OSHPD Reports

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT
USING DATA SUBMITTED BY FACILITY

FACILITY NO:106410817
SETON MEDICAL CENTER
1900 SULLIVAN AVENUE
DALY CITY
CA
PHONE NO:
OWNER:
94015
GENERAL INFORMATION
TYPE OF CONTROL: Church
TYPE OF CARE:
General
LICENSED BEDS*
31
San Mateo
04
HFPA NO:
0425
EMERGENCY SERVICES
INTENSIVE
31
ACUTE
224
ACUTE
224
LONG-TERM
223
LONG-TERM
160
TOTAL
OCCUPANCY RATE
478
48.10%
*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
EMERGENCY ROOM
TRAUMA CENTER DESIGNATION
OBSERVATION
ORTHOPEDIC
415
PSYCHIATRIC
55.40%
HELICOPTER
TOTAL
OCCUPANCY RATE
X
X
OTHER
OTHER
NO. BASSINETS
15
TOTAL
MEDICARE
TRADITIONAL
15,763
2,545
6.2
5.5
54,399
3,283
$355,998,041
$167,909,395
$458,189,535
$44,955,045
$20,762,856
$2,852
$17,664
$382
MEDICARE
MANAGED CARE
7,484
1,261
5.9
5.5
27,678
1,981
$160,779,034
$80,223,881
$214,346,352
$17,783,256
$8,873,307
$2,376
$14,103
$321
MEDI-CAL
TRADITIONAL
43,365
582
74.5
4.1
6,247
1,034
$189,130,931
$10,960,228
$170,725,707
$27,756,925
$1,608,527
$640
$47,692
$257
MEDI-CAL
MANAGED CARE
9,822
712
13.8
4.3
31,153
7,369
$120,144,206
$77,808,186
$184,084,994
$8,416,607
$5,450,791
$857
$11,821
$175
CO. INDIGENT
TRADITIONAL
CO. INDIGENT
MANAGED CARE
THIRD PARTY
TRADITIONAL
431
113
3.8
3.8
3,416
656
$25,630,026
$7,559,769
$27,401,594
$5,338,067
$450,134
$12,385
$47,240
$132
THIRD PARTY
MANAGED CARE
6,202
OTHER
INDIGENT
OTHER
PAYERS
903
83,970
6,841
12.3
4.9
187,415
25,258
$1,041,694,943
$516,185,880
$1,315,283,036
$157,548,893
$85,048,894
$1,876
$23,030
$454
125,579
$1,932
1,475
4.2
153
5.9
3.6
57,443
7,079
8,062
2,873
$175,447,852
$14,564,853

$158,144,217
$226,684,707
$13,580,204
$33,850,147
$56,226,358
($2,927,365)
$50,681,004
($2,777,725)

6/24/2015
1 OF 5
07/01/2013
06/30/2014
(415)992-4000
DAUGHTERS OF CHARITY HEALTH SYSTEM
COUNTY:
HSA NO:
AVAILABLE BEDS
INTENSIVE
DATE PREPARED:
PAGE:
REPORT PERIOD:
THRU
$9,066
($3,242)
$38,120
($19,133)
$882
($392)
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
426
153
579
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
$1,557,880,823
$10,535,872
$457,637,847
$211,473,463
$170,182,951
$181,065,887
$27,005,214
$222,710,634
$11,658,027
$23,013,141
$1,315,283,036
$242,597,787
$4,605,511
$278,796,889
($31,593,591)
$18,909,055
$4,123,450
($16,807,986)
$123,822,920
$43,244,292
$7,116,399
$5,899,389
$36,392,691
$32,378,360
$9,926,457
$3,020,635
$3,714,439
$13,281,307
$278,796,889
$68,067,091
$16,310,351
$81,169,578
$43,377,872
$5,219,680
$49,542,795
$15,109,522
$278,796,889
$449,585,056
$135,505,699
$972,790,068
$1,557,880,823
PERCENT OF TOTAL
28.9
8.7
62.4
100.0


PAGE:
BALANCE SHEET SUMMARY

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

THRU 06/30/2014
$63,574,876
$323,479
$39,799,839
$7,088,933
TOTAL CURRENT LIABILITIES

DEFERRED INCOME
NET LONG-TERM DEBT
TOTAL LIABILITIES
$63,505,085
$65,065,861
$128,570,946
EQUITY
TOTAL LIABILITIES AND EQUITY
$110,787,127
($17,783,819)
$110,787,127
FINANCIAL RATIO FORMULAS

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

PERIOD)
BAD DEBT RATE
0.68% (PROVISION FOR BAD DEBTS / TOTAL GROSS PATIENT REVENUE) X 100
DEBT, RISK, AND LEVERAGE RATIOS

LONG-TERM DEBT TO ASSETS RATE
58.73% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100
DEBT SERVICE COVERAGE RATIO
( .09) (NET INCOME + INTEREST-WORKING CAPITAL + INTEREST-OTHER +

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

OF OPERATING EXPENSE
1.33% ((INTEREST-WORKING CAPITAL + INTEREST-OTHER) / TOTAL OPERATING

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

OPERATING MARGIN
TURNOVER ON OPERATING ASSETS
( 26.97%) ((NET FROM OPERATIONS + INTEREST-WORKING CAPITAL + INTERESTOTHER) / (TOTAL CURRENT ASSETS + NET PROPERTY, PLANT AND
EQUIPMENT)) X 100
94.51% (NET INCOME / EQUITY) X 100
( 12.78%) (NET FROM OPERATIONS / TOTAL OPERATING REVENUE) X 100
2.39 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
11.59% ((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
21.81 ACCUMULATED DEPRECIATION / DEPRECIATION EXPENSE
98,094 (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
CORONARY CARE
UNITS OF
SERVICE
UNIT
CODE
GROSS REV
PER UNIT
3,761
$17,439.83
$2,505.13
1,013
$17,253.59
$3,383.41
$8,154.35
$1,227.76
$7,543.00
$1,613.05
BURN CARE
1
26,135
PEDIATRIC ACUTE
1
1,658
ALTERNATE BIRTHING CENTER
TOTAL PATIENT CARE SERVICES

NURSERY ACUTE
AMBULATORY SERVICES
EMERGENCY SERVICES
1
1
CHEMICAL DEPENDENCY SERVICES

SKILLED NURSING CARE
1
1
PSYCHIATRIC ACUTE - ADULT

OBSTETRICS ACUTE
ADJ DIRECT
EXP PER UNIT
DEFINITIVE OBSERVATION
MEDICAL/SURGICAL ACUTE
ADJ REV
PER UNIT
1
37,382
$1,370.81
$267.41
83,970
$5,300.83
$799.00
1,240
$3,608.31
$786.57
30,178
$3,450.72
$315.99
CLINICS
12,933
$1,493.61
$324.83
OBSERVATION CARE
26,472
$455.32
$97.21
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
579
340,845
114,142
549,298
2,925
77,193
7
8
9
10
11
11
11
11
14
12
11
27
$18,691.64
$318.52
$983.82
$214.51
$18,455.24
$1,738.34
$2,814.10
$31.63
$161.77
$15.96
$975.16
$121.58
$1,145.33
$994.06
$56.14
$61.96
$191.35
$35.75
129,231
85,699
71,532
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
294,758
1,491,758
4,850
321,344
ADJ DIRECT
EXP PER UNIT
$9.79
$0.74
$82.15
$15.54
1,557,881
6,732
UNIT
CODE
16
17
18
19
20
21
22
UNITS OF
SERVICE
1,177
125,579
412
6,732
10,600
1,557,881
379,031
UNIT
CODE*
23
24
25
22
26
21
20
ADJ DIRECT
EXP PER UNIT
$22,137.72
$20.30
$7,424.69
$630.08
$52.22
$0.60
$9.80
$0.86
$472.21
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
COST CENTER GROUP
AMBULATORY SERVICES
ANCILLARY SERVICES
RESEARCH
EDUCATION
GENERAL SERVICES
FISCAL SERVICES
TOTAL OPERATING COST CTRS
NON-OPERATING COST CENTERS
AVERAGE HOURLY RATE
MANAGEMENT
AND
SUPERVISION
1.21%
4.36%
2.85%
2.18%
TECHNICAL
AND
SPECIALIST
3.28%
5.90%
57.61%
24.37%
REGISTERED
NURSES
52.80%
61.24%
20.50%
41.33%
LICENSED
VOCATIONAL
NURSES
9.81%
1.05%
%
5.11%
AIDES
AND
ORDERLIES
27.88%
8.55%
4.23%
16.74%
%
%
6.78%
5.66%
19.71%
%
%
27.77%
5.94%
37.38%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
5.37%
%
25.67%
56.06%
26.57%
%
3.29%
%
10.76%
%
$0.00
$0.00
$0.00
$0.00
$0.00
ENVIRON.
AND
FOOD SERV.
%
%
%
%
%
%
53.09%
%
0.13%
CLERICAL
AND OTHER
EMPLOYEES
4.42%
18.39%
10.95%
8.43%
%
%
12.36%
88.41%
42.78%
REGISTRY
AND
TEMP HELP
0.60%
0.51%
3.87%
1.84%
%
%
7.84%
%
5.06%
TOTAL
PRODUCTIVE
HOURS
684,802
144,890
515,355
1,345,047
TOTAL
PAID
HOURS
844,149
173,396
620,529
1,638,074
366,686
60,304
277,639
453,849
69,064
345,331
9.32%
22.52%
15.81%
21.42%
3.23%
%
2,092,463
8,535
2,506,318
9,510
$0.00
$0.00
$0.00
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
978
12
TOTAL NUMBER OF NURSING FTE'S**

NUMBER OF NURSING REGISTRY FTE'S
412
4
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:

106410817
3. D. B.A. (Doing Business As) Name:

4. Hospital Business Phone:

(415) 992-4000
5.Medi-Cal Contract Provider Number:

HSC00289F
6. Medi-Cal Non-Contract Provider Number:

ZZR00289F
7.Medicare Provider Number:

05-0289
8. Street Address:
1900 SULLIVAN AVENUE
9. City:
DALY CITY
10.Zip Code:
94015
11. Mailing Address (if different) - Street or P.O. Box:

203 REDWOOD SHORES PKWY 8TH FL
12. City:
REDWOOD CITY
13. Zip Code:

94065
14. Chief Executive Officer:

JOANNE ALLEN
15. Title:
CEO
16. Hospital Web Site Address:

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

MOSS ADAMS LLP
25. Phone Number:

(503) 478-2132 Ext: 28. Mailing Address - Street or P.O. Box:
805 SW BROADWAY SUITE 1200
26. FAX Phone Number:

(503) 274-2789
29. City:
PORTLAND
30. State :
OR
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:

97205
40. Was this disclosure report completed after an independent financial audit ?
__X__
Yes
____
No
41. Are audit adjustments made by the independent auditor reflected in this report ?
__X__
Yes
____
No

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

Line
No
( Page 1 (1 of 2) Submitted Data )
MISC INFORMATION
Report Period End:
(1)
TYPE OF CONTROL
(2)
06/30/2014
TYPE OF CARE
Licensed Beds (End of Period)
478
Church
Available Beds
415
Non-Profit Corporation
Short-Term - Childrens
10
15
Staffed Beds (Average)
231
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
(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)
110 Aerospace Medicine
Other
(3)
NON-HOSPITAL BASED
Board
Certified
(4)
Board
Eligible
(5)
Other
(6)
RESIDENTS/FELLOWS
(Enter FTEs)
Residents
(7)
Line
No
Fellows
(8)
110
115 Allergy and Immunology
120 Anesthesiology
16
125 Cardiovascular Diseases
21
115
5
120
125
130 Child Psychiatry
130
135 Colon and Rectal Surgery
135
140 Dental
145 Dermatology
140
145
150 Diagnostic Radiology
150
155 Forensic Pathology
155
160 Gastroenterology
160
165 General/Family Practice
12
165
175 General Surgery
17
175
180 Internal Medicine
90
13
180
185 Neurological Surgery
185
190 Neurology
170 General Preventive Medicine
170
190
195 Nuclear Medicine

200 Obstetrics and Gynecology
195
17
205 Occupational Medicine
200
205
210 Oncology
210
215 Ophthalmology
17
215
220 Oral Surgery
220

1.
HOSPITAL DESCRIPTION

Line
No

CLINICAL SPECIALTY
Report Period End:
HOSPITAL BASED
NON-HOSPITAL BASED
Board
Eligible
(5)
RESIDENTS/FELLOWS
(Enter FTEs)
Line
No
Board
Certified
(1)
Board
Eligible
(2)
225 Orthopaedic Surgery
22
13
230 Otolaryngology
230
235 Pathology
235
Other
(3)
Board
Certified
(4)
06/30/2014
Other
(6)
Residents
(7)
Fellows
(8)
225
240 Pediatric-Allergy
240
245 Pediatric-Cardiology
245
250 Pediatric-Surgery
250
255 Pediatrics
35
260 Physical Medicine/Rehabilitation
255
265 Plastic Surgery
12
265
270 Podiatry
270
275 Psychiatry
275
285 Pulmonary Disease
290 Radiology
50
260
280 Public Health
280
285
290
295 Therapeutic Radiology
295
300 Thoracic Surgery
300
305 Urology
305
310 Vascular Surgery
310
381
67
315 Other Specialties

320 TOTAL
315
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)
DAUGHTERS OF CHARITY
HEALTH SYSTEM
Percent
Ownership(5)
100
Type of Business
(6)
CORPORATE
OFFICE/PARENT
4
5
6
7
8
9
10
11
12
Expense Included on
Line
Nature of Service or Supply
Amount
(7)
(8)
No
3
ADMIN, BUS OFFICE, ACCOUNTING
Page
$8,461,442
(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)
Joint
(2)
Contracted
(3)
Rental
(4)
23
Clinical and Pathological Laboratory Services
24
Radiology - Diagnostic and Therapeutic
25
Nuclear Medicine
26
Cardiology Services
27
Emergency Services
28
Gastro-Intestinal Services
29
30
Psychiatric Therapy
31
Anesthesiology
32
Other (Specify)
COMMENTS:
33
34
35
36
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
SR. PATRICIA GEOGHEGAN, D.C.
CHAIR, SMC/SC BOARD OF DIRECTO
$0
38
SR. MARION BILL, D.C.
HEALTH COUNCILLOR
$0
39
SR. LINDA ANN CAHILL, D.C.
N/A
$0
40
SR. MICHELE RANDALL, D.C.
VP, MISSION INTEGRATION
$0
41
SR. RACHELA SILVESTRI, D.C.
COMMUNITY OUTREACH
$0
42
ROBERT ISSAI
PRESIDENT/CEO ? DCHS
$0
43
MICHAEL CRILLY
RETIRED
$0
44
CATHERINE HAMILTON, MD
ANESTHESIOLOGIST
$0
45
MICHAEL PACELLI
PRESIDENT
$0
46
KATHY SHAPIRO, MD
OB/GYN
$0
47
JAMES RUMACK, MD
EPIDEMIOLOGIST
$0
48
COLMAN RYAN, MD
VICE CHAIR
$0
49
DEACON EUGENE B. SMITH
SECRETARY/TREASURER
$0
JOANNE ALLEN
PRESIDENT & CEO SMC/SC
$0
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
* Compensation paid to the individual from all sources for services rendered personally to or on behalf of the hospital.

3.4

I.

Report Period End:
06/30/2014
To be completed by all closely held corporations. If a physician is an owner or an owner of the corporation which owns the hospital,
identify all business relationships between the physician and the hospital. This would include percentage of stock owned by the physician,
all contracts between the physician and the hospital, and all lease arrangements between the physician and the hospital. If more than ten
owners, provide data for the ten with the largest percentage of stock owned.
Line
No
(1)
Physician Name
(2)
Percent of Stock Owned
(3)
Describe Contract, Lease and Other Arrangements
70
71
72
73
74
75
76
77
78
79
J. Is this facility operated by a management firm ?
80.
Yes
(This excludes related parties, e.g, management by a parent corporation.)

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

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

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

88
93
89
94
90
95
91
96
92
97
M. Are the amounts paid to the management firm functionally accounted and reported as required ?
98.
Yes
No.
(If "No", complete lines 99 through 102.)
Please explain why amounts paid to the management firm are not functionally accounted and reported.
99
100
101
102

4
PATIENT UTILIZATION STATISTICS
Report Period End:

BEDS
Line
No
PATIENT (CENSUS) DAYS
(1)
Licensed
(End of
Period)
(2)
Available
(Average)
(3)
Staffed
(Average)
(4)
Adult
(5)
Pediatric
06/30/2014
DISCHARGES
(11)
Service
(12)
Total
Line
No
Medical/Surgical Intensive Care
14
14
10
3,761
737
10
Coronary Care
14
14
1,013
199
10
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
50
Pediatric Acute
50
55
Psychiatric Acute - Adult
55
60
Psychiatric Acute - Adolescent & Child
65
Obstetrics Acute
70
Alternate Birthing Center
70
75
Chemical Dependency Services
75
80
Physical Rehabilitation Care
80
85
Hospice - Inpatient Care
85
90
Other Acute Care
100 Sub-Acute Care
15
255
50
20
40
206
206
72
26,135
5,122
45
60
18
18
1,658
609
65
90
44
44
38
13,766
38
105 Skilled Nursing Care
155
116
102
37,382
86
110 Psychiatric Long-Term Care
24
101 Sub-Acute Care - Pediatric
100
101
105
110
115 Intermediate Care
115
120 Residential Care
120
125 Other Long-Term Care Services
125
145 Other Daily Hospital Services

150 Total
155 Nursery Acute
145
478
415
15
231
83,715
255
6,841
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.
30,178
4,920
25,258
160
AMBULATORY SERVICES
160 Emergency Services
Visits
165 Medical Transportation Services
Occasions of Service
170 Psychiatric Emergency Rooms
Visits
175 Clinics
Visits
180 Satellite Clinics
Visits
180
185 Satellite Ambulatory Surgery Center
Operating Minutes
185
190 Outpatient Chemical Dependency Svcs
Visits
195 Observation Care
Observation Hours
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
579
579
235 Surgery and Recovery Services
Operating Minutes
340,845
250,439
240 Ambulatory Surgery Services
Operating Minutes
71,630
245 Anesthesiology
Anesthesia Minutes
442,701
250 Medical Supplies Sold to Patients
CS & S Adj. Inpatient Days
114,142
255 Durable Medical Equipment
Adjusted Inpatient Days
260 Clinical Laboratory Services
Tests
549,298
271,472
277,826
260
265 Pathological Laboratory Services
Tests
16,698
4,623
12,075
265
270 Blood Bank
Units of Blood Issued
9,037
7,862
1,175
270
275 Echocardiology
Procedures
53,728
31,328
22,400
275
280 Cardiac Catheterization Services
Procedures
2,925
1,497
1,428
280
285 Cardiology Services
Procedures
33,798
16,976
16,822
285
290 Electromyography
Procedures
295 Electroencephalography
Procedures
1,838
1,448
390
295
300 Radiology - Diagnostic
Procedures
77,193
26,137
51,056
300
305 Radiology - Therapeutic
Procedures
14,584
3,393
11,191
305
Procedures
4,629
1,605
3,024
310
315 Magnetic Resonance Imaging
Procedures
315
320 Ultrasonography
Procedures
320
325 Computed Tomographic Scanner
Procedures
330 Drugs Sold to Patients
Pharmacy Adj. Inpatient Days
129,231
330
335 Respiratory Therapy
Respiratory Therapy Adj. Inpatient

Days
85,699
335
340 Pulmonary Function Services
Procedures
3,164
222
2,942
340
345 Renal Dialysis
Hours of Treatment
6,363
6,210
153
345
350 Lithotripsy
Procedures
355 Gastro-Intestinal Services
Procedures
1,986
505
1,481
355
360 Physical Therapy
Sessions
71,532
50,896
20,636
360
365 Speech-Language Pathology
Sessions
7,137
6,844
293
365
370 Occupational Therapy
Sessions
19,950
19,718
232
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
165
170
12,933
40
12,893
175
190
26,472
26,472
268,853
195
230
90,406
235
71,630
240
173,848
245
250
255
290
325
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
520
Open Heart Surgeries
525
Inpatient Operating Rooms
Surgeries
Outpatient Operating Rooms
510
4,264
1,925
2,339
515
530
1,822
1,822
1,103
1,103
545
51
51
550
555 Referred Visits
143,949
143,949
555
560 Total Outpatient Visits(a)
187,415
187,415
560
540
545 Observation Care Days

550 Renal Dialysis Care Visits
LIVE BIRTH SUMMARY
535
(1)
Total Births [Sum of
columns (7) and
(13)]
(7)
Natural Births
(13)
Cesarean Sections
579
426
153
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
579
426
153
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
13,948
6,974
2,127
2,963
(5)
County
Indigent
Programs Traditional
(6)
Line
County
No
Indigent
Programs Managed Care
Acute Care
10
Psychiatric Care
10
15
Chemical Dependency Care
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
Purchased Inpatient Services
20
1,815
510
41,238
6,859
25
15,763
7,484
43,365
9,822
35
521
226
40
30
45
PATIENT (CENSUS ) DAYS

TYPE OF CARE
Line
No
(7)
Other Third
Parties
Traditional
431
(8)
(9)
Other Third
Other Indigent
Parties
Managed Care
5,842
(10)
Other Payors
(11)
Total Patient
Days
537
32,822
Line
No
Acute Care
10
Psychiatric Care
10
15
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
20
360
366
51,148
25
6,202
903
83,970
35
491
1,240
40
30
431
45
DISCHARGES
TYPE OF CARE
Line
No
(12)
(13)
(14)
(15)
2,522
1,257
519
692
(16)
County
Indigent
(17)
County
Line
Indigent
No
Programs Managed Care
Acute Care
10
Psychiatric Care
10
15
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
20
23
63
20
25
2,545
1,261
582
712
35
210
87
40
30
45
DISCHARGES
TYPE OF CARE
Line
No
(18)
Other Third
Parties
Traditional
113
(19)
(20)
Other Third
Other Indigent
Parties
Managed Care
1,464
(21)
Other Payors
150
(22)
Total
Discharges
Line
No
Acute Care
10
Psychiatric Care
6,717
10
15
15
20
Rehabilitation Care
25
Long-Term Care
30
Other Care
35
Total
40
Nursery Acute
45
20
11
124
25
1,475
153
6,841
35
191
489
40
30
113
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)
3,283
1,981
1,034
7,369
60
65
Clinic (incl. Satellite Clinics)
3,993
2,070
436
1,932
65
70
Observation Care Days
342
177
37
165
70
75
Psychiatric Day-Night Care Days
75
80
Home Health Care Services
80
85
Hospice - Outpatient
90
Outpatient Surgeries
1,456
803
13
445
95
Private Referred
45,292
22,647
4,723
21,241
95
100
6,247
31,153
105
100 Other *
85
33
105 Total
54,399
27,678
90
OUTPATIENT VISITS
TYPE OF OUTPATIENT VISIT
(7)
Other Third
Parties Traditional
(8)
Other Third
Parties Managed Care
(9)
Other Indigent
(10)
Other Payors
(11)
Total
OutPatient
Visits
Line
No
Line
No
60
Emergency Svcs. (incl. Psych ER)
656
8,062
2,873
25,258
60
65
Clinic (incl. Satellite Clinics)
221
3,895
346
12,893
65
70
Observation Care Days
19
333
30
1,103
70
75
Psychiatric Day-Night Care Days
75
80
80
85
Hospice - Outpatient
90
Outpatient Surgeries
95
Private Referred
85
71
1,358
15
4,161
2,449
43,782
3,815
143,949
95
51
100
187,415
105
100 Other *
105 Total
13
3,416
57,443
Includes Chemical Dependency Services, Adult Day Health Care, & Renal Dialysis Visits
7,079
90

5
BALANCE SHEET - UNRESTRICTED FUND

Line
No
ASSETS
Report Period End:
06/30/2014
Account No
(1) Current Year
(2) Prior Year
$7,414,273
$9,910,448
Line
No
CURRENT ASSETS
5
Cash
1000
10
Marketable securities
1010
15
Accounts and notes receivable
1020
$221,753,424
$211,276,396
15
20
Less allowance for uncollectible receivables and thrid-party contractual withholds
1040
($187,793,131)
($176,396,614)
20
25
Receivables from third-party payors
1050
$810,118
$1,042,083
25
30
Pledges and other receivables
1060
$1,263,638
$8,184,116
30
35
Due from restricted funds
1070
40
Inventory
1080
$2,953,859
$2,527,716
40
45
Intercompany receivables
1090
$16,756,185
$26,057,829
45
50
Prepaid expenses and other current assets
1100
$416,510
$644,969
50
55
TOTAL CURRENT ASSETS (Sum of lines 5 through 50)
$63,574,876
$83,246,943
55
$323,479
$289,242
$323,479
$289,242
75
10
35
ASSETS WHOSE USE IS LIMITED

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

80
Land
1200
$5,452,823
$5,452,823
80
85
Land improvements
1210
$2,256,906
$2,256,906
85
90
Buildings and improvements
1220
$94,586,856
$93,227,148
90
95
Leasehold improvements
1230
$91,512
$91,512
95
1240
$153,891,878
$150,846,571
100
$256,279,975
$251,874,960
105
1260
($216,480,136)
($206,625,952)
195
$39,799,839
$45,249,008
200
$7,088,933
$5,601,956
205
100 Equipment
105 TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 80 through 100)
195 Less accumulated depreciation and amortization
200 NET TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 105 & 195)
205 Construction in progress
1250
INVESTMENTS AND OTHER ASSETS

210 Investments in property, plant and equipment
1310
210
215 Less accumulated depreciation - investments in plant and equipment
1320
215
220 Other Investments
1330
220
225 Intercompany receivables
1340
225
230 Other Assets
1350
230
235 TOTAL INVESTMENTS IN OTHER ASSETS (Sum of lines 210 through 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
$110,787,127
$134,387,149
270
(1) Current Year
(2) Prior Year
Line
No
$323,479
$289,242
405 Current market value - current assets marketable securities (Line 10)
410 Current market value - limited use investments (Line 65)
405
415 Current market value - other investments (Line 220)

420 Total cost to complete construction in progress (Line 205)
410
415
$7,088,933
$5,601,957
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
$738,592
$1,143,351
10
Accounts payable
2020
$9,272,389
$5,319,134
10
15
Accrued compensation and related liabilities
2030
$15,042,016
$15,350,680
15
20
Other accrued expenses
2040
25
Advances from third-party payors
2050
30
Payable to third-party payors
2060
35
Due to restricted funds
2070
40
Income Taxes payable
2080
45
Intercompany payables
2090
$31,969,164
$31,566,675
50
Current maturities of long-term debt (Must agree with line 125)
55
Other current liabilities
2100
$5,496,122
$9,532,915
55
60
TOTAL CURRENT LIABILITIES (Sum of lines 5 through 55)
$63,505,085
$65,719,976
60
20
25
$986,802
$2,807,221
30
35
40
45
50
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
$20,703
75
$20,703
80
LONG-TERM DEBT Unpaid Principal(a)

85
Mortgages payable
2210
85
90
Construction loans
2220
90
95
Notes under revolving credit
2230
95
100 Capital lease obligations
2240
100
105 Bonds payable
2250
110 Intercompany payables
2260
115 Other non-current liabilities
2270
120 TOTAL LONG-TERM DEBT (Sum of lines 85 through 115)
$65,065,861
$96,956,083
105
110
115
$65,065,861
$96,956,083
130 NET TOTAL LONG-TERM DEBT(Sum of lines 120 and 125)
$65,065,861
$96,956,083
130
135 TOTAL LIABILITIES (Sum of lines 60,80 and 130)
$128,570,946
$162,696,762
135
($17,783,819)
($28,309,613)
140
125 Less amount shown as current maturities (Must agree with line 50)
120
125
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
($17,783,819)
($28,309,613)
205
$110,787,127
$134,387,149
270
TOTAL
270 TOTAL LIABILITIES AND EQUITY (Sum of lines 135 and 205)
(a) Complete Report Page 5.1 to provide detailed long-term debt information.

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

column(3), Line No
(6)Date Obligation
Incurred (Year Only*)
105
2006

Report Period End:
(7) Due Date

(Year Only*)
2040
(8) Interest
Rate (a)
7.45
(9) Unpaid Principal

Balance at Year End
$65,065,861
06/30/2014
Line
No
5
10
10
15
15
20
20
25
25
30
30
35
35
40
40
45
45
50
50
55
55
60
60
65
65
70
70
75
75
80
80
85
85
90
90
95
95
100
100
105
105
110
110
115
115
120
120
125
125
130
130
135
135
140
140
145
145
150
150
155
155
160
160
165
165
170
170
175
175
180
180
185
185
190
190
195
195
200
200
205
205
210
210
215
215
220
220
225
225
230
230
235
235
240
240
245
245
250
250
*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
$5,452,823
$5,452,823
10
Land Improvements
$2,256,906
$2,256,906
10
15
Buildings and Improvements
$93,227,148
$94,586,856
15
20
Leasehold Improvements
$91,512
20
25
Equipment
$153,891,878
25
30
Construction-in-progress
35
TOTAL
$1,359,708
$91,512
$150,846,571
$3,045,307
$5,601,956
$1,486,977
$7,088,933
30
$257,476,916
$5,891,992
$263,368,908
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
10
Prior period audit adjustment
10
15
Restatement (describe)
15
($28,309,613)
20
20
25
25
30
30
35
35
40
40
45
45
50
BALANCE AT BEGINNING OF YEAR, AS

RESTATED
($28,309,613)
50
55
ADDITIONS (DEDUCTIONS):
Net Income (Loss)
($16,807,986)
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
110
Other (Describe) VARIANCE PER MCR COST

REPORT
115
RECONCILIATION TO PY EFB
105
$17,611,810
$9,721,970
120
110
115
120
125
TOTAL ADDITIONS (DEDUCTIONS)
130
TRANSFERS:
Property and equipment additions
$10,525,794
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
($17,783,819)
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
$449,585,056
$399,278,654
10
Ambulatory services
$135,505,699
$110,559,531
10
15
Ancillary services
$972,790,068
$976,870,392
15
30
GROSS PATIENT REVENUE (Sum of lines 5 through 15)
$1,557,880,823
$1,486,708,577
30
105
DEDUCTIONS FROM REVENUE (From line 395) (a)
$1,315,283,036
$1,220,680,985
105
107
CAPITATION PREMIUM REVENUE (From line 450) (b)
110
NET PATIENT REVENUE (Line 30 minus line 105 plus line 107)
$242,597,787
$266,027,592
110
135
TOTAL OTHER OPERATING REVENUE
$4,605,511
$3,273,727
135
140
TOTAL OPERATING REVENUE (Sum of lines 110 and 135)
$247,203,298
$269,301,319
140
146
OPERATING EXPENSES:
Daily Hospital Services
$68,067,091
$72,587,431
146
151
Ambulatory Services
$16,310,351
$16,860,564
151
156
Ancillary Services
$81,169,578
$85,033,857
156
161
Research Costs
166
Education Costs
171
General Services
$43,377,872
$42,092,751
171
176
Fiscal Services
$5,219,680
$5,132,348
176
181
Administrative Services
$49,542,795
$66,850,942
181
186
Unassigned Costs
$15,109,522
$10,409,502
186
190
195
Purchased Outpatient Services
200
TOTAL OPERATING EXPENSES (Sum of Lines 146 through 195)
$278,796,889
$298,967,395
200
205
NET FROM OPERATIONS (Line 140 minus line 200)
($31,593,591)
($29,666,076)
205
210
NET NON-OPERATING REVENUE AND EXPENSE (From Line 700) (c)
$14,785,605
$4,682,592
210
215
NET INCOME BEFORE TAXES AND EXTRAORDINARY ITEMS: (Sum of lines

205 and 210)
($16,807,986)
($24,983,484)
215
220
PROVISION FOR INCOME TAXES:

Current
220
225
Deferred
225
230
NET INCOME BEFORE EXTRAORDINARY ITEMS: (Line 215 minus 220 and
225)
107
161
166
190
195
($16,807,986)
($24,983,484)
230
EXTRAORDINARY ITEMS:(Specify)
235
235
240
245
240
NET INCOME (Line 230 minus lines 235 and 240)
($16,807,986)
(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.
($24,983,484)
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
$10,535,872
$9,721,971
300
305
Contractual adjustments - Medicare - traditional
$457,637,847
$438,065,955
305
310
Contractual adjustments - Medicare - managed care
$211,473,463
$202,668,463
310
315
Contractual adjustments - Medi-Cal - traditional
$170,182,951
$162,025,403
315
320
Contractual adjustments - Medi-Cal - managed care
$181,065,887
$128,176,940
320
325
Disproportionate share payments for Medi-Cal patient days (SB 855) (credit bal)
(d)
325
330
Contractual adjustments - County indigent programs - traditional
330
335
Contractual adjustments - County indigent programs - managed care
340
Contractual adjustments - Other third parties - traditional
$27,005,214
$23,651,351
340
345
Contractual adjustments - Other third parties - managed care
$222,710,634
$219,747,648
345
350
Charity discounts - Hill Burton
$13,342,962
350
355
Charity discounts - other
360
Restricted donations and subsidies for indigent care (credit balance)
360
365
Teaching allowances (Teaching Hospitals only)
365
370
Support for clinical teaching (credit balance (Teaching Hospitals only)
370
375
Policy discounts
380
Administrative adjustments
385
Other deductions from revenue
395
TOTAL DEDUCTIONS FROM REVENUE (Sum of lines 300 thru 385)
430
CAPITATION PREMIUM REVENUE:

Capitation Premium Revenue - Medicare
430
435
Capitation Premium Revenue - Medi-Cal
435
440
Capitation Premium Revenue - County indigent programs
440
445
Capitation Premium Revenue - Other third parties
445
450
TOTAL CAPITATION PREMIUM REVENUE (Sum of lines 430 thru 445)
450
335
$11,658,027
355
375
$23,280,292
$23,013,141
$1,315,283,036
(d) Disproportionate share funds transferred back to a related public entity must be reported on page 7, column(1), line 105.
380
385
$1,220,680,985
395

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
550
County allocation of taxes revenue (e)
9160
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
$38,615
$158,398
610
615
Other non-operating revenue
9400
$114,061
$20,286
615
625
TOTAL NON-OPERATING REVENUE (Sum of lines 500 thru 615)
$18,909,055
$9,079,453
625
640
NON-OPERATING EXPENSES:
Loses on sale of hospital property
9020
($34,915)
640
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
$32,418
$238,250
670
675
Other non-operating expense
9800
$602,292
$772,663
675
685
TOTAL NON-OPERATING EXPENSE (Sum of lines 640 thru 675)
$4,123,450
$4,396,861
685
700
NET NON-OPERATING REVENUE AND EXPENSE (Line 625

minus line 685)
$14,785,605
$4,682,592
700
705
Interest on long-term debt (e)
(e) District Hospital only.
500
505
$4,569,073
$4,593,618
$52,613
$1,028,938
510
515
520
545
$10,800,000
550
590
$3,334,693
$3,278,213
595
600
605
645
650
$3,488,740
$3,420,863
655
660
665
705

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

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

Report Period End:
06/30/2014
(1) Current Year
(2) Prior Year
Line
No
($16,807,986)
($24,983,484)
$10,747,956
$10,790,405
15
17
20
$919,489
($1,714,361)
30
$231,965
$741,798
35
$6,920,478
($221,174)
40
Change in inventory
($426,143)
$576,270
50
55
Change in intercompany receivables
$9,301,644
$6,779,153
55
57
Change in Prepaid expenses and other current assets
$228,459
$513,702
57
60
Change in accounts payable
$3,953,255
$768,709
60
65
Change in accrued compensation and related liabilities
($308,664)
$15,350,680
65
70
Change in other accrued expenses
($15,827,068)
70
75
Change in advances from third-party payors
80
Change in payable to third-party payors
85
Change in due to restricted funds
87
Change in income taxes payable
90
Change in intercompany payables
$402,489
$3,014,964
95
Change in other current liabilities
($4,036,793)
($7,583,563)
95
($20,703)
$4,668
100
100 Change in deferred credits
45
75
($1,820,419)
($3,670,535)
80
85
87
90
102 Other (Describe):
102
103
104
105 TOTAL ADJUSTMENTS (Sum of lines 15 through 104)
$26,093,013
$9,523,648
105
115 NET CASH PROVIDED BY (USED FOR) OPERATING ACTIVITIES (Sum of lines 5 and 105)
$9,285,027
($15,459,836)
115
($34,237)
$18,097,672
130
($5,891,992)
($11,234,753)
135
CASH FLOW FROM INVESTING ACTIVITIES:

130 Change in assets whose use is limited
135 Purchase of plant, property and equipment and construction-in-progress
140
141
142
NET CASH PROVIDED BY (USED FOR) INVESTING ACTIVITIES (Sum of lines 130 through
145 142)
($5,926,229)
CASH FLOW FROM FINANCING ACTIVITIES:

160 Proceeds from issuance of long-term debt
165 Principal payments on long-term debt
145
$1,788,923
160
($31,890,222)
170 Proceeds from issuance of short-term notes and loans

175 Principal payments on short-term notes and loans
$6,862,919
165
$1,143,351
($404,759)
175
180 Dividends paid
180
185 Proceeds from issuance of common stock

190 Other (Describe): UNLOCATED VARIANCE
170
185
$26,440,008
$1,754,178
190
191
192
NET CASH PROVIDED BY (USED FOR) FINANCING ACTIVITIES (Sum of lines 160 through
195 192)
($5,854,973)
$4,686,452
195
205 NET INCREASE (DECREASE) IN CASH (Sum of lines 115, 145 and 195)
($2,496,175)
($3,910,465)
205
215 CASH AT BEGINNING OF YEAR
$9,910,448
$13,820,913
215
225 CASH AT END OF YEAR (Sum of lines 205 and 215)
$7,414,273
$9,910,448
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
$28,735,530
$14,622,456
10
Coronary Care
3030
$7,387,146
$3,386,414
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
Psychiatric Acute - Adolescent and Child
3360
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
$31,109
$26,386
95
100 Sub-Acute Care
3560
$8,058,389
$2,191,011
100
3570
3580
$1,625,395
$431,693
110 Psychiatric - Long Term Care
3610
3630
115
3680
120
3780
125
3900
40
$97,781,697
$47,840,848
45
60
$86,955
$73,751
65
90
101
105
110
145
$143,706,221
$68,572,559
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
190 Outpatient Chemical Dependency Services
4220
4230
4260
200
4290
205
4310
210
4320
215
4390
$13,354,956
$11,929,026
$6,708,747
$6,898,620
160
165
170
$9,057,350
$2,712,817
175
190
$4,931,979
$2,006,799
195
220
$13,354,956
$25,918,355
$6,708,747
$11,618,236
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
$2,998,144
$5,844,130
10
Coronary Care
3030
$596,417
$1,508,230
10
15
3050
20
3070
$1,246,251
$201,858
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
$1,781,583
$866,252
95
100 Sub-Acute Care
3560
$58,607,191
$13,254,167
100
3570
3580
$39,384,606
$7,339,927
3610
3630
115
3680
120
3780
125
3900
15
20
40
$9,612,897
$18,114,618
45
60
$4,979,768
$2,421,292
65
90
101
105
110
145
$119,206,857
$49,550,474
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
4230
4260
200
4290
205
4310
210
4320
215
4390
$1,507,042
$3,038,209
$3,145,843
$18,628,714
160
165
170
$1,826,941
$2,728,865
175
190
$288,393
$1,407,303
195
220
$1,507,042
$5,153,543
$3,145,843
$22,764,882
225

12

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

Traditional
(9) Gross
Inpatient Revenue
Line
No
PATIENT
Managed Care
(10) Gross
Outpatient
Revenue
(11) Gross
Inpatient Revenue
(12) Gross
Outpatient
Revenue
Account
No
Line
No
.07
.47
.17
.57

3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
40
45
3170
45
50
Pediatric Acute
3290
50
55
3340
55
60
3360
60
65
Obstetrics Acute
3380
65
70
3400
70
75
3420
75
80
3440
80
85
3470
85
90
Other Acute Care
3510
90
95
Nursery Acute
3530
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
150
4010
160
4040
165
4060
170
175 Clinics
4070
175
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
220
225

12

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

Traditional
(13) Gross
Inpatient Revenue
Line
No
PATIENT
(14) Gross
Outpatient
Revenue
Managed Care
(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
$393,382
$11,382,588
10
Coronary Care
3030
$113,068
$4,161,830
10
15
3050
20
3070
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
$1,747,615
95
100 Sub-Acute Care
3560
$829,029
100
3570
3580
3610
3630
115
3680
120
3780
125
3900
15
$789,877
20
40
$3,133,253
$33,631,403
45
60
$4,884,819
65
90
101
$722,981
105
110
145
$3,639,703
$58,150,142
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
4230
4260
200
4290
205
4310
210
4320
215
4390
$66,989
$1,384,318
$5,425,949
$23,780,441
160
165
170
$192,984
$2,740,203
175
190
$146,750
$3,054,664
195
220
$66,989
$1,724,052
$5,425,949
$29,575,308
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
$1,614,985
10
Coronary Care
3030
$324,781
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
40
$2,999,160
45
60
$59,712
65
90
$21,362
95
100 Sub-Acute Care
3560
3570
3580
3610
3630
115
3680
120
3780
125
3900
100
101
$1,739,100
105
110
145
$6,759,100
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
4230
4260
200
4290
205
4310
210
4320
215
4390
$864,799
$7,402,094
160
165
170
$57,689
175
190
$217,215
195
220
$864,799
$7,676,998
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
$65,591,215
$65,591,215
10
Coronary Care
3030
$17,477,886
$17,477,886
10
15
3050
20
3070
$2,237,986
$2,237,986
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
$4,474,307
$4,474,307
95
100 Sub-Acute Care
3560
$82,939,787
$82,939,787
100
3570
3580
$51,243,702
$51,243,702
3610
3630
115
3680
120
3780
125
3900
15
20
40
$213,113,876
$213,113,876
45
60
$12,506,297
$12,506,297
65
90
101
105
110
145
$449,585,056
$449,585,056
150
$104,135,747
160
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
4230
4260
200
4290
205
4310
210
4320
215
4390
$31,074,325
$73,061,422
165
170
$19,316,849
$19,316,849
175
190
$12,053,103
$12,053,103
195
220
$31,074,325
$104,431,374
$135,505,699
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
$10,541,894
$8,534,371
ANCILLARY SERVICES:
4400
$43,341
4420
$27,117,524
4430
245 Anesthesiology
4450
$9,509,681
$5,266,138
250 Medical Supplies sold to Patients
4470
$29,134,086
4480
4500
(4) Gross
Outpatient
Revenue
Line
No
.54
$27,379
230
$4,523,449
235
$4,638,312
240
$3,322,511
$2,629,807
245
$11,101,993
$10,025,494
$4,235,768
250
$26,568,265
$18,204,584
$13,012,685
$9,294,382
260
4520
$634,718
$1,351,952
$314,225
$705,845
265
270 Blood Bank
4540
$411,905
$73,727
$215,061
$16,051
270
275 Echocardiology
4560
$5,203,014
$2,664,845
$2,287,116
$1,636,630
275
4570
$10,976,965
$12,390,514
$4,171,688
$3,841,973
280
4590
$2,488,336
$2,157,865
$1,158,048
$1,011,191
285
4610
4620
$134,641
$22,684
$54,968
$28,620
295
4630
$19,706,616
$27,370,800
$8,744,058
$13,422,170
300
4640
$1,024,682
$13,149,801
$411,828
$6,186,238
305
4650
$1,281,888
$3,163,372
$640,786
$1,775,300
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$35,445,538
$20,153,241
$17,225,864
$10,591,985
330
4720
$15,752,371
$487,593
$9,761,349
$237,626
335
4730
$70,406
$594,076
$21,203
$310,372
340
345 Renal Dialysis
4740
$4,266,450
$126,929
$1,196,447
$33,738
345
350 Lithotripsy
4750
4760
$2,300,291
$2,303,784
$1,302,181
$1,845,217
355
4770
$2,890,691
$1,957,534
$1,256,809
$1,055,412
360
365 Speech- Language Pathology
4780
$664,351
$37,508
$325,849
$13,203
365
4790
$1,928,767
$70,244
$873,148
$38,039
370
4800
375
4820
380
4830
385
4840
390
4860
4870
$7,743,502
255
290
325
350
395
$1,382,337
$1,056,460
$614,660
$534,317
400
$198,936,864
$141,991,040
$85,497,728
$68,605,645
405
415 TOTAL PATIENT REVENUE
$355,998,041
$167,909,395
MEDICARE
Traditional
Inpatient
Outpatient
$160,779,034
MEDICARE
Managed Care
Total
$80,223,881
415
DEDUCTIONS FROM REVENUE

420 Provision for Bad Debts
425 Contractual Adjustments (exclude capitation revenue)
$374,515
$177,173
$2,872,889
420
$310,668,481
$146,969,366
$211,473,463
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
$311,042,996
$147,146,539
$214,346,352
$44,955,045
$20,762,856
$26,656,563
457 CAPITATION PREMIUM REVENUE

460 NET PATIENT REVENUE (Line 415 - 455 + 457)
455
457
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
ANCILLARY SERVICES:
4400
$4,404,813
4420
$2,138,248
4430
245 Anesthesiology
4450
$1,094,011
$153,736
4470
$6,301,440
4480
4500
$2,056,320
$440,206
$3,486,831
Line
No
230
$4,638,302
235
$2,182,547
240
$1,704,019
$2,117,279
245
$345,786
$8,016,602
$3,965,396
250
$5,976,251
$1,445,650
$6,800,386
$9,028,979
260
4520
$167,263
$45,981
$169,280
$815,232
265
270 Blood Bank
4540
$61,663
$1,007
$69,311
$25,753
270
275 Echocardiology
4560
$523,711
$68,874
$783,404
$882,881
275
4570
$860,064
$83,594
$2,849,489
$3,076,961
280
4590
$259,563
$112,563
$483,642
$953,011
285
4610
4620
$25,685
$29,874
$11,637
295
4630
$2,343,471
$1,611,067
$3,524,383
$12,134,157
300
4640
$97,468
$290,520
$124,071
$3,543,021
305
4650
$141,251
$32,632
$255,833
$1,071,797
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$11,091,796
$1,026,322
$11,861,315
$5,761,750
330
4720
$30,448,650
$44,916
$23,058,891
$288,933
335
4730
$4,285
$3,026
$5,822
$145,241
340
345 Renal Dialysis
4740
$1,025,715
$507,095
$24,074
345
350 Lithotripsy
4750
4760
$256,162
$30,168
$398,434
$2,795,249
355
4770
$470,866
$12,618
$574,693
$1,323,403
360
4780
$216,827
$142,975
$26,762
365
4790
$302,011
$324,956
$13,763
370
4800
375
4820
380
4830
385
4840
390
4860
4870
$45,782
255
290
325
350
395
$205,818
$12,237
$220,263
$217,176
400
$68,417,032
$5,806,685
$67,447,889
$55,043,304
405
$189,130,931
$10,960,228
$120,144,206
$77,808,186
415
MEDI-CAL
Traditional
Total
MEDI-CAL
Managed Care
Total
$2,396,061
420
$170,182,951
$181,065,887
425
$542,756
$623,046

430 Charity
426
430

(Credit Balance)
435
440
445

450
$170,725,707
$184,084,994
$29,365,452
$13,867,398

455
457
460

12

Report Period End:
06/30/2014

Traditional
Line
No
PATIENT
Account
No
Managed Care
(9) Gross
Inpatient Revenue
(10) Gross
Outpatient
Revenue
(11) Gross
Inpatient Revenue
(12) Gross
Outpatient
Revenue
.07
.47
.17
.57
Line
No
ANCILLARY SERVICES:
4400
230
4420
235
4430
240
245 Anesthesiology
4450
245
4470
250
4480
255
4500
260
4520
265
270 Blood Bank
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
4610
290
4620
295
4630
300
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
325
4710
330
4720
335
4730
340
345 Renal Dialysis
4740
345
350 Lithotripsy
4750
350
4760
355
4770
360
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
400
405

415
Traditional
Inpatient
Outpatient
CO. INDIGENT
PROGRAMS
Managed Care
Total
420
425

426
430 Charity
430

(Credit Balance)
435
440
445
450
455
457
460

12

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

Traditional
Line
No
PATIENT
Account
No
Managed Care
(13) Gross
Inpatient Revenue
(14) Gross
Outpatient
Revenue
(15) Gross
Inpatient Revenue
(16) Gross
Outpatient
Revenue
.02, .03, .06
.42, .43, .46
.12,.13,.16
.52, .53, .56
$9,576,667
$1,078,552
$20,865,773
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
4450
$2,257,263
$406,240
4470
$7,021,442
4480
4500
$4,236,611
Line
No
230
$14,900,517
235
$7,192,777
240
$7,345,707
$6,305,373
245
$380,078
$21,309,449
$9,079,686
250
$532,697
$349,172
$10,644,792
$13,344,090
260
4520
$2,102
$10,459
$463,423
$2,089,196
265
270 Blood Bank
4540
$5,505
$150,699
$43,871
270
275 Echocardiology
4560
$39,743
$53,434
$1,983,573
$2,923,231
275
4570
$56,849
$8,232,717
$6,721,659
280
4590
$210,507
$1,027,715
$2,199,858
285
4610
4620
$1,939
$76,095
$35,906
295
4630
$1,445,430
$9,058,498
$31,284,596
300
4640
$2,897
$371,932
$8,554,122
305
4650
$48,974
$504,000
$2,152,770
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$1,225,532
$266,922
$17,825,265
$13,489,498
330
4720
$207,564
$428
$3,999,266
$547,531
335
4730
$3,439
$10,155
$444,355
340
345 Renal Dialysis
4740
$750,377
$28,086
345
350 Lithotripsy
4750
4760
$9,101
$859,618
$4,629,832
355
4770
$1,013,153
$930,088
$1,824,734
360
4780
$187,303
$12,682
365
4790
$609,715
$41,695
370
4800
375
4820
380
4830
385
4840
390
4860
4870
$443,691
255
$58,401
290
$560,281
$6,416
325
$15,367
350
$276,360
$115,587
$2,621
395
$22,407
$51,831
$428,990
$722,844
400
$21,923,334
$5,835,717
$111,871,761
$128,568,909
405
$25,630,026
$7,559,769
OTHER THIRD PARTIES
Traditional
$175,447,852
OTHER THIRD
PARTIES
Managed Care
Total
$158,144,217
415
Inpatient
Outpatient
$305,831
$90,549
$3,974,073
420
$19,986,128
$7,019,086
$222,710,634
425

426
430 Charity
430

(Credit Balance)
435
440
445

450
$20,291,959
$7,109,635
$226,684,707
$5,338,067
$450,134
$106,907,362

455
457
460

12

Report Period End:
OTHER INDIGENT
Line
No
PATIENT
Account
No
06/30/2014
OTHER PAYORS
(17) Gross
Inpatient Revenue
(18) Gross
Outpatient
Revenue
(19) Gross
Inpatient Revenue
(20) Gross
Outpatient
Revenue
.08
.48
.00, .09
.40, .49
ANCILLARY SERVICES:
4400
$53,994
4420
$572,014
4430
245 Anesthesiology
4450
4470
4480
Line
No
230
$150,634
235
$132,664
240
$255,076
$82,191
245
$802,626
$575,171
250
4500
$1,203,599
$1,425,849
260
4520
$27,694
$12,665
265
270 Blood Bank
4540
$14,661
$3,714
270
275 Echocardiology
4560
$266,234
$53,331
275
4570
$533,690
$185,413
280
4590
$121,787
$345,926
285
4610
4620
$19,410
$1,821
295
4630
$954,436
$2,027,946
300
4640
$20,573
$137,983
305
4650
$69,844
4660
315
320 Ultrasonography
4670
320
4680
4710
$1,497,794
$548,974
330
4720
$242,884
$112,179
335
4730
345 Renal Dialysis
4740
350 Lithotripsy
4750
4760
$117,300
$23,840
355
4770
$48,524
$52,495
360
4780
$16,816
365
4790
$55,704
370
4800
375
4820
380
4830
385
4840
390
4860
4870
255
290
310
325
340
$15,367
345
350
395
$30,927
$30,410
400
$6,940,954
$5,903,206
405
$14,564,853
$13,580,204
OTHER PAYORS
415
OTHER INDIGENT
Inpatient
Outpatient
Inpatient
Outpatient
$178,167
$166,614
425

430 Charity
420
426
$5,421,905
$5,070,320
430

(Credit Balance)
435
440
445
$11,892,146
$11,120,995
450
$17,492,218
$16,357,929
455
($2,927,365)
($2,777,725)

457
460

12

Report Period End:
06/30/2014
TOTAL
Line
No
PATIENT
Account
No
(21) Gross
Inpatient Revenue
ANCILLARY SERVICES:
4400
$10,822,458
4420
$72,291,428
4430
245 Anesthesiology
4450
4470
4480
(22) Gross
Outpatient
Revenue
(23) Gross patient

Revenue
Line
No
$10,822,458
230
$36,273,554
$108,564,982
235
$22,379,275
$22,379,275
240
$25,488,268
$16,960,764
$42,449,032
245
$82,611,139
$29,683,878
$112,295,017
250
4500
$64,738,675
$53,092,706
$117,831,381
260
4520
$1,778,705
$5,031,330
$6,810,035
265
270 Blood Bank
4540
$928,805
$164,123
$1,092,928
270
275 Echocardiology
4560
$11,086,795
$8,283,226
$19,370,021
275
4570
$27,624,613
$26,356,963
$53,981,576
280
4590
$5,597,492
$6,990,921
$12,588,413
285
4610
4620
$340,673
$102,607
$443,280
295
4630
$44,891,743
$89,296,166
$134,187,909
300
4640
$2,050,554
$31,864,582
$33,915,136
305
4650
$2,900,018
$8,244,845
$11,144,863
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$96,173,104
$51,838,692
$148,011,796
330
4720
$83,470,975
$1,719,206
$85,190,181
335
4730
$111,871
$1,500,509
$1,612,380
340
345 Renal Dialysis
4740
$7,776,818
$212,827
$7,989,645
345
350 Lithotripsy
4750
4760
$5,233,986
$11,637,191
$16,871,177
355
4770
$6,448,031
$7,239,349
$13,687,380
360
4780
$1,554,121
$90,155
$1,644,276
365
4790
$4,209,888
$166,362
$4,376,250
370
4800
375
4820
380
4830
385
4840
390
4860
4870

255
290
325
350
395
$2,905,402
$2,625,275
$5,530,677
400
$561,035,562
$411,754,506
$972,790,068
405
$1,041,694,943
$516,185,880
$1,557,880,823
415
Total Inpatient
Total Outpatient
Total
$10,535,872
420
$1,270,075,996
425

430 Charity
426
$11,658,027
430

(Credit Balance)
435
440

445
$23,013,141
450
$1,315,283,036
455

457
$242,597,787
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)
15
$129,117
20
35
40
40
45
45
50
50
65
PART II: MINOR RECOVERIES DISTRIBUTED TO ONE COST CENTER

Telephone and Telegraph Revenue
5470
70
Donated Blood
5750
70
75
Vending Machine Commissions
5690
75
80
Television/Radio Rentals
5720
85
Finance Charges on Patient Accounts Receivable
5520
90
Child Care Services Revenue - Employees
5760
95
Other (Specify)
$20,180
65
80
$9,416
85
90
95
100
100
105
105
110
110
115
115
120
TOTAL PARTS I AND II
$158,713
120
130
PART III: OTHER OPERATING REVENUE ALLOCATED

Non-Patient Food Sales
5320
135
Laundry and Linen Revenue
5340
$372,254
130
135
140
Social Work Services Revenue
5350
140
145
Supplies sold to Non-Patients Revenue
5370
150
Drugs Sold to Non-Patients Revenue
5380
155
Purchasing Services Revenue
5390
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
180
Management Services Revenue
5740
180
185
Transfers from Restricted Funds for Operations (Non-Revenue Centers)
5790
185
190
Worker's Compensation Refunds
5782
190
195
Community Health Education Revenue
5770
195
196
Reinsurance Recoveries
5781
200
Other (Specify) OTHER OPERATING REVS
145
$615,188
150
170
$23,930
175
196
$3,435,426
200
205
205
210
210
215
215
220
TOTAL PART III
$4,446,798
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
$4,605,511
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
45
6170
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
6580
6610
6630
115
6680
120
6780
125
6900
40
$37,200
$37,200
45
101
$103,200
$103,200
105
110
145
$140,400
$140,400
150
$522,000
$522,000
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
190 Outpatient Chemical Dependency Svcs.
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
$384,928
$384,928
175
220
$906,928
$906,928
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
45
6170
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
6580
6610
6630
115
6680
120
6780
125
6900
40
$37,200
45
101
$103,200
105
110
145
$140,400
150
$522,000
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
165
170
$384,928
175
220
$906,928
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
245 Anesthesiology
7450
7470
7480
7500
7520
270 Blood Bank
7540
275 Echocardiology
7560
$18,000
$18,000
275
7570
$47,013
$47,013
280
7590
$164,500
$164,500
285
7610
7620
$435,440
$435,440
295
7630
$116,070
$116,070
300
7640
$64,224
$64,224
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
7720
7730
340
345 Renal Dialysis
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
240
$1,400,556
$1,400,556
245
250
255
$155,988
$155,988
260
265
270
290
330
$92,255
$92,255
335
400
$2,494,046
$2,494,046
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
245 Anesthesiology
7450
7470
7480
7500
7520
270 Blood Bank
7540
275 Echocardiology
7560
$18,000
275
7570
$47,013
280
7590
$164,500
285
7610
7620
$435,440
295
7630
$116,070
300
7640
$64,224
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
7720
7730
340
345 Renal Dialysis
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
240
$1,400,556
245
250
255
$155,988
260
265
270
290
330
$92,255
335
400
$2,494,046
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
45
Other Health Profession Education
8290
50
TOTAL EDUCATION
40
$841,597
$841,597
45
$841,597
$841,597
50
$429,476
$429,476
205
205 Hospital Administration
8610
210 Governing Board Expense
8620
210
215 Public Relations
8630
215
220 Management Engineering
8640
220
225 Personnel
8650
230 Employee Health Services
8660
235 Auxiliary Groups
8670
235
240 Chaplaincy Services
8680
240
245 Medical Library
8690
245
250 Medical Records
8700
255 Medical Staff Administration
8710
260 Nursing Administration
8720
260
265 Nursing Float Personnel
8730
265
270 Inservice Education - Nursing
8740
270
275 Utilization Management
8750
275
280 Community Health Education
8760
295 Other Administrative Services
8790
300 TOTAL ADMINISTRATIVE SERVICES
225
$31,200
$31,200
230
250
$2,202,112
$2,202,112
255
280
$70,640
$70,640
295
$2,733,428
$2,733,428
300
$7,116,399
$7,116,399
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
45
8290
50
TOTAL EDUCATION
40
$841,597
45
$841,597
50
$429,476
205
8610
8620
210
8630
215
8640
220
225 Personnel
8650
8660
8670
235
8680
240
245 Medical Library
8690
245
250 Medical Records
8700
8710
8720
260
8730
265
8740
270
8750
275
8760
8790
225
$31,200
230
250
$2,202,112
255
280
$70,640
295
$2,733,428
300
TOTAL
$7,116,399
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
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
$6,668,983
$2,329,096
$44,042
10
Coronary Care
6030
$2,472,689
$863,569
$2,426
10
15
6050
20
6070
$929,749
$324,708
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
95
Nursery Acute
6530
$675,568
$235,937
100 Sub-Acute Care
6560
$5,630,767
$1,966,506
6570
6580
$7,038,876
$2,458,278
6610
6630
115
6680
120
6780
125
6900
15
20
40
$22,944,405
$8,013,175
$187,283
45
60
$1,888,305
$659,477
$66,231
65
90
$23,695
95
100
101
$215
105
110
145
$48,249,342
$16,850,746
$323,892
150
$6,739,332
$2,353,665
$63,952
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
7220
7230
7260
200
7290
205
7310
210
7320
215
7390
165
170
$1,850,295
$646,203
$1,516
175
190
$1,863,417
$650,785
$12,341
195
220
$10,453,044
$3,650,653
$77,809
225

17

Line
No
PATIENT
Report Period End:

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

5
6010
$333,707
$2,858
10
Coronary Care
6030
$86,045
$1,573
10
15
6050
20
6070
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
95
Nursery Acute
6530
$38,689
$983
100 Sub-Acute Care
6560
$503,010
$3,769
$94,039
6570
6580
$232,026
$58,995
$163,905
6610
6630
115
6680
120
6780
125
6900
15
$8,045
20
40
$734,633
$26,551
45
60
$56,367
$2,749
65
90
95
100
101
105
110
145
$1,992,522
$97,478
$257,944
150
$215,236
$88,765
$60,988
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
7220
7230
7260
200
7290
205
7310
210
7320
215
7390
165
170
$754,404
$896,110
175
190
$45,994
$348
195
220
$1,015,634
$985,223
$60,988
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
$43,093
$9,421,779
10
Coronary Care
6030
$1,095
$3,427,397
10
15
6050
20
6070
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
95
Nursery Acute
6530
$470
$975,342
95
100 Sub-Acute Care
6560
$23,833
$8,221,924
100
6570
6580
$43,856
$9,996,151
6610
6630
115
6680
120
6780
125
6900
15
$1,262,502
20
40
$181,507
$32,087,554
45
60
$1,313
$2,674,442
65
90
101
105
110
145
$295,167
$68,067,091
150
$14,104
$9,536,042
160
AMBULATORY SERVICES
7010
7040
7060
175 Clinics
7070
7180
180
7200
185
7220
7230
7260
200
7290
205
7310
210
7320
215
7390
165
170
$52,506
$4,201,034
175
190
$390
$2,573,275
195
220
$67,000
$16,310,351
225

17

Line
No
PATIENT
Account
No
Report Period End:

(13) (Optional)
Units of Service
from Page 4,
Columns (4) + (5)
or Col(1)
(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
.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. (8) & (10)
(4)
Professional
Fees
.07,.10-.19,.20
.21-.29
Line
No
ANCILLARY SERVICES
7400
$1,115,141
$389,455
$101,115
230
7420
$6,808,606
$2,377,858
$239,374
235
7430
$1,315,930
$459,579
$57,382
240
245 Anesthesiology
7450
245
7470
250
7480
7500
$4,228,147
$1,476,651
7520
$222,165
$77,590
270 Blood Bank
7540
275 Echocardiology
7560
$677,241
$236,522
7570
$1,869,776
$653,006
7590
$813,818
$284,220
7610
7620
$74,045
$25,860
7630
$6,587,218
$2,300,540
7640
$1,988,805
$694,576
$55,228
305
7650
$633,873
$221,376
$69,880
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
7720
$3,873,377
$1,352,750
335
7730
$47,643
$16,639
340
345 Renal Dialysis
7740
$645,315
$225,372
345
350 Lithotripsy
7750
7760
$1,288,921
$450,147
7770
$1,049,324
$366,469
7780
$153,350
$53,556
365
7790
$390,032
$136,216
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
255
$2,185
260
265
270
275
$3,400
280
285
290
295
300
330
350
355
$919,649
360
400
$33,782,727
$11,798,382
$1,448,213
405
PATIENT CARE SERVICES

7900
7950
415 TOTAL PATIENT CARE SERVICES
410
411
$92,485,113
$32,299,781
$1,849,914
415

17

Line
No
PATIENT
Report Period End:

(5)
Supplies
Account
No
.31-.50,.93,.97
(6)
Purchased
Services
.61-.69
(7)
Depreciation
.71-.74
06/30/2014
(8)
Leases
and Rentals
Line
No
.75-.76
ANCILLARY SERVICES
7400
$19,651
$3,325
230
7420
$373,742
$522,689
$411,238
235
7430
$62,499
$14,255
$54,000
240
245 Anesthesiology
7450
$87,167
$6,039
7470
$18,464,531
7480
7500
$1,915,901
$866,681
7520
$17,772
$117,716
265
270 Blood Bank
7540
$1,114,472
$700
270
275 Echocardiology
7560
$6,007
$1,990
7570
$136,220
$125,531
7590
$11,682
$738
7610
7620
$2,800
$455
7630
$292,950
$26,493
$143,206
300
7640
$154,783
$9,584
$135
305
7650
$540,145
$419,714
$36,427
310
7660
315
320 Ultrasonography
7670
320
7680
7710
$7,254,835
7720
$19,242
7730
$1,249
340
345 Renal Dialysis
7740
$52,904
345
350 Lithotripsy
7750
7760
$39,524
$12,228
7770
$29,271
$3,536
7780
$2,570
$213
365
7790
$1,462
$986
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
245
250
255
$201,333
260
275
$63,326
280
285
290
295
325
330
$943
$45,180
335
350
355
$185,149
360
400
$30,601,379
$2,130,491
$1,143,319
405

7900
7950
410
411
$33,609,535
$3,213,192
$1,462,251
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
$676
$1,629,363
230
7420
$48,117
$10,781,624
235
7430
$6,040
$1,969,685
240
245 Anesthesiology
7450
$93,206
245
7470
$18,464,531
250
7480
7500
$77,487
$8,768,385
260
7520
$105
$435,348
265
270 Blood Bank
7540
$1,115,172
270
275 Echocardiology
7560
$56,770
$978,530
275
7570
$1,085
$2,852,344
280
7590
$4,801
$1,115,259
285
7610
7620
$511
$103,671
295
7630
$34,551
$9,384,958
300
7640
$2,699
$2,905,810
305
7650
$8,465
$1,929,880
310
7660
315
320 Ultrasonography
7670
320
7680
7710
7720
7730
345 Renal Dialysis
7740
350 Lithotripsy
7750
7760
$21
$1,790,841
355
7770
$3,569
$2,556,967
360
7780
$299
$209,988
365
7790
$982
$529,678
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
255
290
325
$7,254,835
330
$18,389
$5,309,881
335
$500
$66,031
340
$923,591
345
350
400
$265,067
$81,169,578
405

7900
7950
410
411
$627,234
$165,547,020
415

17

Line
No
PATIENT
Account
No
Report Period End:

(13) (Optional)
Units of Service
from Page 4,
Columns (4) + (5)
or Col(1)
(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
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
Printing and Duplicating
8310
60
Kitchen
8320
$52,178
$18,223
65
Non-Patient Food Services
70
55
8330
$1,579,296
$551,558
65
Dietary
8340
$1,684,056
$588,145
70
75
Laundry and Linen
8350
$117,557
$41,056
75
80
8360
$292,403
$102,120
80
85
Central Transportation
8370
90
Central Services and Supplies
8380
$33,020
$11,532
95
Pharmacy
8390
$3,039,678
$1,061,586
100 Purchasing and Stores
8400
$1,400,070
$488,965
105 Grounds
8410
110 Security
8420
115 Parking
8430
120 Housekeeping
8440
125 Plant Operations
8450
130 Plant Maintenance
60
85
90
95
$39,752
100
105
$669,149
110
120
115
$3,007,482
$1,050,342
$12,297
8460
$2,605,941
$910,107
$96,329
135 Communications
8470
$376,265
$131,408
135
140 Data Processing
8480
$449,612
$157,024
140
145 Other General Services
8490
$175,164
$61,175
$14,812,722
$5,173,241
$817,527
150
$49,930
$17,438
$404,472
155
150 TOTAL GENERAL SERVICES
125
130
145
FISCAL SERVICES
155 General Accounting
8510
160 Patient Accounting
8530
165 Credit and Collection
8550
170 Admitting
8560
175 Outpatient Registration
8570
195 Other Fiscal Services
8590
200 TOTAL FISCAL SERVICES
160
165
$2,045,923
$714,524
170
175
195
$2,095,853
$731,962
$404,472
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
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
$2,068
$11,880
65
8330
$517,314
$50,634
65
70
Dietary
8340
$551,630
$53,993
70
75
Laundry and Linen
8350
$67,058
$871,272
75
80
8360
$2,106
85
8370
90
8380
$85,259
$39,209
$316,039
95
Pharmacy
8390
$158,872
$121,401
$473,000
95
8400
$59,228
$145,492
100
105 Grounds
8410
110 Security
8420
115 Parking
8430
120 Housekeeping
8440
8450
60
80
85
90
105
$4,957
$29,577
$357,154
$548,362
$288
8460
$130,623
$5,207,643
$344,088
135 Communications
8470
$6,380
$91,677
140 Data Processing
8480
$26,592
$9,349,620
8490
55
110
115
120
125
135
$199,690
$27,912
$1,969,241
$16,391,300
130
140
145
$1,490,477
150
FISCAL SERVICES
8510
$1,721
$945
155
8530
$15,822
$1,297,939
160
8550
170 Admitting
8560
$126,459
$7,435
8570
8590
165
170
175
$1,964
$145,966
195
$1,306,319
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
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
$45,036
$129,385
65
70
8330
$8,376
$2,707,178
65
Dietary
8340
$8,931
$2,886,755
70
75
Laundry and Linen
8350
$26
$1,096,969
75
80
8360
$1,819
$398,448
80
85
8370
90
8380
$2,152
$487,211
95
Pharmacy
8390
$27,179
$4,881,716
95
8400
$3,853
$2,137,360
100
105 Grounds
8410
110 Security
8420
$2
$703,685
110
115 Parking
8430
120 Housekeeping
8440
$18,257
$4,994,182
120
8450
8460
$2,154,181
$11,448,912
130
135 Communications
8470
$445,385
$1,051,115
135
140 Data Processing
8480
$2,203
$10,184,741
140
8490
$5,964
$270,215
145
$2,723,364
$43,377,872
150
55
60
85
90
105
115
125
FISCAL SERVICES
8510
$224,567
$699,073
8530
$25,960
$1,339,721
8550
170 Admitting
8560
$284,575
$3,178,916
8570
8590
$6
$1,970
$535,108
$5,219,680
$9,416
155
160
165
170
175
195
$9,416
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
13,547
55
65
8330
276,422
65
70
Dietary
8340
294,758
70
75
Laundry and Linen
8350
1,491,758
75
80
8360
4,850
80
85
8370
90
8380
114,142
95
Pharmacy
8390
129,231
95
8400
28,773
100
105 Grounds
8410
110 Security
8420
115 Parking
8430
120 Housekeeping
8440
8450
8460
379,031
130
135 Communications
8470
1,177
135
140 Data Processing
8480
1,557,881
140
8490
60
85
90
105
1,177
110
321,344
120
115
125
145
150
FISCAL SERVICES
8510
1,177
155
8530
1,557,881
160
8550
170 Admitting
8560
8570
175
8590
195
165
6,732
170
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
$4,899,277
$1,711,039
$246,158
$85,969
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
$451,308
$157,616
225
8660
$382,396
$133,549
230
8670
$128,301
$44,808
235
8680
$499,951
$174,604
245 Medical Library
8690
$45,912
$16,034
250 Medical Records
8700
$1,254,076
$437,977
8710
$314,455
$109,821
$45,972
255
8720
$2,085,590
$728,378
$120,754
260
8730
8740
$479,636
$167,510
8750
$2,823,807
$986,195
8770
$311,184
$108,679
8790
$507,181
$177,129
$7,116,399
$14,429,232
$5,039,308
$7,116,399
$2,449,523
205
210
215
220
240
$1,980
245
250
265
270
$209,247
275
280
295
$2,827,476
300
UNASSIGNED COSTS
305 Depreciation and Amortization
8810
305
310 Leases and Rentals
8820
310
315 Insurance - Hosp and Prof. Malpractice
8830
315
320 Insurance - Other
8840
320
325 Lic. & Other Taxes (Other than income)
8850
325
330 Interest - Working Capital
8860
330
345 Interest - Other
8870
345
350 Employee Benefits (Non-Payroll Related)
8880
350
355 Other Unassigned costs
8890
355
360 TOTAL UNASSIGNED COSTS
360
TOTAL
365 TOTAL OPERATING COSTS (17 & 18)
370 Non-Operating Cost Centers
375 TOTAL COSTS
$123,822,920
$43,244,292
$439,969
$153,656
$124,262,889
$43,397,948
$7,116,399
$7,116,399
$5,899,389
365
$9,257
370
$5,908,646
375

18

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

(5)
Supplies
Account
No
(6)
Purchased
Services
(7)
Depreciation
06/30/2014
(8)
Leases and
Rentals
.31-.50,.93,.97
.61-.69
.71-.74
.75-.76
$233,216
$10,349,075
$50,839
$67,907
$5,596
$1,561
Line
No
8610
8620
8630
8640
225 Personnel
8650
$17,063
$23,660
225
8660
$35,992
$7,792
230
8670
$6,893
$7,515
235
8680
$3,917
$4,204
240
245 Medical Library
8690
$18,520
$425
245
250 Medical Records
8700
$47,184
$807,000
250
8710
$165,063
$72,695
255
8720
$46,290
$58,517
260
8730
8740
$30,132
$31,448
270
8750
$23,239
$91,103
275
8770
$18,116
$12,554
280
8790
$16,728
205
210
215
220
265
$667,949
295
$11,467,549
$50,839
$67,907
300
UNASSIGNED COSTS
8810
8820
$9,875,618
305
310
8830
315
8840
320
8850
325
8860
330
8870
345
8880
350
8890
355
$9,875,618
360
TOTAL
375 TOTAL COSTS
$36,392,691
$32,378,360
$9,926,457
$81,731
$1,330,338
$821,499
$36,474,422
$33,708,698
$10,747,956
$3,020,635
365
370
$3,020,635
375

18

Line
No
(10)
Total Direct
Expenses
Columns (1) thru
(9)
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
$6,424,332
$26,185,208
$129,117
$286,600
$625,884
Account
No
Report Period End:

(9)
Other Direct
Expenses
NON REVENUE
PRODUCING CENTERS
06/30/2014
(12) (Optional)
Adjusted Direct
Page 20, Column
(1)
.77-.90,.94-.98
8610
8620
8630
8640
225 Personnel
8650
$753,263
$1,402,910
8660
$5,265
$564,994
8670
$19,662
$207,179
8680
$2,722
$685,398
240
245 Medical Library
8690
$60,680
$143,551
245
250 Medical Records
8700
$3,117
$2,549,354
250
8710
$49,354
$757,360
255
8720
$19,445
$3,058,974
260
8730
8740
$37,964
$746,690
270
8750
$108,115
$4,241,706
275
8770
$103,011
$553,544
280
8790
$2,606
$7,820,043
$7,876,136
$49,542,795
205
210
215
220
225
230
$20,180
235
265
295
$149,297
300
UNASSIGNED COSTS
8810
8820
8830
$933,215
$933,215
315
8840
$564,369
$564,369
320
8850
$21,881
$21,881
325
8860
8870
$3,714,439
$3,714,439
8880
8890
$9,875,618
305
310
330
345
350
355
$5,233,904
$15,109,522
$16,995,746
$278,796,889
$1,287,000
$4,123,450
375 TOTAL COSTS
$18,282,746
$282,920,339
360
TOTAL
$158,713
365
370
$158,713
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
1,177
205
8630
8640
225 Personnel
8650
1,177
225
8660
1,177
230
8670
25,200
235
8680
83,970
240
245 Medical Library
8690
448
245
250 Medical Records
8700
125,579
250
8710
448
255
8720
412
260
8730
8740
15,043
270
8750
6,732
275
8770
10,600
280
8790
210
1,562,486
215
220
265
295
300
UNASSIGNED COSTS
8810
8820
8830
1,557,881
315
8840
379,031
320
8850
379,031
325
8860
8870
8880
350
8890
355
379,031
305
310
330
379,031
345
360
TOTAL
365
370
375 TOTAL COSTS
375
06/30/2014

19
COST ALLOCATION - STATISTICAL BASIS

BASIS OF ALLOCATION
Report Period End: 06/30/2014
(2) Square Feet
(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
188
65
70
Communications
420
70
75
Other Fiscal Services
80
85
30
11,460
35
40
135
45
50
352
55
60
75
413
80
Personnel
1,915
85
90
Employee Health Services
2,086
90
95
Employee Benefits (Non-Payroll Related)
2,011
95
8,318
100
5,118
105
110 Housekeeping
2,572
110
100 Non-Patient Food Services
115 Grounds
120 Security
115
407
407
8,450
8,450
130
6,822
6,822
135
450
450
140
145 Dietary
1,893
1,893
145
150 Laundry and Linen
4,534
4,534
150
2,237
2,237
1,571
1,571
170
1,452
1,452
175
180 Medical Library
2,229
2,229
180
185 Medical Records
7,311
7,311
185
933
933
190
195 Social Work Services
480
480
195
1,257
1,257
200
5,239
5,239
125 Parking
125

160 Data Processing
155
160
165
205 Insurance - Hospital and Professional Malpractice

210 Admitting
120
205
215 Other Unassigned Costs
210
215
220
2,938
2,938
225
230 Inservice Education-Nursing
1,616
1,616
230
235 Central Services and Supplies
8,016
8,016
235
240 Pharmacy
4,107
4,107
240
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
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

19

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

Revenue from
All Approved
Column (11)
Programs
Line
No
245
250-255
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

19

BASIS OF ALLOCATION
Line
No
(19) Nursing
Student
Departmental
Assignment
260-265
(20) Paramedic
Student
Departmental
Assignment
270-275
(21) Medical
PostGraduate
Departmental
Assignment
Line
No
280
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
255 Student Housing
255
260
265
270
275
280

19

BASIS OF ALLOCATION
(2) Square Feet
(4) Accumulated
Costs
(5) Hospital
FTE's
Line
No
5-25
30-80
85-100
(6) Supplies from

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

6,016
6,016
505
510 Coronary Care
6,052
6,052
510
229
229

515
520
525
530 Burn Care
530
535

540
53,376
53,376
545
550 Pediatric Acute
550
555
560 Psychiatric Acute - Adolescent & Child

560
15,944
15,944
565
570
575
580
585
590 Other Acute Care

595 Nursery Acute
600 Sub-Acute Care
590
229
229
595
13,441
13,441
600
19,491
19,491

601
605
610
615
620
625
645
AMBULATORY SERVICES
11,566
11,566
665

675 Clinics
660
670
19,229
19,229
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
3,175
3,175
730
6,831
6,831
735
8,336
745 Anesthesiology
2,904
740
2,904
750

745
755
11,310
11,310
760
630
630
765
770 Blood Bank
351
351
770
775 Echocardiology
241
241
775
8,922
8,922
780

19

BASIS OF ALLOCATION
Line
No

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

220
6,791
87,205
505
510 Coronary Care
2,439
38,461
510
515
520
525
530 Burn Care
530
535

540
99,666
560,760
545
550 Pediatric Acute
550
555

560
1,162
565
570
575
580
585
590
595 Nursery Acute

600 Sub-Acute Care
595
49,710
108,781
134,990
431,928

600
601
605
610
615
620
625
645
AMBULATORY SERVICES
100,152
665

675 Clinics
660
670
8,483
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
730
44,706
735
21,841
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
14,136
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
$18,464,531
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)

3,842
3,842
334
334
795
28,258
15,539
800
9,657
8,013
805
4,391
4,391
810
785
790
815
820 Ultrasonography
820
825
830
6,174
6,174
835
1,967
1,967
840
548
548
845
1,444
1,444
855
9,989
9,989
860
80
80
865
5,371
5,371
870
845 Renal Dialysis

850 Lithotripsy
865 Speech - Language Pathology

850
875
880
885
890

895
1,943
1,943
900
910
911
19,830
19,830
915
920 Total Statistical Units (Lines 5-915)
379,031
321,344
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
45,812
800
10,272
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
19,221
860
865
870
875
880
885
890
895
900
910
911
915
294,758
1,491,758
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
$7,254,835
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
860
865
870
875
880
885
890
895
900
910
911
915
$18,464,531
$7,254,835
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
COST RECOVERY INFORMATION
(1) Transfers for

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

( Page 20a (1 of 6) Submitted Data )
Report Period End:

(2)Other Operating
Revenue Page
14,Col(1), Line 200
($3,435,426)
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
Cost Recovery
Interest - Other
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
$3,435,426
35
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250

20a.
Line
No
Report Period End:
(1) Transfers for

Operations NonRevenue Centers Page
14, Col(1), Line 185
(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
Report Period End:
(1)
CLASSIFICATION DESCRIPTION
Line
No
(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
$64.50
$79.56
67,393
$75.33
19,532
10
$78.37
11,464

5
$86.32
903
10
Coronary Care
$86.68
992
15
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
100 Sub-Acute Care
15
40
$81.65
3,415
$28.76
17,352
$76.33
212,584
45
60
$76.89
1,069
$92.43
12,261
65
90
$76.98
382
$87.57
120
$37.04
$62.22
1,428
$40.94
$92.42
4,387
95
2,817
$78.23
18,835
100
2,261
$82.14
15,120

20
101
105
110
115
120
125
145
8,309
22,432
361,576
150
62,706
160
AMBULATORY SERVICES
$88.94
1,711
$16.85
20
$80.38
165

175 Clinics
170
$45.98
4,600
$49.50
8,524
$65.94
5,643
175
180
185
190
$73.12
20,383
195
200
205
210
215

220
6,311
8,544
88,732
225

21

Report Period End:
(7)
Line
No
(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
Average
Hourly Rate
06/30/2014
(11)
.04
Productive
Hours
(12)
Clerical and Other

Administrative
.05
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
No

5
$27.76
63
$34.51
4,454
10
Coronary Care
$33.08
83
$35.72
1,395
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
100 Sub-Acute Care
40
$41.44
166
$29.40
50,976
$31.65
13,958
60
$28.20
10
$38.32
2,718
65
90
$33.67
$38.29
973
95
100
$43.86
38,723
$30.93
40,761
$30.18
3,224
$44.26
28,323
$32.80
99,031
$30.07
3,518

45
101
105
110
115
120
125
145
67,212
190,927
30,240
150
9,750
160
AMBULATORY SERVICES
$27.37
8,577
$31.14
165

175 Clinics
170
$37.80
1,520
$26.34
3,370
$26.95
14,986
175
180
185

190
$37.50
$29.51
441
$30.30
1,914
195
200
205
210
215

220
1,528
12,388
26,650
225

21

Report Period End:
(13)
Line
No
"REVENUE PRODUCING CENTERS
(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
180
185
190
195
200
205
210
215
220
225

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

5
$75.33
10
Coronary Care
$68.84
10
15
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
$77.99
95
100
Sub-Acute Care
$43.57
100
101
Sub-Acute Care - Pediatric
105
Skilled Nursing Care
110
Psychiatric Long-Term Care
115
Intermediate Care
115
120
Residential Care
120
125
Other Long-Term Care Services
125
145
Other Daily Hospital Services
145
150
TOTAL DAILY HOSPITAL SERVICES
150
15
$78.08
20
40
$62.83
45
60
$77.99
65
90
101
$39.91
105
110
AMBULATORY SERVICES
160
Emergency Services
165
Medical Transportation Services
$67.93
160
170
Psychiatric Emergency Rooms
175
Clinics
180
Satellite Clinics
180
185
Satellite Ambulatory Surgery Center
185
190
Outpatient Chemical Dependency Svcs.
195
Observation Care
200
Partial Hospitalization - Psychiatric
200
205
205
210
Hospice - Outpatient Services
210
215
Adult Day Health Care Services
215
220
Other Ambulatory Services
220
225
TOTAL AMBULATORY SERVICES
225
165
170
$40.72
175
190
$66.54
195
06/30/2014

21

(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

5
72,815
15,716
88,531
10
Coronary Care
22,002
13,918
35,920
10
15
20
11,464
443
11,907
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
100 Sub-Acute Care
15
40
298,451
66,723
365,174
45
60
16,058
8,155
24,213
65
90
5,745
2,917
8,662
95
104,480
24,769
129,249
100
149,681
26,706
176,387

20
101
105
110
115
120
125

145
680,696
159,347
840,043
150
82,764
16,446
99,210
160
AMBULATORY SERVICES
165

175 Clinics
170
38,643
6,801
45,444
175
180
185

190
22,746
5,259
28,005
195
200
205
210
215

220
144,153
28,506
172,659
225

21

Report Period End:
(1)
Line
No
(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
.02
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$79.48
1,255
$50.14
17,987
$37.31
5,333
Line
Average
Hourly Rate
Productive
Hours
No
$78.13
13,748
230
$91.43
43,733
235
$71.72
9,640
240
ANCILLARY SERVICES
245 Anesthesiology
245
250

255
$69.99
1,696
$40.94
75,852
$36.97
2,960
$70.46
7,675
$76.48
204
275
$78.94
7,310
$83.51
12,625
280
$54.88
12,686
$85.27
11
285
$42.64
1,495
$28.65
23
265
270 Blood Bank

275 Echocardiology
260
270
$65.51
946
290
295
$56.99
6,012
$67.34
59,275
$100.55
6,560
300
$101.72
1,853
$73.16
9,058
$72.35
7,610
305
$80.36
14
$75.59
6,309
$57.50
310
315
320 Ultrasonography
320
325

330
$53.85
465
$50.69
57,520
$45.12
873
340
$55.10
10,214
345
$41.00
$46.34
12,477
360
$46.42
2,722
365
$47.41
7,123
370

345 Renal Dialysis
$69.15
1,193
$51.86
37
350 Lithotripsy
350

335
$55.06
1,233
$98.05
11,441
355
375
380
385
390
395

400
14,667
296,871
105,634
405

21

Report Period End:
(7)
Line
No
(8)
Licensed
Vocational Nurses
(9)
(10)
Aides and
Orderlies
.03
Average
Hourly Rate
06/30/2014
(11)
.04
Productive
Hours
(12)
Clerical and Other

Administrative
.05
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
No
$27.58
10,478
$29.17
6,032
235
$25.97
1,217
$29.85
3,228
240
ANCILLARY SERVICES
230
245 Anesthesiology
245
250
255
$29.68
8,588
260
$33.70
2,461
265
270 Blood Bank
270
275 Echocardiology
275

280
$28.73
60
$29.58
1,669
290
295

285
$25.85
1,933
$30.00
22,749
300
$31.80
6,420
305
$31.09
2,517
310
315
320 Ultrasonography
320
325

330
$24.38
$32.79
1,831
335
340
345 Renal Dialysis
345
350 Lithotripsy
350

355
$25.04
8,085
$26.83
948
360
365
370
375
380
385
390
395

400
21,781
56,443
405

21

Report Period End:
(13)
Line
No
(14)
Environmental and
Food Service
(15)
(16)
Productive
Hours
(17)
(18)
Physicians
(Salaried)
Non-Physicians Medical
Practitioners
.07
.08
.06
Average
Hourly Rate
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
$77.89
230
235
Surgery and Recovery Services
$66.11
235
240
Ambulatory Surgery Services
$51.27
240
245
Anesthesiology
245
250
Medical Supplies Sold to Patients
250
255
Durable Medical Equipment
260
Clinical Laboratory Services
$40.91
260
265
Pathological Laboratory Services
$34.07
265
270
Blood Bank
275
Echocardiology
$68.26
275
280
Cardiac Catheterization Services
$78.93
280
285
Cardiology Services
$50.55
285
290
Electromyography
295
Electroencephalography
$40.80
295
300
Radiology - Diagnostic
$58.89
300
305
Radiology - Therapeutic
$63.40
305
310
Nuclear Medicine
$61.22
310
315
Magnetic Resonance Imaging
315
320
Ultrasonography
320
325
Computed Tomographic Scanner
325
330
Drugs Sold to Patients
335
Respiratory Therapy
$49.87
335
340
$45.59
340
345
Renal Dialysis
$56.57
345
350
Lithotripsy
355
Gastro-Intestinal Services
$92.39
355
360
Physical Therapy
$39.05
360
365
Speech-Language Pathology
$43.64
365
370
Occupational Therapy
$47.79
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
400
405
TOTAL ANCILLARY SERVICES
405
255
270
290
330
350
06/30/2014

21


(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
ANCILLARY SERVICES
13,748
569
14,317
230
79,485
23,501
102,986
235
19,418
6,250
25,668
240
245 Anesthesiology
245
250
255
86,159
17,197
103,356
260
5,421
1,100
6,521
265
275 Echocardiology
8,825
1,096
9,921
275
19,935
3,755
23,690
280
14,426
1,674
16,100
285
1,495
320
1,815
295
94,596
17,263
111,859
300
26,874
4,493
31,367
305
8,842
1,512
10,354
310
270 Blood Bank
270
290
315
320 Ultrasonography
320
325

345 Renal Dialysis
330
59,861
17,806
77,667
335
873
172
1,045
340
11,407
345
11,407
350 Lithotripsy
350
11,443
2,507
13,950
355
22,743
4,128
26,871
360
2,722
792
3,514
365
7,123
1,039
8,162
370
375
380
385
390
395

400
495,396
105,174
600,570
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
Average Hourly
Rate
Productive Hours
No

5
$73.21
578
578
10
Coronary Care
$67.82
34
34
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
95
Nursery Acute
40
$72.88
1,522
$1.72
898
2,420
45
60
$83.73
791
791
65
90
$83.73
283
283
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
3,208
898
4,106
150
585
160
AMBULATORY SERVICES
$83.48
585
165
170
175 Clinics
175
180
185

190
$81.19
152
152
195
200
205
210
215

220
737
737
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
$85.55
1,182
$95.46
1,742
$89.10
644
Average Hourly
Rate
Productive Hours
$84.47
825
No
ANCILLARY SERVICES
1,182
230
2,567
235
644
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
$125.05
437
437
305
$71.23
981
981
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
$65.00
14,148
14,148
360
365
370
375
380
385
390
395

400
3,568
16,391
19,959
405

22

Report Period End:
(1)
Line
No
(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
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
65
$43.49
70
Dietary
75
Laundry and Linen
80
85
90
95
Pharmacy
$25.19
266
55
3,364
$48.85
3,302
65
$43.49
3,587
$32.33
5,320
70
$48.56
1,933
$38.69
3,260
$28.01
1,026
60
75
80
85
90
$76.72
5,182
$49.45
43,557
95
$36.43
3,624
$29.61
36,196
100
105 Grounds
105
110 Security
110
115 Parking
120 Housekeeping
115
$40.21
3,684
$86.28
1,749
135 Communications
$29.70
1,733
$30.94
1,805
120
125
140 Data Processing
130
135
$57.27
7,094
140
145
24,856
101,826
150
1,119
155
FISCAL SERVICES
$38.66
160

170 Admitting
165
$49.70
3,411
$31.09
2,461
175

170
195
3,411
3,580
200

22

Report Period End:
(1)
Line
No
(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
$89.99
16,345
$39.93
28,029
$61.07
3,476
225 Personnel
$115.43
1,869
$37.17
2,340
225
$54.10
2,955
$44.34
2,473
230
$53.12
2,274
$30.02
250
235
$50.16
1,757
$36.19
9,317
240
$37.99
1,014
245
205
210
215
220
245 Medical Library

250 Medical Records
$48.59
5,254
$51.62
1,837
$34.12
1,843
250
255
$73.37
10,612
$53.34
7,384
260
$58.75
752
$62.16
3,158
270
$76.24
5,162
$60.82
30,137
275
$44.03
2,436
$19.09
1,135
280
$25.77
16,699
295
103,779
300
265

54,729

350
$53.37
4,785
370

22

Report Period End:
(7)
Line
No
(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
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
$23.90
1,640
65
$28.83
8,099
65
70
Dietary
$28.83
8,637
70
75
Laundry and Linen
$25.91
3,563
75
80
$26.77
1,709
80
85
85
90
90
95
Pharmacy
55
60
95
$26.02
1,913
100
105 Grounds
105
110 Security
110
115 Parking
120 Housekeeping
115
$28.06
1,998
$32.92
2,037
130
135 Communications
$27.55
9,690
135
$25.63
6,032
145
45,318
150
125
140 Data Processing

120
140

FISCAL SERVICES
155
160

170 Admitting
165
$28.54
53,313
175

170
195
53,313
200

22

Report Period End:
(7)
Line
No
(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
$28.07
57,174
205
210
215
220
225 Personnel
$25.86
3,627
225
$26.84
3,972
230
235
240
245 Medical Library
245
250 Medical Records
$29.90
26,924
250
$25.56
4,591
255
$30.46
8,773
260
$27.19
1,448
270
$34.04
4,064
275
$18.36
8,154
280
$24.08
39
295
118,766
300
265

350
$41.36
1,828
370

22

Report Period End:
(13)
(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
55
65
$25.99
30,720
65
70
Dietary
$25.99
32,768
70
75
Laundry and Linen
$23.18
333
75
80
80
85
85
90
90
95
Pharmacy
60
95
100
105 Grounds
105
110 Security
110
115 Parking
120 Housekeeping
115
$24.91
92,579
$52.76
38,286

120
125
130
135 Communications
135
140 Data Processing
140

145
194,686
150
FISCAL SERVICES
155
160
165
170 Admitting
170
175
195
200

22

Report Period End:
(13)
Line
No
(14)
Environmental and
Food Service
(15)
(16)
Physicians
(Salaried)
.06
Average
Hourly Rate
06/30/2014
(17)
.07
Productive
Hours
Average
Hourly Rate
(18)
Non-Physician Medical
Practitioners
.08
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
205
210
215
220
225 Personnel
225
$42.55
349
230
235
240
245 Medical Library
245
250 Medical Records
250
255
260
265
270
275

280
$24.69
16
295
365
300

350
$25.70
1,922
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
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
$23.13
55
65
$29.71
65
70
Dietary
$28.48
70
75
Laundry and Linen
$25.81
75
80
$38.15
80
85
90
$27.52
95
Pharmacy
$52.56
95
100
Purchasing and Stores
$30.38
100
105
Grounds
105
110
Security
110
115
Parking
120
Housekeeping
125
Plant Operations
130
Plant Maintenance
$53.06
130
135
Communications
$27.94
135
140
Data Processing
$54.68
140
145
Other General Services
$26.76
145
150
TOTAL GENERAL SERVICES
60
85
90
115
$25.96
120
125
150
FISCAL SERVICES
155
General Accounting
160
Patient Accounting
$39.38
155
165
Credit and Collection
170
Admitting
175
Outpatient Registration
175
195
195
200
TOTAL FISCAL SERVICES
200
160
165
$30.18
170
06/30/2014

22


Report Period End:
(19)
(20)
Other Salaries
and Wages
Line
.09
No
Average Hourly
Rate
(21)
Cost Center
Average Hourly
Rate
Line
Productive
Hours
No
205
210
$41.70
205
215
Public Relations
220
225
Personnel
$51.01
225
230
$35.82
230
235
Auxiliary Groups
$50.83
235
240
Chaplaincy Services
$37.93
240
245
Medical Library
$38.81
245
250
Medical Records
$33.22
250
255
Medical Staff Administration
$33.51
255
260
Nursing Administration
$54.71
260
265
Nursing Float Personnel
270
Inservice Education - Nursing
$56.42
270
275
Utilization Management
$60.37
275
280
$23.95
280
295
$25.49
295
300
TOTAL ADMINISTRATIVE SERVICES
350
370
Non-Operating Cost Centers
210
$62.07
215
220
265
300
350
$46.26
370
06/30/2014

22


(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
Total Paid
Hours
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Line
No
Column (22)
2080
RESEARCH COSTS
5
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
1,906
350
2,256
65
45,485
7,676
53,161
65
70
Dietary
50,312
8,824
59,136
70
75
Laundry and Linen
3,896
658
4,554
75
80
6,902
763
7,665
80
85
90
1,026
174
1,200
95
Pharmacy
48,739
9,093
57,832
95
41,733
4,356
46,089
100
55
60
85
90
105 Grounds
105
110 Security
110
115 Parking
120 Housekeeping
115
100,066
15,803
115,869
42,072
7,043
49,115
130
135 Communications
11,423
2,045
13,468
135
140 Data Processing
7,094
1,129
8,223
140
6,032
514
6,546
145
366,686
58,428
425,114
150
1,119
149
1,268
155
120
125
FISCAL SERVICES
160

170 Admitting
165
59,185
8,611
67,796
175

170
195
60,304
8,760
69,064
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
101,548
15,928
117,476
3,476
490
3,966
225 Personnel
7,836
1,011
8,847
225
9,749
926
10,675
230
2,524
2,524
235
11,074
2,108
13,182
240
245 Medical Library
1,014
169
1,183
245
250 Medical Records
32,178
5,573
37,751
250
8,271
1,114
9,385
255
26,769
11,350
38,119
260
5,358
3,143
8,501
270
39,363
7,412
46,775
275
11,725
1,269
12,994
280
16,754
3,147
19,901
295
277,639
53,640
331,279
300
8,535
975
9,510
210
215
220
265

205
350
370

22.1

Report Period End:
(3)
Line
No
(4)
Other Contracted
Services
.26
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
75
80
80
85
85
90
90
95
Pharmacy
95
$56.38
702
$22.17
26,984
110
$25.83
476
120
$28.03
573
105 Grounds
110 Security
115

100
105
115 Parking
120 Housekeeping
125
130
135 Communications
135
140 Data Processing
140

145
28,735
150
FISCAL SERVICES
155
160
165
170 Admitting
170
175
195
200
06/30/2014

22.1

Report Period End:
(3)
Line
No
(4)
Other Contracted
Services
.26
Line
Average
Hourly Rate
Productive
Hours
No
$88.89
10,031
205
210
215
220
225 Personnel
225
230
235
240
245 Medical Library
245
250 Medical Records
250

255
$89.76
1,341
270
$73.47
2,680
275
280

260
265

295
14,052
300
350
370
06/30/2014

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HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

USING DATA SUBMITTED BY FACILITY

*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

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

BAD DEBT RATE

DEBT, RISK, AND LEVERAGE RATIOS

58.73% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100

DEBT SERVICE COVERAGE RATIO

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

INTEREST EXPENSE AS A PERCENTAGE

1.33% ((INTEREST-WORKING CAPITAL + INTEREST-OTHER) / TOTAL OPERATING

NET RETURN ON EQUITY

FIXED ASSET RATIOS

AVERAGE AGE OF PLANT

11.59% ((CURRENT YEAR GROSS PROPERTY, PLANT AND EQUIPMENT +

SUMMARY OF FINANCIAL AND UTILIZATION DATA FOR SELECTED COST CENTERS

ALTERNATE BIRTHING CENTER

TOTAL PATIENT CARE SERVICES

CHEMICAL DEPENDENCY SERVICES

PSYCHIATRIC ACUTE - ADULT

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

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:

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

4. Hospital Business Phone:

5.Medi-Cal Contract Provider Number:

6. Medi-Cal Non-Contract Provider Number: