OSHPD Reports

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT
USING DATA SUBMITTED BY FACILITY

FACILITY NO:106190754
ST. FRANCIS MEDICAL CENTER
3630 E. IMPERIAL HIGHWAY
LYNWOOD
CA
PHONE NO:
OWNER:
90262
GENERAL INFORMATION
TYPE OF CONTROL: Church
TYPE OF CARE:
General
LICENSED BEDS*
65
ACUTE
289
LONG-TERM
30
TOTAL
OCCUPANCY RATE
Los Angeles
11
HFPA NO:
0923
EMERGENCY SERVICES
INTENSIVE
65
EMERGENCY ROOM
288
TRAUMA CENTER DESIGNATION
30
OBSERVATION
ORTHOPEDIC
383
PSYCHIATRIC
62.70%
HELICOPTER
ACUTE
LONG-TERM
OTHER
OTHER
384
62.60%
*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
TOTAL
OCCUPANCY RATE
NO. BASSINETS
40
TOTAL
MEDICARE
TRADITIONAL
19,145
2,896
6.6
5.7
14,871
3,065
$214,555,715
$50,852,342
$204,716,844
$55,605,979
$5,085,234
$2,904
$19,201
$342
MEDICARE
MANAGED CARE
6,147
1,302
4.7
4.6
11,623
2,126
$94,814,766
$40,329,873
$124,688,496
$22,839,323
$9,714,806
$3,716
$17,542
$836
MEDI-CAL
TRADITIONAL
23,390
5,516
4.2
4.1
36,653
12,664
$200,880,072
$84,587,791
$160,642,878
$87,837,740
$36,987,245
$3,755
$15,924
$1,009
MEDI-CAL
MANAGED CARE
21,018
5,808
3.6
3.5
50,264
29,140
$295,561,854
$161,338,459
$416,079,032
$36,251,922
$19,788,850
$1,725
$6,242
$394
CO. INDIGENT
TRADITIONAL
CO. INDIGENT
MANAGED CARE
4,314
1,011
4.3
4.3
521
476
$62,282,503
$12,897,410
$61,746,906
$11,128,522
$2,304,485
$2,580
$11,007
$4,423
THIRD PARTY
TRADITIONAL
6,066
411
14.8
14.8
21,266
4,145
$3,200,778
$1,626,351
$3,785,878
$690,434
$350,817
$114
$1,680
$16
THIRD PARTY
MANAGED CARE
5,960
OTHER
INDIGENT
929
OTHER
PAYERS
724
1,545
3.9
207
4.5
161
4.5
87,693
18,857
4.7
4.4
184,703
67,373
$1,000,123,882
$452,799,614
$1,154,235,588
$244,301,700
$94,597,364
$2,786
$12,955
$512
127,395
$2,660
3.8
4.2
4.2
1,227
24,456
23,822
862
7,573
7,322
$67,023,409
$35,002,596
$26,802,189

$50,941,308
$82,245,420
$28,445,099
$63,447,695
$21,780,981
$36,882,439
$21,938,537
$8,009,243
$16,674,439
$3,691,488
$3,681
$11,062
$14,200
$49,747
$13,590
$155

6/24/2015
1 OF 5
07/01/2013
06/30/2014
(310)603-6000
DAUGHTERS OF CHARITY
COUNTY:
HSA NO:
AVAILABLE BEDS
INTENSIVE
DATE PREPARED:
PAGE:
REPORT PERIOD:
THRU
LIVE BIRTH SUMMARY
NATURAL BIRTHS
CESAREAN SECTIONS
TOTAL LIVE BIRTHS
REPORT PERIOD: 07/01/2013

THRU 06/30/2014
GROSS PATIENT REVENUE BY REVENUE CENTER
3,202
1,901
5,103
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

AMBULATORY SERVICES
ANCILLARY SERVICES
TOTAL GROSS PATIENT REVENUE
$1,452,923,496
$12,128,088
$204,716,844
$124,688,496
$187,638,919
$416,079,032
($26,996,041)
$61,746,906
$3,785,878
$82,245,420
$63,447,695
$24,754,351
$1,154,235,588
$40,211,156
$338,899,064
$2,367,246
$369,420,775
($28,154,465)
$13,817,345
$1,258,808
($15,595,928)
$135,049,288
$59,142,345
$12,748,650
$4,084,626
$32,531,935
$65,439,012
$19,738,577
$3,455,597
$5,158,310
$32,072,435
$369,420,775
$90,731,275
$27,574,846
$83,645,423
$25,094,332
$67,850
$49,183,403
$8,588,041
$73,064,632
$11,470,973
$369,420,775
$312,153,643
$232,573,360
$908,196,493
$1,452,923,496
PERCENT OF TOTAL
21.5
16.0
62.5
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
$261,331,926
$3,446,631
$124,804,267
$1,143,957
$50,293
$390,777,074
TOTAL CURRENT LIABILITIES

DEFERRED INCOME
NET LONG-TERM DEBT
TOTAL LIABILITIES
$134,958,044
$157,198
$79,114,230
$214,229,472
EQUITY
TOTAL LIABILITIES AND EQUITY
$176,547,602
$390,777,074
FINANCIAL RATIO FORMULAS

LIQUIDITY RATIOS
CURRENT RATIO
ACID TEST RATIO
FORMULAS
1.96 (TOTAL CURRENT ASSETS + BOARD DESIG. CASH + BOARD DESIG.
INVESTMENTS) / TOTAL CURRENT LIABILITIES
.31 (CASH + MARKETABLE SECURITIES + BOARD DESIG. CASH + BOARD DESIG.
INVESTMENTS) / TOTAL CURRENT LIABILITIES
DAYS IN ACCOUNTS RECEIVABLE
59.77 NET ACCOUNTS RECEIVABLE / (NET PATIENT REVENUE / DAYS IN REPORT

PERIOD)
BAD DEBT RATE
0.83% (PROVISION FOR BAD DEBTS / TOTAL GROSS PATIENT REVENUE) X 100
DEBT, RISK, AND LEVERAGE RATIOS

LONG-TERM DEBT TO ASSETS RATE
DEBT SERVICE COVERAGE RATIO
INTEREST EXPENSE AS A PERCENTAGE

OF OPERATING EXPENSE
20.25% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100

.26 (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)
1.40% ((INTEREST-WORKING CAPITAL + INTEREST-OTHER) / TOTAL OPERATING
EXPENSE) X 100
PROFITABILITY RATIOS
NET RETURN ON OPERATING ASSETS
( 5.96%) ((NET FROM OPERATIONS + INTEREST-WORKING CAPITAL + INTERESTOTHER) / (TOTAL CURRENT ASSETS + NET PROPERTY, PLANT AND
EQUIPMENT)) X 100
NET RETURN ON EQUITY
( 8.83%) (NET INCOME / EQUITY) X 100
OPERATING MARGIN
( 8.25%) (NET FROM OPERATIONS / TOTAL OPERATING REVENUE) X 100
TURNOVER ON OPERATING ASSETS
.88 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
4.90% ((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
9.56 ACCUMULATED DEPRECIATION / DEPRECIATION EXPENSE
327,990 (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
9,214
$7,431.44
CORONARY CARE
BURN CARE
DEFINITIVE OBSERVATION
MEDICAL/SURGICAL ACUTE
ADJ REV
PER UNIT
ADJ DIRECT
EXP PER UNIT
$2,008.80
1
38,896
$3,635.34
$888.45
1,780
$3,259.02
$1,311.92
PSYCHIATRIC ACUTE - ADULT
12,253
$1,409.45
$552.65
OBSTETRICS ACUTE
12,395
$2,927.13
$1,040.10
PEDIATRIC ACUTE
ALTERNATE BIRTHING CENTER
CHEMICAL DEPENDENCY SERVICES

SKILLED NURSING CARE
TOTAL PATIENT CARE SERVICES
NURSERY ACUTE
AMBULATORY SERVICES
EMERGENCY SERVICES
CLINICS
1
5,758
$981.22
$438.30
87,693
$3,543.10
$1,009.53
11,716
$123.62
$188.03
78,953
$2,705.75
$251.11
11,364
$1,427.97
$213.87
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
GROSS REV
PER UNIT
5,102
557,840
109,346
1,765,165
3,669
38,347
334
21,746
96,645
91,886
7
8
9
10
11
11
11
11
14
12
11
27
$10,891.75
$190.16
$406.23
$102.07
$18,295.45
$1,022.42
$33,451.39
$3,046.64
$1,035.52
$881.34
$3,439.11
$18.12
$82.37
$4.56
$2,367.36
$99.82
$2,326.89
$67.51
$54.88
$73.82
$2,885.60
$552.70
2,829
ADJ REV
PER UNIT
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
266,742
1,401,632
87,693
379,551
737,945
1,452,923
28,140
UNIT
CODE
16
17
18
19
20
21
22
ADJ DIRECT
EXP PER UNIT
$14.75
$0.17
$16.05
$12.51
$15.24
$1.48
$108.33
UNITS OF
SERVICE
1,708
127,395
674
28,140
56,451
1,452,923
737,945
UNIT
CODE*
23
24
25
22
26
21
20
ADJ DIRECT
EXP PER UNIT
$22,671.21
$28.76
$3,578.61
$134.88
$14.80
$2.63
$6.99
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
2.69%
5.85%
5.74%
4.18%
TECHNICAL
AND
SPECIALIST
2.93%
29.82%
45.49%
20.79%
REGISTERED
NURSES
64.60%
34.96%
30.65%
48.93%
LICENSED
VOCATIONAL
NURSES
6.90%
4.65%
1.23%
4.75%
AIDES
AND
ORDERLIES
16.00%
7.47%
5.72%
11.33%
%
14.97%
5.25%
6.70%
20.51%
%
42.09%
28.76%
1.25%
48.99%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
6.34%
%
24.32%
%
32.64%
%
3.17%
%
7.56%
%
$0.00
$0.00
$0.00
$0.00
$0.00
ENVIRON.
AND
FOOD SERV.
%
%
%
%
%
%
49.85%
%
0.73%
CLERICAL
AND OTHER
EMPLOYEES
6.23%
16.42%
9.32%
8.96%
%
42.94%
16.14%
92.05%
29.77%
REGISTRY
AND
TEMP HELP
0.66%
0.83%
1.86%
1.06%
%
%
0.13%
0.78%
1.29%
TOTAL
PRODUCTIVE
HOURS
1,095,981
369,580
656,924
2,122,485
TOTAL
PAID
HOURS
1,245,524
412,481
740,218
2,398,223
11,433
526,094
159,367
356,136
13,760
588,087
178,756
402,244
TOTAL OPERATING COST CTRS

NON-OPERATING COST CENTERS
8.32%
%
16.74%
%
0.91%
%
3,182,049
3,581,070
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
1,516
12
TOTAL NUMBER OF NURSING FTE'S**

NUMBER OF NURSING REGISTRY FTE'S
674
11
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:

106190754
3. D. B.A. (Doing Business As) Name:

4. Hospital Business Phone:

(310) 603-6000
5.Medi-Cal Contract Provider Number:

HSC30104F
6. Medi-Cal Non-Contract Provider Number:

ZZT30104F
7.Medicare Provider Number:

05-0104
8. Street Address:
3630 E. IMPERIAL HIGHWAY
9. City:
LYNWOOD
10.Zip Code:
90262
11. Mailing Address (if different) - Street or P.O. Box:
12. City:
13. Zip Code:

00000
14. Chief Executive Officer:

GERALD KOZAI
15. Title:
CEO
16. Hospital Web Site Address:

WWW.STFRANCISMEDICALCENTER.ORG
17. Name of Owner:
18.Previous Name of Institution if Changed Since Previous Report:
23. Person Completing Report:
KEVIN SEELEY
24. Organization Name:

STEVE CLARK & ASSOCIATES, INC.
25. Phone Number:

(916) 673-2020 Ext: -20
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 ?
____
Yes
__X__
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
Licensed Beds (End of Period)
384
Church
Available Beds
383
Non-Profit Corporation
Short-Term - Childrens
10
15
Staffed Beds (Average)
248
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
GOVERNMENT PROGRAMS
(1)
Short-Term - General
Line
No
10
11
(3)
55
PREPAID PROGRAMS
(2)
No.of
Each Type
24 HR. ON PREMISES
COVERAGE
(3)
Line
No
60
60
Medicare
HospitalBased
Emergency Services
65
Medi-Cal
Parent Organization Based
Psychiatric ER
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
Anesthesiologist
95
65
95
100
100
105
105
ACTIVE MEDICAL STAFF PROFILE - MD's, DO's, Podiatrists and Dentists (Enter No)
Line
No
CLINICAL SPECIALTY
HOSPITAL BASED
Board
Certified
(1)
Board
Eligible
(2)
Other
(3)
NON-HOSPITAL BASED
Board
Certified
(4)
Board
Eligible
(5)
110 Aerospace Medicine
125 Cardiovascular Diseases
2
3
Fellows
(8)
115
120
9
130 Child Psychiatry
125
130
135 Colon and Rectal Surgery
135
140 Dental
145 Dermatology
Residents
(7)
Line
No
110
115 Allergy and Immunology

120 Anesthesiology
Other
(6)
RESIDENTS/FELLOWS
(Enter FTEs)
140
145
150 Diagnostic Radiology
150
155 Forensic Pathology
155
160 Gastroenterology
165 General/Family Practice
30
160
175 General Surgery
13
175
180 Internal Medicine
12
180
185 Neurological Surgery
185
190 Neurology
190
29
12
170 General Preventive Medicine
170
195 Nuclear Medicine

200 Obstetrics and Gynecology
195
205 Occupational Medicine
200
205
210 Oncology
215 Ophthalmology
220 Oral Surgery
165
210
1
215
220

1.
HOSPITAL DESCRIPTION

Line
No

CLINICAL SPECIALTY
Report Period End:
HOSPITAL BASED
Board
Certified
(1)
Board
Eligible
(2)
Other
(3)
NON-HOSPITAL BASED
Board
Certified
(4)
225 Orthopaedic Surgery
230 Otolaryngology
235 Pathology
Board
Eligible
(5)
Other
(6)
06/30/2014
RESIDENTS/FELLOWS
(Enter FTEs)
Residents
(7)
Line
No
Fellows
(8)
225
230
235
240 Pediatric-Allergy
240
245 Pediatric-Cardiology
250 Pediatric-Surgery
255 Pediatrics
18
245
250
260 Physical Medicine/Rehabilitation
255
260
265 Plastic Surgery
270 Podiatry
275 Psychiatry
265
6
270
275
280 Public Health
280
285 Pulmonary Disease

290 Radiology
16
295 Therapeutic Radiology
285
290
295
300 Thoracic Surgery
300
305 Urology
310 Vascular Surgery
305
310
315 Other Specialties
11
20
15
315
320 TOTAL
41
11
163
108
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
3
(4)
Percent
Ownership(5)
100
Type of Business
(6)
HEALTHCARE
4
5
6
7
8
9
10
11
12
Expense Included on
Line
No
3
Nature of Service or Supply
Amount
(7)
(8)
MANAGEMENT, FINANCIAL, INSURANCE SERVICES
Page
$9,118,440
(9)
Column (10)
18
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)
205

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)
Joint
(2)
Contracted
(3)
Rental
(4)
COMMENTS:
33
NEPHROLOGY, INFECTIOUS DISEASE, ENDOCRINOLOGY, PERNIATOLOGY,
34
HEMATOLOGY.
35
36
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 JOYCE WELLER
BOARD CHAIR
$0
38
SISTER MARION BILL
HEALTHCARE ADMIN
$0
39
SISTER PATRICIA MIGUEL
HEALTHCARE ADMIN
$0
40
URSULA HYMAN ESQ
ATTORNEY
$0
41
SISTER JO-ANNE LAVIOLETTE
HEALTHCARE ADMIN
$0
42
ALLEN MILLER
CEO COPE
$0
43
ROBERT ISSAI
PRESIDENT & CEO DCHS
$0
44
VICTOR CABALLERO
OWNER, FIESTA TAXI
$0
45
LOUIS RUBINO, PHD
PROFESSOR
$0
46
SAMUEL P. YNZUNZA
INVESTMENT BANKER
$0
47
CHARLES DRUTEN
DIRECTOR, EAS, INC.
$0
48
HARDING YOUNG
MD
$0
49
ANDY MOOSA
MD
$0
50
ANTHONY SOUZA
REAL ESTATE INVESTMENT
$0
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
36
36
27
9,214
(5)
Pediatric
06/30/2014
DISCHARGES
(11)
Service
(12)
Total
653
Line
No
Medical/Surgical Intensive Care
10
Coronary Care
15
Pediatric Intensive Care
20
Neonatal Intensive Care
25
Psychiatric Intensive ( Isolation ) Care
25
30
Burn Care
30
35
Other Intensive Care
35
40
Definitive Observation
45
Medical/Surgical Acute
185
184
107
50
Pediatric Acute
14
14
55
Psychiatric Acute - Adult
40
40
34
60
Psychiatric Acute - Adolescent & Child
65
Obstetrics Acute
50
50
34
70
Alternate Birthing Center
70
75
Chemical Dependency Services
75
80
Physical Rehabilitation Care
80
85
Hospice - Inpatient Care
85
90
Other Acute Care
15
29
29
22
7,397
528
20
40
38,896
9,099
45
623
50
12,253
2,225
55
12,395
5,433
1,780
60
65
90
100 Sub-Acute Care
100
101 Sub-Acute Care - Pediatric

105 Skilled Nursing Care
5
10
101
30
30
19
5,758
296
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
145
150 Total
384
383
248
155 Nursery Acute
40
40
40
78,516
9,177
18,857
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.
78,953
11,580
67,373
160
AMBULATORY SERVICES
160 Emergency Services
Visits
165 Medical Transportation Services
Occasions of Service
170 Psychiatric Emergency Rooms
Visits
175 Clinics
Visits
11,364
11,364
175
180 Satellite Clinics
Visits
39,254
39,254
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
5,102
5,102
557,840
397,240
160,600
230
Anesthesia Minutes
574,691
410,308
164,383
250 Medical Supplies Sold to Patients
CS & S Adj. Inpatient Days
109,346
255 Durable Medical Equipment
Adjusted Inpatient Days
260 Clinical Laboratory Services
Tests
1,765,165
1,283,280
481,885
260
265 Pathological Laboratory Services
Tests
2,791
1,847
944
265
270 Blood Bank
Units of Blood Issued
16,574
15,160
1,414
270
275 Echocardiology
Procedures
280 Cardiac Catheterization Services
Procedures
3,669
2,309
1,360
280
285 Cardiology Services
Procedures
30,691
20,771
9,920
285
290 Electromyography
Procedures
295 Electroencephalography
Procedures
981
878
103
295
300 Radiology - Diagnostic
Procedures
38,347
11,436
26,911
300
305 Radiology - Therapeutic
Procedures
76,462
1,226
75,236
305
Procedures
180
116
64
310
315 Magnetic Resonance Imaging
Procedures
334
219
115
315
320 Ultrasonography
Procedures
7,149
2,324
4,825
320
325 Computed Tomographic Scanner
Procedures
21,746
9,472
12,274
325
330 Drugs Sold to Patients
Pharmacy Adj. Inpatient Days
96,645
330
335 Respiratory Therapy
Respiratory Therapy Adj. Inpatient

Days
91,886
335
340 Pulmonary Function Services
Procedures
1,787
810
977
340
345 Renal Dialysis
Hours of Treatment
16,529
15,997
532
345
350 Lithotripsy
Procedures
355 Gastro-Intestinal Services
Procedures
296
145
151
355
360 Physical Therapy
Sessions
2,829
2,296
533
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
390
395 Organ Acquisition
Organs acquired
395
235
240
245
250
255
275
290
350

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
14,566
3,081
41
41
11,485
520
525
545 Observation Care Days
545
550 Renal Dialysis Care Visits

555 Referred Visits
560 Total Outpatient Visits(a)
LIVE BIRTH SUMMARY
515
111
111
550
55,116
55,116
555
184,703
184,703
560
(1)
Total Births [Sum of
columns (7) and
(13)]
(7)
Natural Births
(13)
Cesarean Sections
5,103
3,202
1,901
600
605
610 Alternate Birthing Services
610
615 Obstetrics Acute
615
620 Emergency Services and other areas within the hospital

625 Total Births (Sum of Lines 600 through 620)
(a) Sum of column 13, lines 160,170,175,180,190,200,205,210,215,505,515,535,545,550, and 555.
620
5,103
3,202
1,901
625

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
(5)
County
Indigent
Programs Traditional
(6)
Line
County
No
Indigent
Programs Managed Care
Acute Care
13,307
5,602
13,620
20,429
3,903
10
Psychiatric Care
2,035
235
9,047
411
10
15
Chemical Dependency Care
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
Purchased Inpatient Services
15
20
3,803
310
723
584
25
19,145
6,147
23,390
21,018
4,314
35
5,489
5,250
40
30
45
PATIENT (CENSUS ) DAYS

TYPE OF CARE
Line
No
5
Acute Care
10
Psychiatric Care
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
(7)
Other Third
Parties
Traditional
(8)
(9)
Other Third
Other Indigent
Parties
Managed Care
(10)
Other Payors
(11)
Total Patient
Days
Line
No
6,052
5,442
746
581
69,682
353
93
73
12,253
10
15
20
13
165
90
70
5,758
25
6,066
5,960
929
724
87,693
35
39
740
111
86
11,716
40
30
45
DISCHARGES
TYPE OF CARE
Line
No
5
Acute Care
10
Psychiatric Care
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
(12)
(13)
(14)
(15)
(16)
County
Indigent
(17)
County
Line
Indigent
No
Programs Managed Care
2,416
1,222
3,868
5,772
893
277
58
1,625
118
10
15
20
203
22
23
33
25
2,896
1,302
5,516
5,808
1,011
35
2,189
2,106
40
30
45
DISCHARGES
TYPE OF CARE
Line
No
5
Acute Care
10
Psychiatric Care
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
(18)
Other Third
Parties
Traditional
(19)
(20)
Other Third
Other Indigent
Parties
Managed Care
(21)
Other Payors
(22)
Total
Discharges
Line
No
409
1,441
177
138
16,336
99
25
19
2,225
10
15
20
296
25
411
1,545
207
161
18,857
35
291
43
34
4,671
40
30
45

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)
3,065
2,126
12,664
29,140
65
Clinic (incl. Satellite Clinics)
1,901
316
15,694
2,217
70
Observation Care Days
70
75
Psychiatric Day-Night Care Days
75
80
Home Health Care Services
80
85
Hospice - Outpatient
90
Outpatient Surgeries
1,018
1,306
1,371
3,680
95
Private Referred
8,836
7,863
6,921
15,193
39
51
12
34
14,871
11,623
36,653
50,264
100 Other *
105 Total
476
65
85
(7)
Other Third
Parties Traditional
(8)
Other Third
Parties Managed Care
(9)
Other Indigent
4,145
862
7,573
605
15,059
(10)
Other Payors
521
(11)
Total
OutPatient
Visits
Line
No
7,322
67,373
60
14,821
50,618
65
Line
No
60
Emergency Svcs. (incl. Psych ER)
65
Clinic (incl. Satellite Clinics)
70
Observation Care Days
70
75
Psychiatric Day-Night Care Days
75
80
80
85
Hospice - Outpatient
90
Outpatient Surgeries
1,372
62
1,399
1,271
11,485
95
Private Referred
15,135
297
425
407
55,116
95
111
100
21,266
1,227
23,822
184,703
105
100 Other *
105 Total
85
Includes Chemical Dependency Services, Adult Day Health Care, & Renal Dialysis Visits
24,456
90
95
100
OUTPATIENT VISITS
TYPE OF OUTPATIENT VISIT
60
90
105

5
BALANCE SHEET - UNRESTRICTED FUND

Line
No
ASSETS
Report Period End:
06/30/2014
Account No
(1) Current Year
(2) Prior Year
$38,940,700
$27,879,420
Line
No
CURRENT ASSETS
5
Cash
1000
10
Marketable securities
1010
15
Accounts and notes receivable
1020
$366,793,831
$291,627,460
15
20
Less allowance for uncollectible receivables and thrid-party contractual withholds
1040
($311,300,216)
($246,255,002)
20
25
Receivables from third-party payors
1050
$15,628,118
$46,797,999
25
30
Pledges and other receivables
1060
35
Due from restricted funds
1070
40
Inventory
1080
$5,598,916
$4,260,899
40
45
Intercompany receivables
1090
$143,348,189
$64,839,681
45
50
Prepaid expenses and other current assets
1100
$2,322,388
$1,257,035
50
55
TOTAL CURRENT ASSETS (Sum of lines 5 through 50)
$261,331,926
$190,407,492
55
$3,446,631
$82,256,073
60
10
30
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
$3,446,631
$82,256,073
75
PROPERTY, PLANT AND EQUIPMENT - AT COST

80
Land
1200
$2,156,721
$2,156,721
80
85
Land improvements
1210
$5,239,409
$5,239,409
85
90
Buildings and improvements
1220
$172,467,949
$172,350,954
90
95
Leasehold improvements
1230
1240
$133,707,516
$127,660,217
100
$313,571,595
$307,407,301
105
1260
($188,767,328)
($169,267,131)
195
$124,804,267
$138,140,170
200
$1,143,957
$509,380
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
95
INVESTMENTS AND OTHER ASSETS

210 Investments in property, plant and equipment
1310
210
215 Less accumulated depreciation - investments in plant and equipment
1320
215
220 Other Investments
1330
220
225 Intercompany receivables
1340
230 Other Assets
1350
235 TOTAL INVESTMENTS IN OTHER ASSETS (Sum of lines 210 through 230)
225
$50,293
$57,230
230
$50,293
$57,230
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
$390,777,074
$411,370,345
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)
415
420 Total cost to complete construction in progress (Line 205)
$1,143,957
$509,380
420

5
BALANCE SHEET - UNRESTRICTED FUND
Line
No
LIABILITIES AND EQUITY

Account No
(3) Current Year
(4)Prior Year
Line
No
CURRENT LIABILITIES
5
Notes and loans payable
2010
10
Accounts payable
2020
$8,798,633
$4,662,904
10
15
Accrued compensation and related liabilities
2030
$120,990,061
$123,578,460
15
20
Other accrued expenses
2040
25
Advances from third-party payors
2050
$1,355,069
$3,682,924
30
Payable to third-party payors
2060
30
35
Due to restricted funds
2070
35
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)
20
25
40
$400,039
$13,989,071
45
$3,414,242
$3,544,556
50
$134,958,044
$149,457,915
$157,198
$147,676
$157,198
$147,676
2100
55
60
DEFERRED CREDITS
65
Deferred income taxes
2110
70
Deferred third-party income
2120
75
Other deferred credits
2130
80
TOTAL DEFERRED CREDITS (Sum of lines 65 through 75)
65
70
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
$82,528,472
105
110
115
120 TOTAL LONG-TERM DEBT (Sum of lines 85 through 115)
$82,528,472
125 Less amount shown as current maturities (Must agree with line 50)
130 NET TOTAL LONG-TERM DEBT(Sum of lines 120 and 125)
135 TOTAL LIABILITIES (Sum of lines 60,80 and 130)
$113,225,911
$113,225,911
120
($3,414,242)
($3,544,556)
125
$79,114,230
$109,681,355
130
$214,229,472
$259,286,946
135
$176,547,602
$152,083,399
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
$176,547,602
$152,083,399
205
$390,777,074
$411,370,345
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

(7) Due Date
(Year Only*)

Report Period End:

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

Balance at Year End
06/30/2014
Line
No
(5) Detail For Page 5,

column(3), Line No
(6)Date Obligation
Incurred (Year Only*)
Line
No
105
2005
2039
5.25
$53,584,146
10
105
2005
2025
5.25
$28,944,326
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
Land
$2,156,721
$2,156,721
10
Land Improvements
$5,239,409
$5,239,409
10
15
Buildings and Improvements
$172,467,949
15
20
Leasehold Improvements
25
Equipment
30
Construction-in-progress
35
TOTAL
$172,350,954
$116,995
20
$127,660,217
$6,047,299
$133,707,516
25
$509,380
$634,577
$1,143,957
30
$307,916,681
$6,798,871
$314,715,552
35
(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.

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
205
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
240
275
TOTAL ENDOWMENT FUND ASSETS (Sum of lines 205 through 240)
Line
No
OTHER INFORMATION
275
(1)
Current Year
(2)
Prior Year
Line
No
405
Current market value - specific purpose funds marketable securities (Line 10)
405
410
Current market value - Property Replacement & Exp. funds marketable securities (line
110)
410
415
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
225
270
Fund balance
2670
270
275
TOTAL ENDOWMENT FUND LIABILITIES AND FUND BALANCE (Sum of

lines 205 through 270)
275

7
STATEMENT OF CHANGES IN EQUITY

Report Period End:
06/30/2014
RESTRICTED FUNDS
Line
No
ASSETS
(1) Funds
Unrestricted
(2) Specific Purpose (3) Plant Replacement

(a)
and Expansion
(4) Endowment
Line
No
BALANCE AT BEGINNING OF YEAR, AS

PREVIOUSLY REPORTED
$152,083,399
10
Prior period audit adjustment
$40,060,131
10
15
Restatement (describe)
15
20
20
25
25
30
30
35
35
40
40
45
45
50
BALANCE AT BEGINNING OF YEAR, AS

RESTATED
$192,143,530
50
55
ADDITIONS (DEDUCTIONS):
Net Income (Loss)
($15,595,928)
55
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) ROUNDING
110
115
BOND ISSUES
115
120
UNREALIZED GAIN
120
125
TOTAL ADDITIONS (DEDUCTIONS)
130
TRANSFERS:
Property and equipment additions
($15,595,928)
125
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
$176,547,602
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
$312,153,643
$268,276,940
10
Ambulatory services
$232,573,360
$214,041,592
10
15
Ancillary services
$908,196,493
$829,597,702
15
30
GROSS PATIENT REVENUE (Sum of lines 5 through 15)
$1,452,923,496
$1,311,916,234
30
105
DEDUCTIONS FROM REVENUE (From line 395) (a)
$1,154,235,588
$940,115,144
105
107
CAPITATION PREMIUM REVENUE (From line 450) (b)
107
110
NET PATIENT REVENUE (Line 30 minus line 105 plus line 107)
135
TOTAL OTHER OPERATING REVENUE
140
$40,211,156
$33,018,543
$338,899,064
$404,819,633
110
$2,367,246
$2,456,176
135
TOTAL OPERATING REVENUE (Sum of lines 110 and 135)
$341,266,310
$407,275,809
140
146
OPERATING EXPENSES:
Daily Hospital Services
$90,731,275
$88,624,068
146
151
Ambulatory Services
$27,574,846
$26,119,784
151
156
Ancillary Services
$83,645,423
$80,018,894
156
161
Research Costs
166
Education Costs
$67,850
$1,069,806
166
171
General Services
$49,183,403
$42,650,125
171
176
Fiscal Services
$8,588,041
$8,681,324
176
181
Administrative Services
$73,064,632
$99,700,873
181
186
Unassigned Costs
$11,470,973
$13,238,727
186
190
$25,094,332
$17,983,932
190
195
Purchased Outpatient Services
200
TOTAL OPERATING EXPENSES (Sum of Lines 146 through 195)
$369,420,775
$378,087,533
200
205
NET FROM OPERATIONS (Line 140 minus line 200)
($28,154,465)
$29,188,276
205
210
NET NON-OPERATING REVENUE AND EXPENSE (From Line 700) (c)
$12,558,537
$15,385,860
210
215
NET INCOME BEFORE TAXES AND EXTRAORDINARY ITEMS: (Sum of lines

205 and 210)
($15,595,928)
$44,574,136
215
220
PROVISION FOR INCOME TAXES:

Current
220
225
Deferred
225
230
NET INCOME BEFORE EXTRAORDINARY ITEMS: (Line 215 minus 220 and
225)
161
195
($15,595,928)
$44,574,136
230
EXTRAORDINARY ITEMS:(Specify)
235
235
240
245
240
NET INCOME (Line 230 minus lines 235 and 240)
($15,595,928)
(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.
$44,574,136
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
$12,128,088
$11,829,702
300
305
Contractual adjustments - Medicare - traditional
$204,716,844
$163,629,488
305
310
Contractual adjustments - Medicare - managed care
$124,688,496
$98,234,269
310
315
Contractual adjustments - Medi-Cal - traditional
$187,638,919
$194,681,573
315
320
Contractual adjustments - Medi-Cal - managed care
$416,079,032
$310,064,347
320
325
Disproportionate share payments for Medi-Cal patient days (SB 855) (credit bal)
(d)
($26,996,041)
($31,676,601)
325
330
Contractual adjustments - County indigent programs - traditional
335
Contractual adjustments - County indigent programs - managed care
$61,746,906
$17,736,550
335
340
Contractual adjustments - Other third parties - traditional
$3,785,878
$1,473,124
340
345
Contractual adjustments - Other third parties - managed care
$82,245,420
$72,367,302
345
350
Charity discounts - Hill Burton
355
Charity discounts - other
$63,447,695
$68,274,953
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
$19,949,931
375
380
Administrative adjustments
$13,550,506
380
385
Other deductions from revenue
395
TOTAL DEDUCTIONS FROM REVENUE (Sum of lines 300 thru 385)
430
CAPITATION PREMIUM REVENUE:

Capitation Premium Revenue - Medicare
435
Capitation Premium Revenue - Medi-Cal
440
Capitation Premium Revenue - County indigent programs
445
Capitation Premium Revenue - Other third parties
450
TOTAL CAPITATION PREMIUM REVENUE (Sum of lines 430 thru 445)
330
350
355
370
$24,754,351
$1,154,235,588
385
$940,115,144
395
$22,097,986
$5,733,643
430
$15,219,491
$18,815,096
435
$3,191,416
440
$2,893,679
$5,278,388
445
$40,211,156
$33,018,543
450
(d) Disproportionate share funds transferred back to a related public entity must be reported on page 7, column(1), line 105.

8

(NON-OPERATING REVENUE AND EXPENSE)
Line SECTION III

No

Report Period End:

Account
No
(1)
Current Year
06/30/2014
(2)
Prior Year
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
520
Income, gains and losses from unrestricted investments
9060
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
585
590
Physician's offices and other rentals - revenue
9250
595
Medical office building revenue
9260
600
Child care services revenue (non-employee)
9270
605
Family housing revenue
9280
610
Retail operations revenue
9290
$346,563
$380,334
610
615
Other non-operating revenue
9400
$1,088,900
$4,591,676
615
625
TOTAL NON-OPERATING REVENUE (Sum of lines 500 thru 615)
$13,817,345
$17,616,588
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
655
Medical office building expense
9520
660
Child care services expense (non-employee)
9530
665
Family housing expense
9540
670
Retail operations expense
9550
$44,904
$49,539
670
675
Other non-operating expense
9800
$837,265
$1,542,958
675
685
TOTAL NON-OPERATING EXPENSE (Sum of lines 640 thru 675)
$1,258,808
$2,230,728
685
700
NET NON-OPERATING REVENUE AND EXPENSE (Line 625

minus line 685)
$12,558,537
$15,385,860
700
705
Interest on long-term debt (e)
(e) District Hospital only.
$13,487
500
505
$7,170,655
$8,181,425
$5,122,992
$4,359,198
510
515
520
590
$88,235
$90,468
595
600
605
$166,015
640
645
650
$210,624
$638,231
655
660
665
705

9
STATEMENT OF CASH FLOWS - UNRESTRICTED FUND
Line
No

Report Period End:
06/30/2014
(1) Current Year
(2) Prior Year
Line
No
($15,595,928)
$44,574,136
$19,738,577
$17,795,664
15
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
($1,338,017)
$337,933
50
55
Change in intercompany receivables
($78,508,508)
($42,675,659)
55
57
Change in Prepaid expenses and other current assets
($1,065,353)
$334,208
57
60
Change in accounts payable
$4,135,729
$1,193,796
60
65
Change in accrued compensation and related liabilities
($2,588,399)
($28,937,974)
65
70
Change in other accrued expenses
75
Change in advances from third-party payors
($2,327,855)
($1,779,371)
80
Change in payable to third-party payors
80
85
Change in due to restricted funds
85
87
Change in income taxes payable
90
Change in intercompany payables
95
Change in other current liabilities
17
20
($10,121,157)
$3,757,376
30
$31,169,881
$18,512,427
35
40
45
70
75
87
($13,589,032)
$6,697,545
90
$9,522
$7,874
100
$6,937
$53,307
103
($238,380)
($1,428,186)
104
105 TOTAL ADJUSTMENTS (Sum of lines 15 through 104)
($54,716,055)
($26,131,060)
105
115 NET CASH PROVIDED BY (USED FOR) OPERATING ACTIVITIES (Sum of lines 5 and 105)
($70,311,983)
$18,443,076
115
100 Change in deferred credits
95
102 Other (Describe): GAIN FROM SALE OF EQUIPMENT

103 Other (Describe): CHANGE IN OTHER ASSETS
104 Other (Describe): DEPRECIATION ADJ
102
CASH FLOW FROM INVESTING ACTIVITIES:

130 Change in assets whose use is limited
$78,809,442
$7,084,402
130
135 Purchase of plant, property and equipment and construction-in-progress
($6,798,871)
($162,468,384)
135
$40,060,131
($3,935,699)
141
$150,065,485
142
$112,070,702
($9,254,196)
145
($30,697,439)
($9,860,001)
140 Other (Describe): ROUNDING

141 Other (Describe): PRIOR PERIOD ADJ
140
142 Other (Describe): DISPOSAL

NET CASH PROVIDED BY (USED FOR) INVESTING ACTIVITIES (Sum of lines 130 through
145 142)
CASH FLOW FROM FINANCING ACTIVITIES:
160 Proceeds from issuance of long-term debt
165 Principal payments on long-term debt
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):
190
191
192
NET CASH PROVIDED BY (USED FOR) FINANCING ACTIVITIES (Sum of lines 160 through
195 192)
($30,697,439)
($9,860,001)
195
205 NET INCREASE (DECREASE) IN CASH (Sum of lines 115, 145 and 195)
$11,061,280
($671,121)
205
215 CASH AT BEGINNING OF YEAR
$27,879,420
$28,550,541
215
225 CASH AT END OF YEAR (Sum of lines 205 and 215)
$38,940,700
$27,879,420
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
15
3050
20
3070
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
55
3340
60
Psychiatric Acute - Adolescent and Child
3360
65
Obstetrics Acute
3380
70
3400
70
75
3420
75
80
3440
80
85
Hospice - Inpatient Services
3470
85
90
Other Acute Care
3510
95
Nursery Acute
3530
$20,992,680
$9,174,090
5
10
15
$9,492
20
40
$38,850,760
$16,609,855
$2,848,792
$323,816
$67,618
$26,410
45
50
55
60
65
90
$3,990
$3,192
95
100 Sub-Acute Care
3560
3570
3580
110 Psychiatric - Long Term Care
3610
3630
115
3680
120
3780
125
3900
100
101
$3,801,973
$306,397
105
110
145
$66,575,305
$26,443,760
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
$11,358,644
$8,742,494
$4,701,152
$7,277,572
160
165
170
$13,911
$2,374,192
$4,636
$302,922
175
220
$11,372,555
$11,116,686
$4,705,788
$7,580,494
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
15
3050
20
3070
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
$16,428,304
$42,780,762
45
50
Pediatric Acute
3290
$1,159,066
$3,971,635
50
55
3340
$12,783,230
$313,015
55
60
3360
65
Obstetrics Acute
3380
$16,288,823
$16,336,202
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
Other Acute Care
3510
95
Nursery Acute
3530
$7,376,816
$15,976,750
5
10
15
$22,601,230
$9,462,078
20
40
60
65
90
$642,436
$628,026
95
100 Sub-Acute Care
3560
3570
3580
3610
3630
115
3680
120
3780
125
3900
100
101
$512,565
$587,778
105
110
145
$77,792,470
$90,056,246
150
4010
4040
4060
175 Clinics
4070
4180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$10,097,112
$31,327,085
$15,339,936
$65,444,678
160
165
170
$1,705,383
$5,471,799
$1,569,701
$3,418,828
$2,718,558
175
180
220
$11,802,495
$39,517,442
$16,909,637
$68,863,506
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
45
3170
50
Pediatric Acute
3290
55
3340
60
3360
65
Obstetrics Acute
3380
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
Other Acute Care
3510
95
Nursery Acute
3530
$6,588,960
40
$7,093,920
45
50
$22,727
55
60
$45,558
65
90
$8,778
95
100 Sub-Acute Care
3560
3570
3580
3610
3630
115
3680
120
3780
125
3900
100
101
$84,911
105
110
145
$13,844,854
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$4,707,883
$5,083,143
160
165
170
$12,669
$1,673
175
220
$4,720,552
$5,084,816
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
15
3050
20
3070
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
55
$178,080
$4,046,870
5
10
15
$1,712,082
20
40
$512,490
$9,227,371
45
3290
$326,100
50
3340
$121,474
55
60
3360
65
Obstetrics Acute
3380
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
Other Acute Care
3510
95
Nursery Acute
3530
60
$2,206,740
65
90
$78,204
95
100 Sub-Acute Care
3560
3570
3580
3610
3630
115
3680
120
3780
125
3900
100
101
$11,772
$153,381
105
110
145
$702,342
$17,872,222
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$241,225
$549,187
$3,785,191
$11,213,610
160
165
170
$2,793
$176,798
$600,924
175
220
$241,225
$551,980
$3,961,989
$11,814,534
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
15
3050
20
3070
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
$5,605,005
$4,291,865
45
50
Pediatric Acute
3290
$194,966
$149,289
50
55
3340
$485,328
$371,625
55
60
3360
65
Obstetrics Acute
3380
$742,176
$568,299
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
Other Acute Care
3510
95
Nursery Acute
3530
$2,344,100
$1,794,924
5
10
15
$1,157,610
$886,406
20
40
60
65
90
$47,428
$36,316
95
100 Sub-Acute Care
3560
3570
3580
3610
3630
115
3680
120
3780
125
3900
100
101
$108,232
$82,875
105
110
145
$10,684,845
$8,181,599
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$2,865,796
$16,253,011
$2,194,397
$12,445,256
160
165
170
$104,125
$219,369
$79,731
$167,976
175
220
$2,969,921
$16,472,380
$2,274,128
$12,613,232
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
15
3050
20
3070
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
$141,400,332
$141,400,332
45
50
Pediatric Acute
3290
$5,801,056
$5,801,056
50
55
3340
$17,270,007
$17,270,007
55
60
3360
65
Obstetrics Acute
3380
$36,281,826
$36,281,826
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
Other Acute Care
3510
95
Nursery Acute
3530
$68,473,270
$68,473,270
5
10
15
$35,828,898
$35,828,898
20
40
60
65
90
$1,448,370
$1,448,370
95
100 Sub-Acute Care
3560
3570
3580
3610
3630
115
3680
120
3780
125
3900
100
101
$5,649,884
$5,649,884
105
110
145
$312,153,643
$312,153,643
150
$213,627,372
160
4010
4040
4060
175 Clinics
4070
4180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$55,291,336
$158,336,036
165
170
$3,666,954
$12,560,476
$16,227,430
175
$2,718,558
$2,718,558
180
220
$58,958,290
$173,615,070
$232,573,360
225

12

Report Period End:
06/30/2014
MEDICARE
Traditional
Line
No
PATIENT
(1) Gross
Inpatient Revenue
Account
No
.04
Managed Care
(2) Gross
Outpatient
Revenue
(3) Gross
Inpatient Revenue
.44
.14
(4) Gross
Outpatient
Revenue
Line
No
.54
ANCILLARY SERVICES:
4400
$97,070
$26,982
$35,981
$8,377
230
4420
$12,071,102
$3,763,503
$8,342,890
$3,599,540
235
4430
245 Anesthesiology
4450
$1,406,727
$405,426
$951,552
$384,048
245
250 Medical Supplies sold to Patients
4470
$5,967,628
$1,060,967
$5,174,719
$995,675
250
4480
4500
$30,016,605
$4,709,138
$13,426,107
$4,323,403
260
4520
$627,648
$252,085
$368,418
$407,410
265
270 Blood Bank
4540
$483,038
$41,213
$261,430
$25,805
270
275 Echocardiology
4560
4570
$12,928,286
$9,367,252
$6,936,849
$6,210,998
280
4590
$7,561,763
$1,634,187
$3,235,370
$1,909,880
285
4610
4620
$284,602
$31,386
$91,802
$10,504
295
4630
$2,913,540
$3,464,494
$1,346,233
$1,615,949
300
4640
$100,817
$2,944,301
$87,500
$4,725,138
305
4650
$1,407,019
$516,028
$499,950
$603,644
310
4660
$1,919,772
$1,590,402
$844,352
$418,648
315
320 Ultrasonography
4670
$2,320,056
$2,463,094
$1,120,280
$959,807
320
4680
$5,933,033
$4,559,383
$2,778,880
$3,367,444
325
4710
$19,240,274
$1,050,700
$7,092,063
$1,094,737
330
4720
$19,370,746
$585,297
$8,399,996
$405,620
335
4730
$136,349
$214,917
$71,632
$119,671
340
345 Renal Dialysis
4740
$8,803,008
$318,580
$1,446,020
$40,154
345
350 Lithotripsy
4750
4760
$1,173,362
$444,364
$429,954
$1,281,657
355
4770
$1,845,410
$291,957
$723,240
$241,270
360
365 Speech- Language Pathology
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
240
255
275
290
350
400
$136,607,855
415 TOTAL PATIENT REVENUE
$214,555,715
$50,852,342
MEDICARE
Traditional
Inpatient
Outpatient
DEDUCTIONS FROM REVENUE
$39,735,656
$63,665,218
$32,749,379
405
$94,814,766
MEDICARE
Managed Care
Total
$40,329,873
415
420 Provision for Bad Debts

425 Contractual Adjustments (exclude capitation revenue)
420
$158,949,736
$45,767,108
$124,688,496
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
$158,949,736
$45,767,108
457 CAPITATION PREMIUM REVENUE

460 NET PATIENT REVENUE (Line 415 - 455 + 457)
$55,605,979
$5,085,234
$124,688,496
455
$22,097,986
457
$32,554,129
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
Account
No
Managed Care
(5) Gross
Inpatient Revenue
Line
No
ANCILLARY SERVICES:
4400
$21,547,097
$2,878,289
$21,635,773
$3,620,928
230
4420
$6,796,556
$1,509,815
$23,304,188
$15,625,168
235
4430
245 Anesthesiology
4450
$767,393
$158,819
$2,645,097
$1,692,285
245
4470
$4,232,002
$563,213
$10,487,287
$4,085,748
250
4480
4500
$26,435,755
$9,022,949
$38,828,896
$18,291,692
260
4520
$1,061,983
$141,227
$1,719,293
$978,597
265
270 Blood Bank
4540
$209,379
$28,493
$532,435
$73,377
270
275 Echocardiology
4560
4570
$3,897,872
$548,211
$10,007,164
$5,765,358
280
4590
$2,766,119
$1,495,669
$5,832,862
$3,325,058
285
4610
4620
$107,281
$10,113
$209,520
$21,486
295
4630
$1,547,733
$5,258,887
$3,057,937
$7,780,037
300
4640
$2,793
$12,978,895
$177,106
$7,250,290
305
4650
$485,514
$70,967
$1,148,394
$586,076
310
4660
$942,110
$70,006
$1,976,767
$495,766
315
320 Ultrasonography
4670
$1,471,041
$3,781,879
$2,641,028
$6,085,353
320
4680
$2,797,750
$4,714,160
$6,769,909
$9,755,925
325
4710
$18,336,124
$1,187,373
$28,384,712
$3,673,722
330
4720
$14,134,093
$408,152
$21,366,444
$1,180,691
335
4730
$77,640
$10,710
$138,610
$166,657
340
345 Renal Dialysis
4740
$1,824,385
$1,886
$5,057,959
$173,043
345
350 Lithotripsy
4750
4760
$533,027
$71,589
$1,119,825
$1,559,627
355
4770
$1,311,460
$159,047
$1,554,765
$288,069
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
240
255
275
290
350
400
$111,285,107
$45,070,349
$188,595,971
$92,474,953
405
$200,880,072
$84,587,791
$295,561,854
$161,338,459
415
MEDI-CAL
Traditional
Total
MEDI-CAL
Managed Care
Total
$187,638,919
$416,079,032

($26,996,041)

420
425
426
430 Charity
430

(Credit Balance)
435
440
445

450
$160,642,878

$124,824,985
$416,079,032
455
$15,219,491
457
$56,040,772
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
$76,672
$23,400
230
4420
$10,154,648
$194,240
235
4430
245 Anesthesiology
4450
$1,213,506
$13,440
245
4470
$4,669,904
$115,294
250
4480
4500
$5,772,021
$1,262,198
260
4520
$120,817
$991
265
270 Blood Bank
4540
$417,635
$23,645
270
275 Echocardiology
4560
4570
$1,113,051
4590
$381,329
4610
4620
$26,182
4630
$1,315,502
4640
4650
$41,253
4660
$384,102
$5,913
315
320 Ultrasonography
4670
$155,298
$87,950
320
4680
$6,208,843
$5,295,187
325
4710
$4,768,967
$150,737
330
4720
$6,332,761
$89,694
335
4730
$70,287
340
345 Renal Dialysis
4740
$70,992
345
350 Lithotripsy
4750
4760
$16,329
355
4770
$406,998
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
240
255
275
295
$523,385
300
305
310
350
400

Traditional
Inpatient
Outpatient
$43,717,097
$7,812,594
405
$62,282,503
CO. INDIGENT
PROGRAMS
Managed Care
Total
$12,897,410
415

285
290
280
$26,520
420
$61,746,906
425

426
430 Charity
430

(Credit Balance)
435
440
445

450
$61,746,906

455
457
$13,433,007
460

12

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

Traditional
Line
No
PATIENT
Account
No
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
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
Line
No
$1,445
$2,978,571
$421,398
230
$745,254
$9,266
$8,390,965
$6,795,398
235
4450
$86,688
$882
$971,229
$745,626
245
4470
$253,193
$7,629
$3,266,427
$1,505,098
250
4480
4500
$274,381
$163,855
$8,325,404
$4,688,584
260
4520
$6,569
$432,943
$508,140
265
270 Blood Bank
4540
$8,305
$162,257
$31,900
270
275 Echocardiology
4560
4570
$57,141
$3,758,130
$2,919,454
280
4590
$37,709
$15,556
$1,449,729
$1,268,698
285
4610
4620
$2,690
$3,647
$42,491
$16,240
295
4630
$67,171
$294,535
$761,548
$5,622,544
300
4640
$38,950
$2,207,748
305
4650
$6,537
$216,706
$497,946
310
4660
$30,937
$88,508
$624,708
$1,141,752
315
320 Ultrasonography
4670
$4,918
$12,622
$543,896
$2,373,232
320
4680
$195,437
$163,781
$2,201,359
$5,174,691
325
4710
$302,168
$17,753
$6,338,184
$1,213,909
330
4720
$136,328
$2,920
$3,498,714
$736,263
335
4730
$11,306
$10,174
$49,686
$181,350
340
345 Renal Dialysis
4740
$4,437
$425,952
$57,681
345
350 Lithotripsy
4750
4760
$3,263
$285,255
$739,603
355
4770
$29,316
$426,094
$279,519
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
240
255
275
290
350
$275,261
400
$2,257,211
$3,200,778
$1,626,351
OTHER THIRD PARTIES
Traditional
Inpatient
$1,074,371
Outpatient
$45,189,198
$67,023,409
OTHER THIRD
PARTIES
Managed Care
Total

$39,126,774
405
$50,941,308
415
420
$2,510,344
$1,275,534
$82,245,420
425

426
430 Charity
430

(Credit Balance)
435
440
445

450
$2,510,344
$1,275,534

$690,434
$350,817
$82,245,420
455
$2,893,679
457
$38,612,976
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
Line
No
ANCILLARY SERVICES:
4400
$955,460
$300,522
$731,614
$230,116
230
4420
$2,589,441
$116,303
$1,982,787
$89,055
235
4430
245 Anesthesiology
4450
$288,772
$6,686
$221,118
$5,120
245
4470
$890,318
$261,808
$681,734
$200,472
250
4480
4500
$4,479,661
$3,809,196
$3,430,166
$2,916,778
260
4520
$127,834
$24,253
$97,885
$18,571
265
270 Blood Bank
4540
$58,476
$10,079
$44,776
$7,718
270
275 Echocardiology
4560
4570
$1,973,977
$74,054
$1,511,514
$56,704
280
4590
$952,644
$727,307
$729,459
$556,914
285
4610
4620
$29,388
$339
$22,503
$259
295
4630
$386,916
$1,673,050
$296,269
$1,281,087
300
4640
$131
$106,372
$100
$81,451
305
4650
$197,756
$6,641
$151,426
$5,085
310
4660
$334,027
$27,876
$255,772
$21,345
315
320 Ultrasonography
4670
$435,906
$1,688,037
$333,782
$1,292,564
320
4680
$1,116,891
$2,471,719
$855,226
$1,892,644
325
4710
$3,593,591
$499,118
$2,751,685
$382,185
330
4720
$2,293,158
$162,215
$1,755,918
$124,211
335
4730
$18,775
$3,480
$14,376
$2,665
340
345 Renal Dialysis
4740
$230,742
$1,570
$176,684
$1,202
345
350 Lithotripsy
4750
4760
$208,627
4770
$185,339
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
240
255
275
290
350
$159,750
$2,094
355
$1,603
$21,347,830
$35,002,596
$28,445,099
OTHER INDIGENT
Inpatient
$11,972,719
Outpatient
$16,346,462
$9,167,749
405
$26,802,189
$21,780,981
OTHER PAYORS
415
Inpatient
Outpatient
$6,690,780
$5,437,308
420
425

430 Charity
360
400

$141,918
426
$35,002,596
$28,445,099
430

(Credit Balance)
435
440
445

$35,002,596
$28,445,099
$12,102,166
$12,652,185
450
$18,792,946
$18,089,493
455
$8,009,243
$3,691,488

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
ANCILLARY SERVICES:
4400
$48,058,238
$7,511,457
$55,569,695
230
4420
$74,377,831
$31,702,288
$106,080,119
235
4430
245 Anesthesiology
4450
$8,552,082
$3,412,332
$11,964,414
245
4470
$35,623,212
$8,795,904
$44,419,116
250
4480
4500
$130,988,996
$49,187,793
$180,176,789
260
4520
$4,563,390
$2,331,274
$6,894,664
265
270 Blood Bank
4540
$2,177,731
$242,230
$2,419,961
270
275 Echocardiology
4560
4570
$42,183,984
$24,942,031
$67,126,015
280
4590
$22,946,984
$10,959,789
$33,906,773
285
4610
4620
$816,459
$93,974
$910,433
295
4630
$11,692,849
$27,513,968
$39,206,817
300
4640
$407,397
$30,294,195
$30,701,592
305
4650
$4,148,018
$2,292,924
$6,440,942
310
4660
$7,312,547
$3,860,216
$11,172,763
315
320 Ultrasonography
4670
$9,026,205
$18,744,538
$27,770,743
320
4680
$28,857,328
$37,394,934
$66,252,262
325
4710
$90,807,768
$9,270,234
$100,078,002
330
4720
$77,288,158
$3,695,063
$80,983,221
335
4730
$588,661
$709,624
$1,298,285
340
345 Renal Dialysis
4740
$18,040,179
$594,116
$18,634,295
345
350 Lithotripsy
4750
4760
$3,929,392
$4,096,840
$8,026,232
355
4770
$6,624,540
$1,538,820
$8,163,360
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870

430 Charity
240
255
275
290
350
400
$629,011,949
$279,184,544
$908,196,493
405
$1,000,123,882
$452,799,614
$1,452,923,496
415
Total Inpatient
Total Outpatient
Total
$12,128,088
420
$1,080,901,495
425
($26,996,041)
426
$63,447,695
430

(Credit Balance)
435
440

445
$24,754,351
450
$1,154,235,588
455
$40,211,156
457
$338,899,064
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
10
15
Sale of Scrap and Waste
5670
20
Rebates and Refunds
5680
25
Other Commissions
5710
25
30
Non-Patient Room Rentals
5730
30
35
Other (Specify) OTHER OPERATING REVENUE
40
OTHER REVENUE - INDUSTRIAL MED
45
OTHER REVENUE - CLINICAL LAB
15
$14,179
20
35
$120,915
40
45
50
50
65
PART II: MINOR RECOVERIES DISTRIBUTED TO ONE COST CENTER

Telephone and Telegraph Revenue
5470
70
Donated Blood
5750
75
Vending Machine Commissions
5690
80
Television/Radio Rentals
5720
80
85
Finance Charges on Patient Accounts Receivable
5520
85
90
Child Care Services Revenue - Employees
5760
95
Other (Specify) CLINIC ADMIN REVENUE
65
70
$172,819
75
90
$353,141
100
95
100
105
OTHER--RAD. DUPLICATING
105
110
OTHER--NSF CHECKS
110
115
OTHER--CHILD CAR SEAT
115
120
TOTAL PARTS I AND II
$661,054
120
130
PART III: OTHER OPERATING REVENUE ALLOCATED

Non-Patient Food Sales
5320
135
Laundry and Linen Revenue
5340
$751,707
130
135
140
Social Work Services Revenue
5350
140
145
Supplies sold to Non-Patients Revenue
5370
145
150
Drugs Sold to Non-Patients Revenue
5380
150
155
Purchasing Services Revenue
5390
155
160
Parking Revenue
5430
160
165
Housekeeping & Maintenance Services Revenue
5440
165
170
Data Processing Services Revenue
5480
175
Medical Records Abstracts Sales
5700
$101,730
175
180
Management Services Revenue
5740
$21,320
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) SECURITY REVENUE
170
196
$8,128
200
205
ARRA FUNDS
$693,999
205
210
MISC OTHER OPER
$129,308
210
215
215
220
TOTAL PART III
$1,706,192
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
$2,367,246
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
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
190 Outpatient Chemical Dependency Svcs.
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
220
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
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

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
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

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
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

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
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

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
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

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
225
230 Employee Health Services
8660
230
235 Auxiliary Groups
8670
235
240 Chaplaincy Services
8680
240
245 Medical Library
8690
245
250 Medical Records
8700
250
255 Medical Staff Administration
8710
255
260 Nursing Administration
8720
260
265 Nursing Float Personnel
8730
265
270 Inservice Education - Nursing
8740
270
275 Utilization Management
8750
275
280 Community Health Education
8760
280
295 Other Administrative Services
8790
300 TOTAL ADMINISTRATIVE SERVICES
$12,748,650
$12,748,650
205
295
$12,748,650
$12,748,650
300
$12,748,650
$12,748,650
305
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
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
$12,748,650
205
295
$12,748,650
300
TOTAL
$12,748,650
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
305
LINE 50 TO PAGE
15, COLUMN(13)
(SEE
INSTRUCTIONS)
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
$11,547,399
$4,823,296
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
$373,883
15
6050
20
6070
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
$22,646,948
$9,683,680
50
Pediatric Acute
6290
$1,534,695
$669,987
55
6340
$4,272,660
$1,869,282
$391,449
60
6360
65
Obstetrics Acute
6380
$8,536,188
$3,729,309
$3,488
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
95
Nursery Acute
6530
10
15
$7,011,475
$2,819,973
20
40
$3,271
45
50
55
60
65
90
$1,411,462
$625,763
95
100 Sub-Acute Care
6560
6570
6580
6610
6630
115
6680
120
6780
125
6900
100
101
$1,585,848
$698,667
$24,335
105
110
145
$58,546,675
$24,919,957
$796,426
150
$11,978,122
$4,926,327
$41,656
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
$1,132,990
$496,738
7180
$2,280,881
$1,033,177
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
175
$426,947
180
220
$15,391,993
$6,456,242
$468,603
225

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
$655,964
$186,169
$863,991
$34,804
Line
No

5
6010
10
Coronary Care
6030
15
6050
20
6070
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
$1,151,008
$343,604
$690,125
50
Pediatric Acute
6290
$50,099
$21,023
$55,477
55
6340
$82,145
$69,378
$83,134
$3,454
60
6360
65
Obstetrics Acute
6380
$371,793
$79,457
$162,285
$1,776
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
95
Nursery Acute
6530
10
15
$306,753
$16,028
$760,377
$15,479
20
40
$6,104
45
50
55
60
65
90
$68,984
$10,354
$86,157
$225
95
100 Sub-Acute Care
6560
6570
6580
6610
6630
115
6680
120
6780
125
6900
100
101
$108,131
$58,387
$26,413
$527
105
110
145
$2,794,877
$784,400
$2,727,959
$62,369
150
$1,482,072
$432,391
$832,281
$4,880
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
$423,031
$130,325
$719,794
$1,072
175
7180
$72,519
$259,204
$541,395
$155,152
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
220
$1,977,622
$821,920
$2,093,470
$161,104
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
$23,622
$18,509,128
15
6050
20
6070
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
$32,582
$34,557,322
45
50
Pediatric Acute
6290
$3,932
$2,335,213
50
55
6340
$138
$6,771,640
55
60
6360
65
Obstetrics Acute
6380
$7,713
$12,892,009
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
95
Nursery Acute
6530
10
15
$9,182
$10,939,267
20
40
60
65
90
$2,202,945
95
100 Sub-Acute Care
6560
6570
6580
6610
6630
115
6680
120
6780
125
6900
100
101
$21,443
$2,523,751
105
110
145
$98,612
$90,731,275
150
$128,458
$19,826,187
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
$511
$2,904,461
7180
$74,923
$4,844,198
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
$474,056
175
180
220
$203,892
$27,574,846
$474,056
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
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
$10,138,700
$4,296,400
$51,737
230
7420
$5,709,763
$2,365,557
$41,081
235
7430
245 Anesthesiology
7450
$54,384
$25,013
7470
7480
7500
$3,131,064
$1,405,804
7520
$95,036
$44,498
270 Blood Bank
7540
275 Echocardiology
7560
7570
$1,840,209
$735,840
$330,339
280
7590
$819,753
$375,750
$7,043
285
7610
7620
$30,838
$13,048
295
7630
$1,870,409
$828,411
300
7640
$611,654
$252,678
7650
$302,863
$121,500
7660
$154,261
$61,378
320 Ultrasonography
7670
$552,106
$235,200
7680
$526,131
$219,288
7710
7720
$3,783,174
$1,698,068
335
7730
$23,465
$7,324
340
345 Renal Dialysis
7740
350 Lithotripsy
7750
7760
$373,829
$163,733
7770
$892,888
$427,540
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
240
245
250
255
$46,435
260
265
270
275
290
305
$3,200
310
315
320
$1,423
325
330
345
350
355
$162,831
360
400
$30,910,527
$13,277,030
$644,089
405
PATIENT CARE SERVICES

7900
7950
415 TOTAL PATIENT CARE SERVICES
410
411
$104,849,195
$44,653,229
$1,909,118
415

17

Line
No
PATIENT
Report Period End:

(5)
Supplies
Account
No
(6)
Purchased
Services
(7)
Depreciation
.31-.50,.93,.97
.61-.69
.71-.74
06/30/2014
(8)
Leases
and Rentals
Line
No
.75-.76
ANCILLARY SERVICES
7400
$983,009
$206,498
$1,777,729
$788
230
7420
$618,460
$456,079
$904,774
$6,456
235
7430
245 Anesthesiology
7450
$70,596
$2,912
$42,853
7470
$8,845,400
$161,724
7480
7500
$1,709,341
$1,084,498
$496,135
7520
$13,942
$135,448
$18,969
265
270 Blood Bank
7540
$2,435,850
$29,011
$56,080
270
275 Echocardiology
7560
7570
$4,747,918
$21,297
$1,005,230
$466
280
7590
$17,204
$11,067
$163,417
$436
285
7610
7620
$2,014
$28,749
$52,907
7630
$108,615
$245,888
$762,770
$2,378
300
7640
$9,257
$86,432
$8,089
$583
305
7650
$170,318
$7,894
$264,062
310
7660
$34,143
$77,494
$449,904
315
320 Ultrasonography
7670
$32,517
$736
$411,414
320
7680
$276,242
$49
$444,886
325
7710
$5,275,653
$27,901
7720
$351,527
$29,896
$885,717
7730
$4,564
$5,038
$62,640
345 Renal Dialysis
7740
$35,413
$1,788,796
$29,773
$136
350 Lithotripsy
7750
7760
$209,520
$4,647
$190,673
$137
355
7770
$16,414
$9,448
$52,438
$322
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
240
245
250
255
$111,334
260
275
290
295
330
$27,702
335
340
345
350
400
$25,967,917
$4,421,502
$8,080,460
$150,738
405

7900
7950
$25,094,332
410
411
$30,740,416
$31,122,154
$12,901,889
$374,211
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
$91,489
$17,546,350
230
7420
$7,255
$10,109,425
235
7430
245 Anesthesiology
7450
$147
$195,905
245
7470
$9,007,124
250
7480
7500
7520
270 Blood Bank
7540
275 Echocardiology
7560
240
255
$8,046,548
260
$307,893
265
$2,665
$2,523,606
270
7570
$4,536
$8,685,835
280
7590
$3,595
$1,398,265
285
7610
7620
$100
$127,656
295
7630
$9,336
$3,827,807
300
7640
$499
$969,192
305
7650
$2,471
$872,308
310
7660
$777,180
315
320 Ultrasonography
7670
$167
$1,232,140
320
7680
$100
$1,468,119
325
7710
$5,303,554
330
7720
$7,040
$6,783,124
335
7730
$51
$103,082
340
345 Renal Dialysis
7740
$1,854,118
345
350 Lithotripsy
7750
7760
$72
$942,611
355
7770
$1,700
$1,563,581
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
$61,937
275
290
350
400
$193,160
$83,645,423
405
$25,094,332
410

7900
7950
411
$495,664
$227,045,876
$474,056
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
.00-.06,.08,
.09,.91,.95
(2)
Employee
Benefits
.10-.19,.92-.96
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
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
20
School of Nursing
8220
15
25
8230
30
8240
30
35
8250
35
40
Student Housing
8260
40
45
8290
50
TOTAL EDUCATION
20
$5,323
$56,602
25
45
$5,323
$56,602
50
$71,732
$33,515
55
GENERAL SERVICES
55
Printing and Duplicating
8310
60
Kitchen
8320
65
Non-Patient Food Services
8330
$27,659
$12,531
65
70
Dietary
8340
$1,587,514
$651,325
70
75
Laundry and Linen
8350
$97,585
$41,667
80
8360
$958,180
$402,201
$11,039
85
Central Transportation
8370
90
Central Services and Supplies
8380
$1,224,140
$543,236
$3,964
95
Pharmacy
8390
$3,457,557
$1,543,228
95
100 Purchasing and Stores
8400
$459,080
$206,781
100
105 Grounds
8410
110 Security
8420
$884,323
$389,286
110
115 Parking
8430
120 Housekeeping
8440
$2,066,120
$890,193
120
125 Plant Operations
8450
$150,018
$71,108
125
130 Plant Maintenance
8460
$1,390,638
$617,792
130
135 Communications
8470
$368,845
$167,771
140 Data Processing
8480
$632,369
$529,973
$12,887
145 Other General Services
8490
$13,375,760
$6,100,607
$27,890
150
150 TOTAL GENERAL SERVICES
60
75
80
85
90
105
115
135
140
145
FISCAL SERVICES
155 General Accounting
8510
$340,435
$161,483
$86,880
155
160 Patient Accounting
8530
$1,042,725
$489,948
$52,737
160
165 Credit and Collection
8550
170 Admitting
8560
$2,000,189
$858,672
$29,425
175 Outpatient Registration
8570
195 Other Fiscal Services
8590
200 TOTAL FISCAL SERVICES
165
170
175
195
$3,383,349
$1,510,103
$169,042
200

18

NON-REVENUE
PRODUCING CENTERS
Line
No
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
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
20
School of Nursing
8220
15
25
8230
30
8240
30
35
8250
35
40
Student Housing
8260
40
45
8290
50
TOTAL EDUCATION
20
$32
$5,881
25
45
$32
$5,881
$55,126
$36,152
50
GENERAL SERVICES
55
8310
60
Kitchen
8320
65
8330
$73,945
$1,208
$27,057
70
Dietary
8340
$24,691
$1,686,831
$153,731
75
Laundry and Linen
8350
$73,334
$19,291
80
8360
85
8370
90
8380
95
Pharmacy
8390
$70,560
55
60
$6,872
$28,976
$3,027
$124,128
65
$3,713
70
75
$208
80
85
$472,804
$362,226
$75,792
$436,066
95
$29,652
$81,229
100
$233,186
$36,501
8410
$207
$104,962
8420
$22,147
$111,337
$85,766
$7,303
$8,737
$1,632,086
$9,169
90
8400
105 Grounds
110 Security
115 Parking
8430
120 Housekeeping
8440
8450
$4,323
$4,874
$774
125
8460
$140,505
$4,662,736
$615,536
$185
130
135 Communications
8470
$18,565
$163,336
$402,718
$851
135
140 Data Processing
8480
$74,090
$10,002,549
$3,083,745
$181
140
8490
$729,700
$18,695,287
$5,020,150
$1,142,220
150
$128,142
105
110
$186,227
115
120
145
FISCAL SERVICES
8510
$1,204
$24,204
$255,507
$157
155
8530
$13,974
$429,906
$104,320
$5,929
160
8550
170 Admitting
8560
$37,375
$14,666
8570
8590
$2,524,281
$72,388
$29,864
165
170
175
195
$87,566
$3,008,255
$397,202
$20,752
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
5
10
EDUCATION COSTS
15
8210
20
School of Nursing
8220
15
25
8230
30
8240
30
35
8250
35
40
Student Housing
8260
40
45
8290
50
TOTAL EDUCATION
20
$12
$67,850
25
45
$12
$67,850
50
$90,319
$357,404
55
GENERAL SERVICES
55
8310
60
Kitchen
8320
65
8330
$45
$142,445
70
Dietary
8340
$529
$4,108,334
75
Laundry and Linen
8350
80
8360
85
8370
90
95
Pharmacy
60
65
$172,819
70
$231,877
75
$264
$1,407,740
80
8380
$2,533
$2,736,058
8390
$18,594
$5,531,237
8400
$3,507
$1,049,936
105 Grounds
8410
$105,169
105
110 Security
8420
$12,277
$1,505,136
110
115 Parking
8430
120 Housekeeping
8440
8450
8460
135 Communications
8470
140 Data Processing
8480
8490
85
90
95
$14,179
100
$202,267
115
$4,749,639
120
$103
$231,200
125
$3,585,890
$11,013,282
130
$351,178
$1,473,264
135
$2,621
$14,338,415
140
$4,091,789
$49,183,403
$869,870
155
$5,816
$2,145,355
160
$2,524,281
165
$3,048,535
170
$23,929
145
$186,998
150
FISCAL SERVICES
8510
8530
8550
170 Admitting
8560
8570
8590
$5,956
175
195
$11,772
$8,588,041
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
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
GENERAL SERVICES
55
8310
60
Kitchen
8320
33,737
55
65
8330
405,949
65
70
Dietary
8340
266,742
70
75
Laundry and Linen
8350
1,401,632
75
80
8360
87,693
80
85
8370
90
8380
109,346
95
Pharmacy
8390
96,645
95
8400
32,645
100
105 Grounds
8410
737,945
105
110 Security
8420
1,708
110
115 Parking
8430
282,000
115
120 Housekeeping
8440
379,551
120
8450
737,945
125
8460
737,945
130
135 Communications
8470
1,708
135
140 Data Processing
8480
1,452,923
140
8490
60
85
90
145
150
FISCAL SERVICES
8510
1,708
155
8530
1,452,923
160
8550
1,452,923
165
170 Admitting
8560
28,140
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
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
$3,545,494
$2,250,689
$1,286,232
$573,712
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
8610
8620
8630
8640
225 Personnel
8650
$449,481
$385,399
8660
$81,524
$37,043
230
8670
$111,769
$52,383
235
8680
$391,992
$182,894
240
245 Medical Library
8690
$34,902
$15,465
250 Medical Records
8700
$1,705,725
$747,963
$2,346
250
8710
$1,142,668
$520,434
$1,700
255
8720
$1,191,807
$571,070
8730
8740
$657,751
$272,345
$2,290
270
8750
$2,344,640
$1,000,199
$108,524
275
8770
$491,676
$212,208
8790
$1,841,199
205
210
215
220
$22,517
225
245
260
265
280
$12,748,650
$13,435,661
$6,821,804
$12,748,650
295
$1,978,576
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)
$135,049,288
$59,142,345
$12,748,650
370 Non-Operating Cost Centers

375 TOTAL COSTS
$135,049,288
$59,142,345
$12,748,650
$4,084,626
365
$48,250
370
$4,132,876
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
Line
No
.31-.50,.93,.97
.61-.69
.71-.74
.75-.76
$529,313
$10,657,981
$194,484
$586,465
$99,733
$31,529
$88,839
$3,456
$13,644
$1,121
225
$83
230
$235
235
$30
240
$248
245
$23,059
250
8610
8620
8630
8640
225 Personnel
8650
$18,982
$20,905
8660
$21,606
$71
8670
$28,748
$43,415
8680
$2,321
$47,444
245 Medical Library
8690
250 Medical Records
8700
$74,452
$1,101,263
8710
$65,982
$298,439
$66,100
$3,125
255
8720
$7,064
$41,735
$589,044
$929
260
8730
8740
$25,121
$39,036
$33,217
$1,712
270
8750
$17,411
$294,573
$2,832
$5,875
275
8770
$77,727
$24,849
$25,190
$33
280
8790
$5,793
$11,616
$220,381
$974,253
$12,613,284
$1,239,723
205
210
215
220
$428
$3,581
$2,411
265
295
$626,371
300
UNASSIGNED COSTS
8810
8820
$173,732
305
8830
315
8840
320
8850
325
8860
330
8870
345
8880
350
8890
$1,292,043
310
355
$173,732
$1,292,043
360
$19,738,577
$3,455,597
365
$872
370
$3,456,469
375
TOTAL
375 TOTAL COSTS
$32,531,935
$65,439,012
$53,041
$118,325
$32,584,976
$65,557,337
$19,738,577

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
8610
8620
$19,116,795
$38,722,420
8630
8640
225 Personnel
$206,529
$2,290,030
8650
$66,980
$979,029
225
8660
$98
$140,425
230
8670
$240,131
235
8680
$626,224
240
245 Medical Library
8690
$53,454
245
250 Medical Records
8700
$8,885
$3,663,693
250
8710
$14,680
$2,113,128
255
8720
$10,333
$2,411,982
260
8730
8740
$42,962
$1,074,434
270
8750
$21,467
$3,795,521
275
8770
$3,725
$835,408
280
8790
$3,132,313
$16,118,753
295
$22,626,310
$73,064,632
300
205
210
215
220
$1,543
265
UNASSIGNED COSTS
8810
$173,732
305
8820
$1,292,043
310
8830
$3,816,189
$3,816,189
315
8840
$1,030,699
$1,030,699
320
8850
8860
8870
8880
8890
325
330
$5,158,310
$5,158,310
345
350
355
$10,005,198
$11,470,973
$37,230,745
$369,420,775
$1,038,320
$1,258,808
375 TOTAL COSTS
$38,269,065
$370,679,583
360
TOTAL
$661,054
365
370
$661,054
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
1,708
205
8630
8640
225 Personnel
8650
1,708
225
8660
1,708
230
8670
45,453
235
8680
87,693
240
245 Medical Library
8690
323
245
250 Medical Records
8700
127,395
250
8710
323
255
8720
674
260
8730
8740
32,767
270
8750
28,140
275
8770
56,451
280
8790
210
1,455,291
215
220
265
295
300
UNASSIGNED COSTS
8810
737,945
305
8820
64,773
310
8830
1,452,923
315
8840
737,945
320
8850
8860
8870
8880
350
8890
355
325
330
737,945
345
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
45
Public Relations
50
Management Engineering
55
Community Health Education
60
Other Administrative Services
65
General Accounting
70
Communications
75
Other Fiscal Services
80
1,793
80
85
Personnel
2,117
85
90
Employee Health Services
414
90
95
Employee Benefits (Non-Payroll Related)
100 Non-Patient Food Services
4,196
100
2,342
105
110 Housekeeping
2,435
110
120 Security
1,582
120
125 Parking
282,000
10,800
12,382
130
8,668
8,668
135
145 Dietary
15,672
15,672
145
150 Laundry and Linen
1,297
1,297
150
3,338
3,338
30
1,462
35
40
833
45
50
219
55
60
999
65
1,160
70
75
95
115 Grounds
115
125
140

160 Data Processing
155

160
165
594
170
3,710
175
180 Medical Library
1,809
185 Medical Records
5,781
5,554
195 Social Work Services

145
180
10,367
190
145
2,663
195
200
205 Insurance - Hospital and Professional Malpractice

210 Admitting
185
205
1,653
1,019
215 Other Unassigned Costs
210
215
220
1,508
3,540
230 Inservice Education-Nursing
2,032
225
235 Central Services and Supplies
4,938
4,938
235
240 Pharmacy
4,900
4,900
240
230
245 Research Projects and Administration
245
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
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

240 Pharmacy
235
11,088
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
23,564
30-80
85-100
(6) Supplies from

Pages 17 & 18
column (5)
(7) Square
Feet Serviced
105
110
Line
No
23,564
510 Coronary Care
510

505
515
5,959
5,959
520
525
530 Burn Care
530
535
540
52,093
52,093
545
550 Pediatric Acute
13,000
13,000
550
15,391
15,391
555
25,032
25,032
560 Psychiatric Acute - Adolescent & Child

560
565
570
575
580
585
590 Other Acute Care

595 Nursery Acute
590
5,829
5,829
600 Sub-Acute Care
600

595
601
7,151
7,151
605
610
615
620
625
645
AMBULATORY SERVICES
18,033
18,033
660
665
670
675 Clinics
1,443
18,148
675
9,918
2,467
680
685
690

695
2,077
2,077
700
705
710
715
720
ANCILLARY SERVICES
27,163
27,163
730
21,908
21,908
735
173
173

745 Anesthesiology
740
745
750
755
10,223
10,223
760
2,641
2,641
765
429
429
770
1,277
1,277
770 Blood Bank

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
13,130
135,529
510 Coronary Care
155-215
Line
No
220
505
510
515
19,494
520
525
530 Burn Care
530
535

540
223,892
400,069
545
550 Pediatric Acute
15,665
550
43,696
555
560
99,487
565
570
575
580
585
590
595 Nursery Acute
11,681
600 Sub-Acute Care
600

595
601
17,894
75,224
605
610
615
620
625
645
AMBULATORY SERVICES
11,826
232,947
660
665
670
675 Clinics
5,147
675
1,709
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
181,176
730
66,710
735
740
745 Anesthesiology
745
750
755
5,905
760
2,116
765
770 Blood Bank
770
775 Echocardiology
775
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
$9,007,124
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
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)

2,211
2,211
537
537
795
5,824
5,824
800
6,874
6,874
805
3,530
3,530
810
2,616
2,616
815
820 Ultrasonography
1,390
1,390
820
1,991
1,991
825
2,501
2,501
835
2,240
2,240
840
845 Renal Dialysis
13,315
13,315
845
790
830
850 Lithotripsy
850

785
855
10,225
10,227
860
865 Speech - Language Pathology
865
870
875
880
885
890
895
900
910
911
915
920 Total Statistical Units (Lines 5-915)
673,172
372,080
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

785
790
795
48,125
800
805
2,803
810
1,440
815
820 Ultrasonography
820
15,641
825
830
17,209
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
3,436
855
5,335
860
865
870
875
880
885
890
895
900
910
911
915
266,742
1,401,632
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
$5,303,554
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
$9,007,124
$5,303,554
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
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
( Page 20a (1 of 6) Submitted Data )
COST RECOVERY INFORMATION
(1) Transfers for

Operations NonRevenue Centers Page
14, Col(1), Line 185
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
($8,128)
($693,999)
(4)Other Operating
Revenue Page 14, Col Line
(1),Line 210
No
Cost Recovery
Interest - Other
($129,308)
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
$129,308
35
95
100
105
110 Housekeeping
110
115 Grounds
120 Security
115
$8,128
120
125 Parking
125
130
135
140
145 Dietary
145
150

160 Data Processing
155
$693,999
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
Average
Hourly Rate
Productive
Hours
$63.21
3,554
Average
Hourly Rate
.02
Productive
Hours
Line
Average
Hourly Rate
Productive
Hours
$72.18
150,743
No

5
10
Coronary Care
15
20
25
25
30
Burn Care
30
35
35
40
45
$59.08
9,368
50
Pediatric Acute
$56.19
1,896
55
$55.71
1,540
$33.68
60
65
Obstetrics Acute
$55.14
4,714
$28.71
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
15
$57.70
4,840
$52.47
3,733
$71.55
85,644
20
40
$22.53
11,063
$64.20
280,007
45
$66.37
20,922
50
7,290
$61.89
39,223
55
7,417
$67.61
105,053
60
65
90
$58.65
1,750
$68.32
17,537
100 Sub-Acute Care
95
100

5
10
101
$76.44
1,792
$41.77
2,655
$66.51
8,872
105
110
115
120
125
145
29,454
32,158
708,001
150
127,267
160
AMBULATORY SERVICES
$60.03
10,032
$28.14
66,027
$65.88
165
170
175 Clinics
$40.57
5,728
$49.40
9,527
$55.46
1,892
175
$49.79
5,850
$27.56
34,670
$91.84
44
180
185
190
195
200
205
210
215

220
21,610
110,224
129,203
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
$37.81
1,092
$17.26
3,825
$19.53
6,834
No

5
10
Coronary Care
15
20
25
25
30
Burn Care
30
35
35
40
45
$34.23
38,373
$17.29
103,606
50
Pediatric Acute
$38.17
195
$19.33
66
55
$34.57
23,015
$20.32
60
65
Obstetrics Acute
$20.66
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
15
$28.00
$14.17
675
$19.50
12,540
20
40
$18.54
20,484
26,463
$20.63
1,882
25,058
$19.73
15,021
45
50
55
60
65
90
$34.33
1,391
$15.03
30
$18.61
2,252
100 Sub-Acute Care
95
100

5
10
101
$32.11
11,523
$17.05
15,587
$21.15
3,367
105
110
115
120
125
145
75,595
175,310
62,380
150
24,279
160
AMBULATORY SERVICES
$36.21
5,698
$17.94
9,136
$21.88
165
170
175 Clinics
$22.83
2,927
$15.53
62
$20.05
12,298
175
$23.15
8,545
$17.39
18,396
$18.51
11,780
180
185
190
195
200
205
210
215

220
17,170
27,594
48,357
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
170
175 Clinics
175
$50.17
3,992
180
185
190
195
200
205
210
215

220
3,992
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
$172.44
1,640
No

5
10
Coronary Care
$67.81
15
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
100
Sub-Acute Care
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
10
15
$62.72
20
40
$30.77
13
$47.47
45
$64.00
50
55
$98.74
3,423
$42.80
$35.73
153
$52.20
60
65
90
$57.75
95
100
101
$47.73
620
$34.74
105
110
145
5,849
150
AMBULATORY SERVICES
160
Emergency Services
165
Medical Transportation Services
$66.84
679
$47.99
160
170
Psychiatric Emergency Rooms
175
Clinics
180
Satellite Clinics
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
$75.49
7,667
$34.44
175
$29.81
180
220
8,346
225
06/30/2014

21

(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
Total Paid
Hours
167,688
23,652
191,340
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No

Line
No
Column (22)
2080

5
10
Coronary Care
15
20
25
25
30
Burn Care
30
35
35
40
45
462,914
61,899
524,813
45
50
Pediatric Acute
23,079
3,368
26,447
50
55
102,836
12,401
115,237
55
60
65
Obstetrics Acute
157,416
24,590
182,006
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
15
107,438
11,854
119,292
20
40
60
65
90
22,960
4,826
27,786
100 Sub-Acute Care
95
100

5
10
101
44,416
6,953
51,369
105
110
115
120
125

145
1,088,747
149,543
1,238,290
150
243,118
27,356
270,474
160
AMBULATORY SERVICES
165
170
175 Clinics
32,434
4,051
36,485
175
90,944
11,494
102,438
180
185
190
195
200
205
210
215

220
366,496
42,901
409,397
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
No
$74.62
3,951
$29.93
16,015
$69.56
123,861
230
$67.45
6,768
$55.56
4,754
$68.50
54,961
235
$28.70
1,893
ANCILLARY SERVICES
240
245 Anesthesiology
245
250

255
$48.41
10,036
$30.98
84,638
260
$18.97
1,902
265
270 Blood Bank
270
275 Echocardiology
275
$63.29
1,856
$78.16
8,429
$71.14
13,796
280
$71.64
1,840
$42.20
12,865
$63.02
1,692
285
$38.88
793
$41.36
32,062
$73.51
6,331
$84.40
3,567
310
$49.05
2,957
315
320 Ultrasonography
$50.45
10,781
320
$47.58
10,795
325
$41.22
79,149
$39.96
568
290
$62.30
3,256
295
300
$49.52
1,872

330
$48.55
8,264
335
$68.00
12
345 Renal Dialysis
340
345
350 Lithotripsy
350

305
$63.81
1,704
$21.18
3,836
$40.27
17,468
$56.27
5,122
355
360
365
370
375
380
385
390
395

400
37,675
298,803
201,316
405

21


(7)
Line
No
Report Period End:

(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
06/30/2014
(11)
.04
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
$35.32
8,109
(12)
Clerical and Other

Administrative
.05
Line
Productive
Hours
Average
Hourly Rate
Productive
Hours
No
$17.69
174
$19.73
15,226
230
$31.44
31,175
$23.07
8,881
235
ANCILLARY SERVICES
240
245 Anesthesiology
245
250
255
260
$20.20
2,927
270 Blood Bank
265
270
275 Echocardiology
275
$15.20
1,293
$21.23
1,792
280
$23.36
1,484
285
290
295
$16.86
411
$18.76
15,647
300
$23.81
1,831
305
310
315
320 Ultrasonography
320
$24.11
$20.52
1,900
325
330
$19.50
1,864
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
$15.44
2,604
$18.96
1,821
360
365
370
375
380
385
390
395

400
8,109
37,566
51,473
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
Average
Hourly Rate
Line
Productive
Hours
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
395
400
405

21

Line
No

Report Period End:
(19)
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Average Hourly
Rate
Line
Productive
Hours
No
ANCILLARY SERVICES
230
Labor and Delivery Services
$63.50
803
$58.42
230
235
Surgery and Recovery Services
$38.92
1,729
$52.02
235
240
Ambulatory Surgery Services
245
Anesthesiology
250
Medical Supplies Sold to Patients
255
Durable Medical Equipment
260
Clinical Laboratory Services
265
Pathological Laboratory Services
270
Blood Bank
275
Echocardiology
280
Cardiac Catheterization Services
$69.58
4,216
$65.63
280
285
Cardiology Services
$90.45
82
$44.76
285
290
Electromyography
295
Electroencephalography
$37.53
295
300
Radiology - Diagnostic
$35.70
300
305
Radiology - Therapeutic
$59.04
305
310
Nuclear Medicine
$80.77
310
315
Magnetic Resonance Imaging
$48.79
315
320
Ultrasonography
$50.30
320
325
Computed Tomographic Scanner
$47.30
325
330
Drugs Sold to Patients
335
Respiratory Therapy
$40.87
335
340
$36.34
340
345
Renal Dialysis
350
Lithotripsy
355
Gastro-Intestinal Services
360
Physical Therapy
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
390
395
Organ Acquisition
395
400
Other Ancillary Services
405
TOTAL ANCILLARY SERVICES
240
$28.66
245
250
255
$97.33
501
$33.03
260
$19.71
265
270
275
290
$30.38
16
330
345
350
$68.41
2,401
$40.55
355
$40.13
360
400
9,748
405
06/30/2014

21


(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
168,139
22,370
190,509
230
108,268
12,177
120,445
235
1,893
315
2,208
ANCILLARY SERVICES

245 Anesthesiology
240
245
250
255
95,175
13,833
109,008
260
4,829
680
5,509
265
270 Blood Bank
270
275 Echocardiology
275
31,382
2,840
34,222
280
17,963
3,170
21,133
285
793
110
903
295
51,376
6,290
57,666
300
10,034
948
10,982
305
3,567
443
4,010
310
2,957
444
3,401
315
320 Ultrasonography
10,781
1,247
12,028
320
10,820
1,519
12,339
325
91,177
11,871
103,048
335
580
67
647
340
290

330
345 Renal Dialysis
345
350 Lithotripsy
350
8,958
1,030
9,988
355
25,998
3,940
29,938
360
365
370
375
380
385
390
395

400
644,690
83,294
727,984
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
$117.94
3,170
Average Hourly
Rate
Productive Hours
No

5
10
Coronary Care
3,170
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
$50.32
65
65
$110.27
3,550
3,550
$64.59
54
54
45
50
55
60
65
95
100 Sub-Acute Care
100

101
$46.81
395
395
105
110
115
120
125
145
7,234
7,234
150
813
813
160
AMBULATORY SERVICES
$58.43
165
170
175 Clinics
175
$160.53
2,271
2,271
180
185
190
195
200
205
210
215

220
3,084
3,084
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
Average Hourly
Rate
Productive Hours
No
ANCILLARY SERVICES
$65.16
794
794
230
$11.87
3,461
3,461
235
240
245 Anesthesiology
245
250

255
$80.26
568
568
260
265
270 Blood Bank
270
275 Echocardiology
275
$68.42
4,828
4,828
280
$85.89
82
82
285
290
295
300
305
310
315
320 Ultrasonography
320
$44.47
32
32
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350

355
$65.95
2,469
2,469
360
365
370
375
380
385
390
395

400
12,234
12,234
405

22


(1)
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
Average
Hourly Rate
06/30/2014
(5)
(6)
Registered
Nurses
.01
Productive
Hours
Average
Hourly Rate
.02
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
20
School of Nursing
15
25
30
30
35
35
40
Student Housing
40
45
50
TOTAL EDUCATION
20
$46.15
1,712
$19.93
4,812
25
45
1,712
4,812
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
70
Dietary
75
Laundry and Linen
80
85
90
95
65
$30.10
8,245
70
75
$38.49
1,816
$32.84
26,647
$23.52
1,568
$20.72
27,744
Pharmacy
$73.66
5,067
$49.49
60,341
95
$38.95
5,438
$17.13
7,153
100
$31.85
3,872
$24.75
1,912
85
105 Grounds
110 Security
80
90
105
110
115 Parking
115
120 Housekeeping
120
$64.36
1,776
$44.47
3,976
135 Communications
$35.29
3,792
140 Data Processing
$72.81
328
125
$29.76
9,996
$62.00
9,244
130
135
140
145
27,633
151,282
150
FISCAL SERVICES
$76.57
1,752
$36.14
1,968
155
$52.67
2,437
$33.65
17
160
$31.55
6,488

170 Admitting
165
170
175

195
10,677
1,985
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
$111.42
14,252
$45.64
10,238
$48.36
15,808
$22.61
14,373
$48.92
3,704
$34.82
7,372
$45.85
1,656
$29.97
10,904
$27.64
1,808
250 Medical Records
$52.39
3,696
$22.64
60,325
250
$51.66
8,752
$34.49
14,509
255
$58.03
7,248
$54.84
10,823
260
$57.66
1,794
$51.82
9,545
270
$64.05
3,250
$54.29
36,801
275
$43.92
1,992
$29.30
8,669
280
210

225 Personnel
215
220
225
230
235
245 Medical Library
240
245
265

205
295
73,056
174,463
300
350
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
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
20
School of Nursing
15
25
30
30
35
35
40
Student Housing
40
45
50
TOTAL EDUCATION
20
$20.55
4,909
25
45
4,909
50
1,744
55
GENERAL SERVICES
55
60
Kitchen
65
70
Dietary
75
Laundry and Linen
75
80
80
85
85
90
95
Pharmacy
$14.61
60
65
$19.41
18,589
90
$25.21
1,774
95
$16.70
6,906
100
$22.00
1,663
105 Grounds
110 Security
70
105
110
115 Parking
115
120 Housekeeping
120
$20.68
1,735
$17.88
13,074

135 Communications
125
130
140 Data Processing
135
140
145
45,485
150
FISCAL SERVICES
$31.38
4,113
155
$19.09
47,538
160
$19.17
92,978

170 Admitting
165
175

170
195
144,629
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
$26.58
13,619
205
$17.33
42,406
225 Personnel
$19.04
25
225
$45.32
1,798
230
$18.00
1,256
235
245 Medical Library
$30.40
1,149
245
250 Medical Records
$16.43
7,280
250
$25.09
6,512
255
$17.47
8,304
260
$18.00
2,339
270
$21.34
6,040
275
$16.17
8,283
280
210
220
240
265

215
295
99,011
300
350
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
60
Kitchen
$21.59
2,127
65
$15.06
1,829
65
70
Dietary
$16.57
57,443
70
75
Laundry and Linen
$16.53
3,858
75
80
85
90
95
Pharmacy
60
80
85
$49.67
100
105 Grounds
105
$16.56
40,727
110
$16.31
125,162
120
$29.11
31,122
115 Parking
120 Housekeeping
115

90
95

110 Security
55
125
130
135 Communications
135
140 Data Processing
140

145
262,271
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
06/30/2014
(17)
.07
Average
Hourly Rate
Productive
Hours
$18.86
1,474
$17.36
446
$16.58
183
$18.58
81
Average
Hourly Rate
(18)
Non-Physician Medical
Practitioners
.08
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
210

225 Personnel
215
220

205
225
230
235
240
245 Medical Library
245
250 Medical Records
250
$20.89
314
255
$19.77
43
260
$17.20
10
$28.71
45

265

275

270
280
295
2,596
300
350
370

22

Line
No

Report Period End:
(19)
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Average Hourly
Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
20
School of Nursing
15
25
30
30
35
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
20
$24.14
25
GENERAL SERVICES
55
60
Kitchen
$18.45
55
65
$15.05
65
70
Dietary
$18.68
70
75
Laundry and Linen
$17.50
1,915
$16.91
75
80
$50.24
225
$33.25
80
85
90
$16.56
36,652
$18.41
95
Pharmacy
$50.63
95
100
Purchasing and Stores
$23.16
100
105
Grounds
110
Security
115
Parking
120
Housekeeping
125
130
60
85
90
105
$18.27
110
$16.31
120
Plant Operations
$42.66
125
Plant Maintenance
$30.32
130
135
Communications
$21.67
135
140
Data Processing
$61.06
140
145
Other General Services
150
TOTAL GENERAL SERVICES
115
$22.88
$45.54
42
589
145
39,423
150
FISCAL SERVICES
155
General Accounting
160
Patient Accounting
165
Credit and Collection
170
Admitting
175
Outpatient Registration
195
200
TOTAL FISCAL SERVICES
$42.97
155
$21.26
717
$20.83
160
$23.49
1,359
$20.03
165
170
175
195
2,076
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
$22.56
5,266
$58.16
$27.75
32
$25.19
205
210
205
215
Public Relations
220
225
Personnel
$39.25
225
230
$45.32
230
235
Auxiliary Groups
$37.33
235
240
Chaplaincy Services
$29.53
240
245
Medical Library
$30.36
245
250
Medical Records
$23.55
250
255
Medical Staff Administration
$37.53
255
260
Nursing Administration
260
265
Nursing Float Personnel
270
210
215
220
$19.61
168
$39.01
79
$44.42
Inservice Education - Nursing
$40.18
34
$46.84
270
275
Utilization Management
$33.01
1,406
$49.89
275
280
$26.28
25
$25.70
280
295
300
TOTAL ADMINISTRATIVE SERVICES
350
350
370
Non-Operating Cost Centers
370
265
295
7,010
300
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
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
20
School of Nursing
15
25
30
30
35
35
40
Student Housing
40
45
50
TOTAL EDUCATION
20
11,433
2,327
13,760
25
45
11,433
2,327
13,760
50
3,871
549
4,420
55
GENERAL SERVICES
55
60
Kitchen
65
1,829
235
2,064
65
70
Dietary
84,277
7,330
91,607
70
75
Laundry and Linen
5,773
339
6,112
75
80
28,688
3,006
31,694
80
85
90
65,967
8,474
74,441
95
Pharmacy
67,182
8,900
76,082
95
19,497
2,672
22,169
100
48,174
5,723
53,897
110
125,204
13,884
139,088
120
60
85
105 Grounds
110 Security
105
115 Parking
120 Housekeeping
90
115
3,511
609
4,120
125
45,094
6,284
51,378
130
135 Communications
16,866
1,769
18,635
135
140 Data Processing
10,161
1,533
11,694
140
526,094
61,307
587,401
150

145
FISCAL SERVICES
7,833
601
8,434
155
50,709
7,070
57,779
160
100,825
10,478
111,303

170 Admitting
165
175

170
195
159,367
18,149
177,516
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
44,849
5,623
50,472
73,065
8,685
81,750
225 Personnel
11,284
1,220
12,504
225
1,798
244
2,042
230
2,993
576
3,569
235
12,712
2,325
15,037
240
245 Medical Library
1,149
113
1,262
245
250 Medical Records
71,469
7,531
79,000
250
30,087
4,201
34,288
255
26,497
3,406
29,903
260
13,722
1,143
14,865
270
47,497
5,155
52,652
275
19,014
1,278
20,292
280
356,136
41,500
397,636
210
215
220
265

205
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
90
95
Pharmacy
75
$49.06
225
$20.33
195
80
85
90
95
100
105 Grounds
105
110 Security
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
140 Data Processing
135
$48.45
266
140
145
686
150
FISCAL SERVICES
155
160

170 Admitting
165
$23.73
1,240
170
175

195
1,240
200
06/30/2014

22.1


(3)
Line
No
Report Period End:

(4)
Other Contracted
Services
.26
Line
Average
Hourly Rate
Productive
Hours
No
$37.12
2,733
205
210
215
220
225 Personnel
225
230
235
240
245 Medical Library

250 Medical Records
245
$19.07
123
250
255
260
265
$72.50
270
$58.26
1,748
275
280

295
4,608
300
350
370
06/30/2014

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HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

USING DATA SUBMITTED BY FACILITY

TRAUMA CENTER DESIGNATION

*EXCLUDES BEDS IN SUSPENSE

FINANCIAL AND UTILIZATION DATA BY PAYER

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

REPORT PERIOD: 07/01/2013

SUMMARY STATEMENT OF INCOME

DATE PREPARED: 6/24/2015

DAILY HOSPITAL SERVICES

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

DAYS IN ACCOUNTS RECEIVABLE

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

BAD DEBT RATE

DEBT, RISK, AND LEVERAGE RATIOS

INTEREST EXPENSE AS A PERCENTAGE

20.25% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100

NET RETURN ON EQUITY

( 8.83%) (NET INCOME / EQUITY) X 100

( 8.25%) (NET FROM OPERATIONS / TOTAL OPERATING REVENUE) X 100

TURNOVER ON OPERATING ASSETS

.88 TOTAL OPERATING REVENUE / (TOTAL CURRENT ASSETS + NET PROPERTY,

FIXED ASSET RATIOS

AVERAGE AGE OF PLANT

4.90% ((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

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 )

1.Health Care Institution(Legal Name):

2. OSHPD Facility Number: