Pleasant Valley Hospital Department Operations Review Review Period Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

Actual I/P Stat O/P Stat Total Stat Revenues: I/P Revenue - Department O/P Revenue - Department Total Revenue 2,921 43,423 46,343 18 430 448

Last Year 19 210 229

Budget 19 210 229

2,982 30,380 33,362

3,168 20,131 23,299

Operating Expenses Salary and Wages 0010 Administrative Wages 0020 Tech Wages 0030 RN Wages 0040 LPN Wages 0050 Aides Wages 0060 Clerical & Other Wages 0070 Envir/Food Serv Aide Wages 0080 Physician Wages Total Salaries & Wages 7,530 8,902 6,468

7,530

8,902 Contract Labor Employee Benefits 712

6,468

0100 FICA/MDCR 0110 Pension 0120 Health 0130 Unemployment 0140 Workers Comp 0150 Life 0160 Disability 0170 Benefits - Allocated Total Employee Benefits

680

495

680 Supplies

712

495

1200 Cost of Goods Sold 3100 Med/Surg Supplies 3110 Chargable Med/Surg Supplies 3120 Radiographic Supplies 3130 IV Solutions 3200 Instruments 3300 Drugs 3325 Radiographic Contrast Drugs 3350 Over the Counter Drugs 3400 Oxygen 3500 Xray Film 3600 Linen 3700 Medical Gas 3800 Food 3801 Catering Food 3810 Liquid Nutrients 3820 Dietary Supplements 3900 Dishes & Utensils 5700 Books 5710 Library Books 5900 Supplies

239

172

Pleasant Valley Hospital Department Operations Review Review Period Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

Actual 5901 Supplies Allocated 5905 Supplies - Implants 5910 Oxygen Supplies 5915 Minor Equipment 5920 Supplies - Blood 5930 Supplies - Coagulation 5940 Non-Reimb Supplies 7200 Postage & Freight 9100 Lithotripter Supplies Total Supplies 1

Last Year

Budget

239

176

Profees 2600 Professional Fees Total Professional Fees -

Pleasant Valley Hospital Department Operations Review Review Period Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

Actual 2200 Collection/Billing Fees 2300 Xray & Lab Fees 2610 Pharmacists 2650 Barber & Beauty Costs 6000 Purchased Service 6001 Purchased Services - Visions 6002 Purch Serv Allocated 6005 Outreach Purchased Service 6010 MRI Purchased Service 6020 Equipment Rental 6030 Rental - Buildings 9200 Lithotripter Purchased Service Total Purchased Services

Last Year Purchased Services

Budget

25

Repairs and Maint 38 56 94 Utilities

25

8000 Repairs 8100 Service Contracts 8300 Motor Vehicle Service Total Repairs & Maintenance

50 50

86 86

6100 Electric 6200 Gas 6300 Water 6400 Garbage 6800 Telephone Total Utilities Insurance 8611 Insurance -

Total Insurance

Other Professional Fees - Legal/Audit/Consult 2000 Legal Fees 2010-2022 Malpractice 2100 Auditing Fees 2410-2420 Recruitment 2620 Consultants Total Other Professional Fees

Travel and Education

1900 Education 1910 Med Staff Education 1950 Tuition Reimbursement 7000 Travel 7500 Continuing Education Total Travel & Education

10

39

10 Dues and Subscriptions

39

6900 Dues & Subscriptions

Total Dues & Subscriptions

Pleasant Valley Hospital Department Operations Review Review Period Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

Actual

Last Year

Budget

All Other Direct Expense 1500 Christmas 1510 Recreation/Empl Appreciation 2110 Late Fees 2390 Grant Expense 2391 Home Care Grant Expense 2400 Advertising 2450 Promotional Activities 6050 Allocated Laundry Costs 6910 License & Permit Fees 8301 Vehicle Fuel 8310 Credit for Billing Fees 8601 Bad Debt 9500 Donations 9501 Disposals/Outdates 9510 EMS Donations 9900 Misc 9950 Allocation - PVH/NRC 9951 Allocaiton PVH/DME 9953 Allocation PVH/PHYS 9954 Allocation PPS Bill/Phys 9955 Allocation PPS Adm/Phys 9901 Misc Allocation 9990 Gross Variance Total Other Direct Expense -

Pleasant Valley Hospital Department Operations Review Review Period Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

Actual

Last Year

Budget

Depreciation & Amortization 8511 Depreciation - Equip 8512 Depreciation - Rental Prop 8515 Depreciation - Buildings 8520 Depreciation Fixed Equipment 8525 Depreciation Land Improvement 8527 Depreciation Phys/Other 8530 Depreciation Leased Equip 8535 Depreciation Leasehold Imp 8537 Depreciation Leased Buildings 8540 Depreciation Inventory Total Depreciation & Amortization

Interest Expense

8691 Interest 8695 Interest Bond Issue 8696 Interest Bond Discount 8697 Amortize Loan Costs Total Interest Expense

Taxes

8602 Medicaid Provider Tax 8683 Sales & Use Tax 8684 Corporate Taxes - State 8685 Corporate Taxes - Federal 8686 B&O Taxes 8689 Other Taxes Total Taxes

Expense Input Total per DOR Difference (s/be 0) Total Manhrs - Department FTE's: Hospital FTE's - Department Contract FTE's - Department Total FTE's - Department Overtime Hrs - Department OT % Pd

8,315 8,315 0

9,928 9,928 0

7,281 7,264 17

301

339

336

1.88 0.00 1.88 1.60 0.53%

2.12 0.00 2.12 10.70 3.16%

2.10 0.00 2.10 0.00 0.00%

Note: When there are three pays in a period under review, change the respective formula highlighted in yellow to reflect 240 hours.

Pleasant Valley Hospital Department Operations Review Review Period: Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

Volume and Revenue

Current Month Actual Last Year 448 229 46,343 33,362 103.45 145.68 Budget 229 23,299 101.74 Last Yr Variance 219 12,982 (42.24) % Variance 95.63% 38.91% -28.99% Budget Variance 219 23,044 1.70 % Variance 95.63% 98.91% 1.67%

Total Stat Total Revenue Revenue Per Stat

Comments Budget1) 2) 3) Prior Year1) 2) 3)

Salary and Wages

Current Month Last Year 9,614 Last Yr Variance (1,405) % Variance -14.61% Budget Variance 1,247 % Variance 17.90%

Salaries & Benefits FTE's Hospital FTE's - Department Contract FTE's - Department Total FTE's - Department Total Manhrs - Department Total Manhrs - Accrual Rate excludes contract FTEs Total S&W/Stat Total Manhr's/Stat (accrual rate) OT %

Actual 8,210

Budget 6,963

1.88 1.88 301 326

2.12 2.12 339 366

2.10 2.10 336 363

(0.23) 0.00 (0.23) (37) (40)

-10.96% 0.00% -10.96% -10.96% -10.96%

(0.22) 0.00 (0.22) (35) (37)

-10.30% 0.00% -10.30% -10.30% -10.30%

18.32 0.73 0.53%

41.98 1.60 3.16%

30.41 1.59 0.00%

(23.66) (0.87) -2.63%

-56.35% -54.49% -83.21%

(12.08) (0.86) 0.53%

-39.73% -54.15% 100.00%

Comments Budget1) 2) 3) 4) 5) Prior Year1) 2) 3) 4) 5)

Pleasant Valley Hospital Department Operations Review Review Period: Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

Supplies
Current Month Last Year 1 239 0.00 1.05 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 239 0 0 0 0 0 0 0 0 0 239 Last Yr Variance (238) (1.04) 1 (239) (238) % Variance -99.40% -99.69% 0.00% 100.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% -100.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% -99.40% Budget Variance (175) (0.77) (3) (172) (175) % Variance -99.18% -99.58% 0.00% -64.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% -100.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% -99.18%

Actual Supply Dollars Supplies/Stat 1200 Cost of Goods Sold 3100 Med/Surg Supplies 3110 Chargable Med/Surg Supplies 3120 Radiographic Supplies 3130 IV Solutions 3200 Instruments 3300 Drugs 3325 Radiographic Contrast Drugs 3350 Over the Counter Drugs 3400 Oxygen 3500 Xray Film 3600 Linen 3700 Medical Gas 3800 Food 3801 Catering Food 3810 Liquid Nutrients 3820 Dietary Supplements 3900 Dishes & Utensils 5700 Books 5710 Library Books 5900 Supplies 5901 Supplies Allocated 5905 Supplies - Implants 5910 Oxygen Supplies 5915 Minor Equipment 5920 Supplies - Blood 5930 Supplies - Coagulation 5940 Non-Reimb Supplies 7200 Postage & Freight 9100 Lithotripter Supplies Total Supplies

Budget 176 0.77 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 172 0 0 0 0 0 0 0 0 0 176

Comments

Pleasant Valley Hospital Department Operations Review Review Period: Department: Department #: Dept Mgr

December 31,2010 Occupational Therapy 7092 Debra Long

All Other Expenses

Current Month Last Year 50 0 0 0 0 25 0 0 0 0 0 0 75 0.33 Last Yr Variance 44 (25) 10 29 (0.10) % Variance 88.00% 0.00% 0.00% 0.00% 0.00% -100.00% 0.00% 0.00% 0.00% 100.00% 0.00% 0.00% 38.21% -29.35% Budget Variance 8 (29) (21) (0.31) % Variance 9.30% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% -75.23% 0.00% 0.00% -17.07% -57.61%

Actual Repairs and Maint Utilities Insurance Other Professional Fees Professional Fees - Physicians Purchased Services Depreciation & Amortication Interest Expense Taxes Travel and Educ Dues and Sub All Other Direct Expense Total Other Exp Other Exp per Stat 94 0 0 0 0 0 0 0 0 10 0 0 104 0.23

Budget 86 0 0 0 0 0 0 0 0 39 0 0 125 0.55

Comments

Total per Explanations Total per DOR Difference (s/be 0)

8,315 8,315 -

9,928 9,928 -

7,264 7,264 -

Volume Adjusted Variance Analysis - Salary Variance

Payroll Hours are stated at the accrual rate. 7092

December 31,2010 Actual Volume of Service Salaries for the Period Payroll Hours for the Period Variable Expense Factor: The Budget was Adjusted for Volume by The Variance Associated with Labor Rate is The Variance Associated with Efficiency is The Total Volume Adjusted Variance is 448 7,530 326 Budget 229 6,468 363 50.00% $ $ $ $ 3,093 (1,728) * 3,759 * 2,031 *

Actual Volume Budget Volume: Variable Expense Factor: Volume Change Volume Adjustment Factor
Description Salaries Volume Adjustment Total Hours Volume Adjustment Total Labor Rate Labor Rate Variance:
([Difference in the Labor Rates] x Total Actual Hours)

448 229 50.00% 95.63% 47.82%

Budget Variance Favorable / (Unfavorable) $6,468 ($1,062) 3,093 $9,561 363.3 173.7 537.0 $17.80 $3,093 $2,031 37.4 173.7 211.1 ($5.30)

Actual $7,530

$7,530 325.9

325.9 $23.11

($1,728) *

Efficiency Variance:
([Difference in Hours] x Budget Labor Rate)

Total Variance:

$3,759 * $2,031 *

Volume Adjusted Variance Analysis - Salary Variance

Payroll Hours are stated at the accrual rate. 7092

December 31,2010

CY Actual 448 7,530 326

PY Actual 229 8,902 366 50.00% $ $ $ $ 4,257 397 * 5,232 * 5,629 *

Volume of Service Salaries for the Period Payroll Hours for the Period Variable Expense Factor: The prior year was Adjusted for Volume by The Variance Associated with Labor Rate is The Variance Associated with Efficiency is The Total Volume Adjusted Variance is

CY Actual Volume PY Actual Volume: Variable Expense Factor: Volume Change Volume Adjustment Factor
Description Salaries Volume Adjustment Total Hours Volume Adjustment Total Labor Rate Labor Rate Variance:
([Difference in the Labor Rates] x Total CY Actual Hours)

448 229 50.00% 95.63% 47.82%

PY Actual $8,902 4,257 $13,159 366.0 175.0 541.0 $24.32 Variance Favorable / (Unfavorable) $1,372 $4,257 $5,629 40.1 175.0 215.1 $1.22

CY Actual $7,530

$7,530 325.9

325.9 $23.11

$397 *

Efficiency Variance:
([Difference in Hours] x PY Labor Rate)

Total Variance:

$5,232 * $5,629 *

Volume Adjusted Variance Analysis - Supply Variance

7092 December 31,2010 Actual Volume of Service Supplies for the period Variable Expense Factor: The Budget was Adjusted for Volume by The Total Volume Adjusted Variance is 448 1 Budget 229 176 50.00% $ $ 84 259 *

Actual Volume Budget Volume: Variable Expense Factor: Volume Change Volume Adjustment Factor
Description Supplies Volume Adjustment Total Actual $1 Budget

448 229 50.00% 95.63% 47.82%

Variance Favorable / (Unfavorable) $176 $175 84 $260 $84 $259

$1

Volume Adjusted Variance Analysis - Supply Variance

7092 December 31,2010 CY Actual 448 1 PY Actual 229 239 50.00% $ $ 114 352 *

Volume of Service Supplies for the period Variable Expense Factor: The Prior Year was Adjusted for Volume by The Total Volume Adjusted Variance is

Actual Volume Prior Year Volume Variable Expense Factor: Volume Change Volume Adjustment Factor
Description Supplies Volume Adjustment Total Actual $1 Prior Year

448 229 50.00% 95.63% 47.82%

Variance Favorable / (Unfavorable) $238 $114 $352

$239 114 $354

$1