
145
27,333
150
FISCAL SERVICES
$30.81
1,803
155
$22.06
28,018
160
$18.85
47,737

170 Admitting
165
175

170
195
77,558
200

22


(7)
Line
No
Report Period End:

(8)
Licensed
Vocational Nurses
(9)
(10)
Productive
Hours
(11)
(12)
Aides and
Orderlies
Clerical and Other

Administrative
.04
.05
.03
Average
Hourly Rate
06/30/2014
Average
Hourly Rate
Productive
Hours
Line
Average
Hourly Rate
Productive
Hours
No
$30.77
14,473
205
$14.80
1,980
225 Personnel
$22.45
3,650
225
$16.77
255
230
210
215
220
235
240
245 Medical Library
245
250 Medical Records
$19.23
18,880
250
$27.91
5,348
255
$23.51
9,740
260
265
270
$22.20
11,377
275
$16.91
18,008
280
295
83,711

300
350
$15.50
5,040
370

22


(13)
Report Period End:

(14)
(15)
(16)
06/30/2014
(17)
(18)
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
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
75
80
80
85
85
90
90
95
Pharmacy
95
100
105 Grounds
110 Security
105
$16.52
25,579
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
135
140 Data Processing
140

145
25,579
150
FISCAL SERVICES
155
160
165
170 Admitting
170
175
195
200

22


(13)
Line
No
Report Period End:

(14)
Environmental and
Food Service
(15)
(16)
Physicians
(Salaried)
.06
Average
Hourly Rate
06/30/2014
(17)
.07
Productive
Hours
Average
Hourly Rate
(18)
Non-Physician Medical
Practitioners
.08
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
205
210
215
220
225 Personnel
225
230
235
240
245 Medical Library
245
250 Medical Records
250
255
260
265
270
275
280
295
300
350
370

22

Line
No

Report Period End:
(19)
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Line
Average Hourly
Rate
Productive
Hours
$11.22
5,759
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
$17.00
5,759
5
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
30
35
35
40
Student Housing
40
45
50
TOTAL EDUCATION
25
$28.93
4,234
$40.35
30
45
4,234
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
80
85
90
75
$42.31
186
$43.32
80
$45.60
45
$19.36
95
Pharmacy
$43.61
6,023
$43.48
100
Purchasing and Stores
105
Grounds
110
Security
115
Parking
115
120
Housekeeping
120
125
Plant Operations
125
130
Plant Maintenance
135
Communications
$14.65
26
$20.87
135
140
Data Processing
$48.02
2,144
$56.83
140
145
Other General Services
150
TOTAL GENERAL SERVICES
85
90
95
100
105
$19.57
142
$17.76
110
130
145
8,566
150
FISCAL SERVICES
155
General Accounting
$73.06
16
$44.65
155
160
Patient Accounting
$21.50
16
$24.19
160
165
Credit and Collection
170
Admitting
$22.92
117
$21.36
175
Outpatient Registration
195
200
TOTAL FISCAL SERVICES
165
170
175
195
149
200
06/30/2014

22


Report Period End:
(19)
(20)
Other Salaries
and Wages
Line
.09
No
(21)
Cost Center
Average Hourly
Rate
Line
Average Hourly
Rate
Productive
Hours
No
$86.61
228
$69.42
$17.09
170
$39.85
205
210
205
215
Public Relations
220
225
Personnel
$34.69
16
$53.37
225
230
$19.70
2,276
$37.82
230
235
Auxiliary Groups
240
Chaplaincy Services
$26.68
31
$28.44
240
245
Medical Library
$37.50
$37.71
245
250
Medical Records
$34.81
273
$27.61
250
255
Medical Staff Administration
$43.78
32
$35.53
255
260
Nursing Administration
$46.67
1,201
$45.22
260
265
Nursing Float Personnel
270
Inservice Education - Nursing
275
Utilization Management
$55.11
383
$52.06
275
280
$15.68
104
$18.88
280
295
300
TOTAL ADMINISTRATIVE SERVICES
350
370
Non-Operating Cost Centers
210
215
220
235
265
270
295
4,722
300
350
$14.31
13
$16.27
370
06/30/2014

22


(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
Total Paid
Hours
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Line
No
Column (22)
2080
RESEARCH COSTS
5
25,697
4,831
30,528
10
TOTAL RESEARCH
25,697
4,831
30,528
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
30
35
35
40
Student Housing
40
45
50
TOTAL EDUCATION
25
12,545
1,167
13,712
30
45
12,545
1,167
13,712
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
80
85
90
95
75
7,607
1,447
9,054
33,343
4,662
38,005
Pharmacy
55,086
7,137
62,223
85
90
95
100
105 Grounds
110 Security
80
105
32,155
3,680
35,835
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
15,767
3,041
18,808
135
140 Data Processing
12,642
1,629
14,271
140
156,600
21,596
178,196
150
7,431
1,194
8,625
155
29,761
4,643
34,404
160
54,246
7,062
61,308

145
FISCAL SERVICES

170 Admitting
165
175

170
195
91,438
12,899
104,337
200

22


(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Line
No
Productive
Hours
NonProductive
Hours
Total Paid
Hours
Column (22)
2080
30,775
5,978
36,753
12,949
2,130
15,079
225 Personnel
9,447
1,521
10,968
225
5,606
468
6,074
230
5,803
713
6,516
240
245 Medical Library
1,829
270
2,099
245
250 Medical Records
30,777
5,244
36,021
250
7,152
883
8,035
255
23,817
3,372
27,189
260
205
210
215
220
235
265
270
54,234
6,916
61,150
275
25,809
2,887
28,696
280
208,198
30,382
238,580
5,208
413
5,621

295

300
350
370

22.1


(3)
Line
No
Report Period End:

(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
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
80
85
85
90
90
95
Pharmacy
75
$82.42
749
80
95
100
105 Grounds
110 Security
105
$100.80
30
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
135
140 Data Processing
140
145
779
150
FISCAL SERVICES
155
$71.01
366
160
165
170 Admitting
170
175

195
366
200
06/30/2014

22.1


(3)
Line
No
Report Period End:

(4)
Other Contracted
Services
.26
Line
Average
Hourly Rate
Productive
Hours
No
$73.52
694
205
210
215

225 Personnel
220
$63.16
228
225
230
235
240
245 Medical Library

250 Medical Records
245
$118.31
241
250
255
260
265

270
$107.88
1,641
275
280

295
2,804
300
350
370
06/30/2014

OSHPD Reports

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OSHPD Reports

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HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

USING DATA SUBMITTED BY FACILITY

*EXCLUDES BEDS IN SUSPENSE

FINANCIAL AND UTILIZATION DATA BY PAYER

TRAUMA CENTER DESIGNATION

Gross Inpatient Revenue

Gross Outpatient Revenue

Net Inpatient Revenue

Net Outpatient Revenue

Net Inpatient Revenue Per Day

USING DATA SUBMITTED BY FACILITY

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

SUMMARY STATEMENT OF INCOME

DATE PREPARED: 6/24/2015

GROSS PATIENT REVENUE BY REVENUE CENTER

USING DATA SUBMITTED BY FACILITY

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

DATE PREPARED: 6/24/2015

BALANCE SHEET SUMMARY

REPORT PERIOD: 07/01/2013

TOTAL CURRENT LIABILITIES

FINANCIAL RATIO FORMULAS

.53 (TOTAL CURRENT ASSETS + BOARD DESIG. CASH + BOARD DESIG.

ACID TEST RATIO

.07 (CASH + MARKETABLE SECURITIES + BOARD DESIG. CASH + BOARD DESIG.

DAYS IN ACCOUNTS RECEIVABLE

46.71 NET ACCOUNTS RECEIVABLE / (NET PATIENT REVENUE / DAYS IN REPORT

BAD DEBT RATE

DEBT, RISK, AND LEVERAGE RATIOS

91.55% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100

DEBT SERVICE COVERAGE RATIO

( .48) (NET INCOME + INTEREST-WORKING CAPITAL + INTEREST-OTHER +

INTEREST EXPENSE AS A PERCENTAGE

1.47% ((INTEREST-WORKING CAPITAL + INTEREST-OTHER) / TOTAL OPERATING

NET RETURN ON EQUITY

FIXED ASSET RATIOS

AVERAGE AGE OF PLANT

13.81% ((CURRENT YEAR GROSS PROPERTY, PLANT AND EQUIPMENT +

SUMMARY OF FINANCIAL AND UTILIZATION DATA FOR SELECTED COST CENTERS

PSYCHIATRIC ACUTE - ADULT

ALTERNATE BIRTHING CENTER

CHEMICAL DEPENDENCY SERVICES

SKILLED NURSING CARE

HOME HEALTH CARE SERVICES

USING DATA SUBMITTED BY FACILITY

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

NON-REVENUE PRODUCING COST CENTERS

UNIT CODE DESCRIPTIONS

DATE PREPARED: 6/24/2015

<-----------------STANDARD UNIT OF MEASURE ------------------>

USING DATA SUBMITTED BY FACILITY

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

PERCENTAGE OF HOURS AND AVERAGE HOURLY RATE BY EMPLOYEE CLASSIFICATION

TOTAL OPERATING COST CTRS

AVERAGE HOURLY RATE

COST CENTER GROUP

HOSPITAL PERSONNEL PROFILE

* EXCLUDES REGISTRY NURSES AND TEMPORARY HELP

TOTAL NUMBER OF NURSING FTE'S**

HOSPITAL DISCLOSURE REPORT FACSIMILE

Date Prepared: 6/24/2015

GENERAL INFORMATION AND CERTIFICATION

( Page 0 Submitted Data )