OSHPD Reports

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT
USING DATA SUBMITTED BY FACILITY

FACILITY NO:106434138
ST LOUISE REGIONAL HOPSITAL
9400 NO NAME UNO
GILROY
CA
PHONE NO:
OWNER:
95020
GENERAL INFORMATION
TYPE OF CONTROL: Church
TYPE OF CARE:
General
LICENSED BEDS*
8
ACUTE
64
6/24/2015
1 OF 5
07/01/2013
06/30/2014
(408)848-8607
DAUGHTERS OF CHARITY HEALTH SYSTEM
COUNTY:
HSA NO:
AVAILABLE BEDS
INTENSIVE
DATE PREPARED:
PAGE:
REPORT PERIOD:
THRU
Santa Clara
07
HFPA NO:
0433
EMERGENCY SERVICES
INTENSIVE
ACUTE
64
EMERGENCY ROOM
TRAUMA CENTER DESIGNATION
LONG-TERM
LONG-TERM
OBSERVATION
OTHER
OTHER
ORTHOPEDIC
72
PSYCHIATRIC
40.10%
HELICOPTER
TOTAL
OCCUPANCY RATE
72
40.10%
*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
TOTAL
OCCUPANCY RATE
NO. BASSINETS
18
TOTAL
MEDICARE
TRADITIONAL
4,776
1,153
4.1
4.1
11,251
2,796
$96,303,850
$60,167,102
$132,650,873
$14,899,587
$8,920,492
$3,120
$12,922
$793
MEDICARE
MANAGED CARE
591
137
4.3
4.3
994
452
$12,075,357
$7,832,534
$17,213,731
$1,634,173
$1,059,987
$2,765
$11,928
$1,066
MEDI-CAL
TRADITIONAL
1,503
498
3
3
7,144
2,894
$29,521,866
$18,307,768
$37,137,587
$6,599,448
$4,092,599
$4,391
$13,252
$573
MEDI-CAL
MANAGED CARE
1,010
412
2.5
2.5
11,453
9,239
$19,640,971
$41,393,750
$54,343,264
$2,153,311
$4,538,146
$2,132
$5,226
$396
CO. INDIGENT
TRADITIONAL
CO. INDIGENT
MANAGED CARE
THIRD PARTY
TRADITIONAL
77
18
4.3
4.3
907
562
$1,488,842
$4,108,562
$4,586,660
$264,115
$746,629
$3,430
$14,673
$823
THIRD PARTY
MANAGED CARE
2,338
OTHER
INDIGENT
OTHER
PAYERS
256
10,551
3,045
3.5
3.5
56,659
24,813
$210,629,453
$220,282,158
$350,675,329
$37,360,673
$42,875,609
$3,541
$12,270
$757
21,586
$3,717
738
3.2
89
2.9
3.2
2.9
21,297
3,613
6,120
2,750
$47,228,580
$4,369,987

$72,345,271
$95,778,606
$16,127,171
$8,964,608
$9,398,507
$2,411,532
$14,396,738
$9,121,018

$4,020
$9,420
$12,735
$27,096
$676
$2,524
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
439
127
566
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
$430,911,611
$3,399,094
$132,473,801
$16,924,623
$36,714,212
$52,947,935
$4,507,051
$81,997,186
$9,647,418
$12,064,009
$350,675,329
$80,236,282
$2,030,636
$93,428,345
($11,161,427)
$1,498,788
$784,244
($10,446,883)
$40,587,201
$13,988,300
$4,151,422
$2,418,143
$7,963,640
$9,783,246
$5,641,101
$546,819
$1,984,617
$6,363,856
$93,428,345
$18,468,877
$7,649,597
$21,552,894
$13,910,476
$2,417,561
$20,295,222
$9,133,718
$93,428,345
$85,917,358
$87,920,968
$257,073,285
$430,911,611
PERCENT OF TOTAL
19.9
20.4
59.7
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
$22,788,522
$277,970
$23,887,070
$204,666
TOTAL CURRENT LIABILITIES

DEFERRED INCOME
NET LONG-TERM DEBT
TOTAL LIABILITIES
$47,158,228
EQUITY
TOTAL LIABILITIES AND EQUITY
$51,165,540
$30,596,239
$81,761,779
($34,603,551)
$47,158,228
FINANCIAL RATIO FORMULAS

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

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

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

PERIOD)
BAD DEBT RATE
0.79% (PROVISION FOR BAD DEBTS / TOTAL GROSS PATIENT REVENUE) X 100
DEBT, RISK, AND LEVERAGE RATIOS

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

OF OPERATING EXPENSE
64.88% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100

( 1.42) (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)
2.12% ((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
( 19.66%) ((NET FROM OPERATIONS + INTEREST-WORKING CAPITAL + INTERESTOTHER) / (TOTAL CURRENT ASSETS + NET PROPERTY, PLANT AND
EQUIPMENT)) X 100
30.19% (NET INCOME / EQUITY) X 100
( 13.57%) (NET FROM OPERATIONS / TOTAL OPERATING REVENUE) X 100
1.76 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
7.23% ((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
10.61 ACCUMULATED DEPRECIATION / DEPRECIATION EXPENSE
334,607 (NET PROPERTY, PLANT, AND EQUIPMENT + CONSTRUCTION-IN-PROGRESS)
/ LICENSED BEDS (END OF PERIOD)
SUMMARY OF FINANCIAL AND UTILIZATION DATA FOR SELECTED COST CENTERS

REVENUE-PRODUCING COST CENTERS
MEDICAL/SURGICAL INTENSIVE CARE
UNITS OF
SERVICE
UNIT
CODE
GROSS REV
PER UNIT
1,780
$12,708.51
$2,925.93
$7,019.30
$1,338.05
$4,562.70
$2,489.62
CORONARY CARE
BURN CARE
DEFINITIVE OBSERVATION
MEDICAL/SURGICAL ACUTE
1
1
PSYCHIATRIC ACUTE - ADULT
1
1,324
ALTERNATE BIRTHING CENTER
CHEMICAL DEPENDENCY SERVICES
SKILLED NURSING CARE

TOTAL PATIENT CARE SERVICES
NURSERY ACUTE
AMBULATORY SERVICES
EMERGENCY SERVICES
CLINICS
ADJ DIRECT
EXP PER UNIT
1
7,447
PEDIATRIC ACUTE
OBSTETRICS ACUTE
ADJ REV
PER UNIT
1
10,551
$7,670.83
$1,750.44
1,093
$4,558.53
$0.00
24,813
$3,130.64
$271.61
11,838
$865.05
$76.89
OBSERVATION CARE
HOME HEALTH CARE SERVICES
ADJ TOTAL
EXP PER UNIT
PROFIT/LOSS
PER UNIT

REVENUE-PRODUCING COST CENTERS
ANCILLARY SERVICES
LABOR AND DELIVERY SERVICES
SURGERY AND RECOVERY SERVICES
MEDICAL SUPPLIES SOLD TO PATIENTS
CLINICAL LABORATORY SERVICES
CARDIAC CATHETERIZATION SERVICES
RADIOLOGY - DIAGNOSTIC
MAGNETIC RESONANCE IMAGING
COMPUTED TOMOGRAPHIC SCANNER
DRUGS SOLD TO PATIENTS
RESPIRATORY THERAPY
LITHOTRIPSY SERVICES
PHYSICAL THERAPY
UNITS OF
SERVICE
UNIT
CODE
GROSS REV
PER UNIT
565
194,994
21,123
186,970
7
8
9
10
11
11
11
11
14
12
11
27
$7,868.43
$213.45
$964.82
$336.72
$3,801.39
$18.90
$139.99
$21.61
$2,038.11
$119.31
$1,437.08
$1,772.00
$98.38
$143.24
$213.32
$22.80
35,219
15,853
13,949
33,136
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
36,112
ADJ DIRECT
EXP PER UNIT
$48.65
2,893
UNIT
CODE
16
17
18
19
20
21
22
UNITS OF
SERVICE
372
21,586
111
2,893
1,553
430,912
120,619
UNIT
CODE*
23
24
25
22
26
21
20
ADJ DIRECT
EXP PER UNIT
$23,223.87
$66.74
$7,188.65
$643.38
$422.27
$0.72
$16.45
2,129
105,453
120,619
$62.46
$14.62
$31.64
$513.76
UNIT CODE DESCRIPTIONS

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

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

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

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

COST CENTER GROUP
AMBULATORY SERVICES
ANCILLARY SERVICES
RESEARCH
EDUCATION
GENERAL SERVICES
FISCAL SERVICES
TOTAL OPERATING COST CTRS
NON-OPERATING COST CENTERS
AVERAGE HOURLY RATE
MANAGEMENT
AND
SUPERVISION
1.39%
4.59%
4.95%
3.41%
TECHNICAL
AND
SPECIALIST
1.24%
8.83%
48.60%
21.64%
REGISTERED
NURSES
74.33%
62.57%
21.07%
50.79%
LICENSED
VOCATIONAL
NURSES
6.08%
%
%
2.53%
AIDES
AND
ORDERLIES
11.18%
%
1.15%
5.10%
%
%
8.07%
3.72%
24.40%
%
%
20.70%
28.88%
30.58%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
7.62%
%
22.42%
%
29.04%
%
1.44%
%
2.92%
%
$0.00
$0.00
$0.00
$0.00
$0.00
ENVIRON.
AND
FOOD SERV.
%
%
%
%
%
%
43.46%
%
0.07%
CLERICAL
AND OTHER
EMPLOYEES
5.34%
23.39%
18.10%
13.77%
%
%
27.76%
67.41%
44.96%
REGISTRY
AND
TEMP HELP
0.43%
0.63%
6.14%
2.76%
%
%
14.30%
%
12.99%
TOTAL
PRODUCTIVE
HOURS
161,841
71,330
156,434
389,605
TOTAL
PAID
HOURS
208,401
86,422
186,816
481,639
108,967
35,169
116,894
142,576
41,440
149,189
TOTAL OPERATING COST CTRS

NON-OPERATING COST CENTERS
6.96%
%
23.50%
%
6.09%
100.00%
681,403
2,883
814,844
2,883
AVERAGE HOURLY RATE
$0.00
$0.00
$0.00
COST CENTER GROUP

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

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

**INCLUDES NURSING REGISTRY
308
5
TOTAL NUMBER OF NURSING FTE'S**

NUMBER OF NURSING REGISTRY FTE'S
111
1
HOSPITAL DISCLOSURE REPORT FACSIMILE
Date Prepared: 6/24/2015
GENERAL INFORMATION AND CERTIFICATION
( Page 0 Submitted Data )
1.Health Care Institution(Legal Name):

ST LOUISE REGIONAL HOSPITAL
2. OSHPD Facility Number:

106434138
3. D. B.A. (Doing Business As) Name:

4. Hospital Business Phone:

(408) 848-8607
5.Medi-Cal Contract Provider Number:
6. Medi-Cal Non-Contract Provider Number:

HSP30688G
7.Medicare Provider Number:

050688
8. Street Address:
9400 NO NAME UNO
9. City:
GILROY
10.Zip Code:
95020
11. Mailing Address (if different) - Street or P.O. Box:

203 REDWOOD SHORES PKWY #800
12. City:
REDWOOD CITY
13. Zip Code:

94065
14. Chief Executive Officer:

JIM DOVER
15. Title:
CEO
16. Hospital Web Site Address:

HTTP://WWW.SAINTLOUISEREGIONALHOSPITAL.ORG
17. Name of Owner:
DAUGHTERS OF CHARITY HEALTH SYSTEM
18.Previous Name of Institution if Changed Since Previous Report:
23. Person Completing Report:
GLENN S BUNTING
24. Organization Name:

MOSS ADAMS LLP
25. Phone Number:

(916) 503-8195 Ext: 28. Mailing Address - Street or P.O. Box:
3100 ZINFANDEL DRIVE
26. FAX Phone Number:

(916) 503-8101
29. City:
RANCHO CORDOVA
30. State :
CA
36. Report Period:

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

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

95670
40. Was this disclosure report completed after an independent financial audit ?
__X__
Yes
____
No
41. Are audit adjustments made by the independent auditor reflected in this report ?
__X__
Yes
____
No

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

Line
No
( Page 1 (1 of 2) Submitted Data )
MISC INFORMATION
(1)
Report Period End:
TYPE OF CONTROL
(2)
06/30/2014
TYPE OF CARE
Licensed Beds (End of Period)
72
Church
Available Beds
72
Non-Profit Corporation
Short-Term - Childrens
10
15
Staffed Beds (Average)
31
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
GOVERNMENT PROGRAMS
(1)
Short-Term - General
Line
No
10
Line
No
(3)
55
PREPAID PROGRAMS
(2)
No.of
Each Type
24 HR. ON PREMISES
COVERAGE
(3)
Line
No
60
60
Medicare
HospitalBased
Emergency Services
65
Medi-Cal
Parent Organization Based
Psychiatric ER
70
Children's Medical Services
State Contracts
Physician
70
75
Short-Doyle
Federal Contracts
Pharmacist
75
80
CHAMPUS
Medical Foundation Contracts
Operating Room
80
85
County Indigent
Commercial Plan Contracts
Laboratory Services
85
90
Other (Specify)
Other (Specify)
Radiology Services
90
Anesthesiologist
95
65
95
100
100
105
105
ACTIVE MEDICAL STAFF PROFILE - MD's, DO's, Podiatrists and Dentists (Enter No)
Line
No
CLINICAL SPECIALTY
HOSPITAL BASED
Board
Certified
(1)
Board
Eligible
(2)
Other
(3)
NON-HOSPITAL BASED
Board
Certified
(4)
110 Aerospace Medicine
Other
(6)
Residents
(7)
Line
No
Fellows
(8)
110
115 Allergy and Immunology

120 Anesthesiology
Board
Eligible
(5)
RESIDENTS/FELLOWS
(Enter FTEs)
2
10
125 Cardiovascular Diseases
115
120
130 Child Psychiatry
125
130
135 Colon and Rectal Surgery
135
140 Dental
140
145 Dermatology
145
150 Diagnostic Radiology
10
150
155 Forensic Pathology
155
160 Gastroenterology
160
165 General/Family Practice
10
165
170 General Preventive Medicine
170
175 General Surgery
175
180 Internal Medicine
180
185 Neurological Surgery
185
190 Neurology
190
195 Nuclear Medicine

200 Obstetrics and Gynecology
195
12
205 Occupational Medicine
200
205
210 Oncology
210
215 Ophthalmology
215
220 Oral Surgery
220

1.
HOSPITAL DESCRIPTION

Line
No

CLINICAL SPECIALTY
Report Period End:
HOSPITAL BASED
Board
Certified
(1)
Board
Eligible
(2)
Other
(3)
NON-HOSPITAL BASED
Board
Certified
(4)
Board
Eligible
(5)
Other
(6)
06/30/2014
RESIDENTS/FELLOWS
(Enter FTEs)
Residents
(7)
Line
No
Fellows
(8)
225 Orthopaedic Surgery
225
230 Otolaryngology
230
235 Pathology
235
240 Pediatric-Allergy
240
245 Pediatric-Cardiology
245
250 Pediatric-Surgery
250
255 Pediatrics
255
260 Physical Medicine/Rehabilitation
260
265 Plastic Surgery
265
270 Podiatry
270
275 Psychiatry
275
280 Public Health
280
285 Pulmonary Disease
285
290 Radiology
290
295 Therapeutic Radiology
295
300 Thoracic Surgery
300
305 Urology
305
310 Vascular Surgery
310
315 Other Specialties
22
53
315
320 TOTAL
45
141
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
$4,442,108
(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)
Independent
(5)
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
X
X
X
Agency
(6)
Salaried
(7)
Other
(8)

3.3

Report Period End:
06/30/2014
G. HOSPITAL OWNERS AND GOVERNMENT BOARD MEMBERS
Line
No
Name
Occupation
(2)
(1)
Check if
Owner
(3)
Percentage of Check if
Hospital
Board
Ownership
Member
(4)
(5)
Compensation*
(6)
37
SISTER ANN LEITAO, DC
NUN
$0
38
SISTER MARION BILL, DC
NUN
$0
39
SISTER ARTHUR GORDON, DC
NUN
$0
40
SISTER FRAN CILUAGA
NUN
$0
41
SISTER JUDITH SCHOMISCH, DC
NUN
$0
42
ROBERT ISSAI
DCHS PRESIDENT
$0
43
MARK AHN
PHYSICIAN
$0
44
GEORGE CHIALA
FARMER
$0
45
SCOTT BENNINGHOVEN
PHYSICIAN
$0
46
GEORGE GREEN
PHYSICIAN
$0
47
ALLEN HAYES
INSURANCE BROKER
$0
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
* Compensation paid to the individual from all sources for services rendered personally to or on behalf of the hospital.

3.4

I.

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

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

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

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

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

4
PATIENT UTILIZATION STATISTICS
Report Period End:
BEDS
Line
No
PATIENT (CENSUS) DAYS
(1)
Licensed
(End of
Period)
(2)
Available
(Average)
(3)
Staffed
(Average)
(4)
Adult
1,780
(5)
Pediatric
06/30/2014
DISCHARGES
(11)
Service
(12)
Total
216
Line
No
Medical/Surgical Intensive Care
10
Coronary Care
10
15
Pediatric Intensive Care
15
20
Neonatal Intensive Care
20
25
Psychiatric Intensive ( Isolation ) Care
25
30
Burn Care
30
35
Other Intensive Care
35
40
Definitive Observation
45
Medical/Surgical Acute
50
Pediatric Acute
50
55
Psychiatric Acute - Adult
55
60
Psychiatric Acute - Adolescent & Child
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
40
48
48
22
7,447
2,138
45
60
16
16
1,324
691
65
90
100 Sub-Acute Care
100
101 Sub-Acute Care - Pediatric
101
105 Skilled Nursing Care
105
110 Psychiatric Long-Term Care
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
72
72
31
18
10,551
3,045
150
155

4

Line
No

ACCOUNT DESCRIPTION
STANDARD UNIT OF MEASURE
Report Period End:

(1)
Total Units of
Service [Sum of
columns (7) and
(13)]
(7)
Total Inpatient Units
of Service
06/30/2014
(13)
Total Outpatient
Units of Service
Line
No.
24,813
160
AMBULATORY SERVICES
160 Emergency Services
Visits
165 Medical Transportation Services
Occasions of Service
170 Psychiatric Emergency Rooms
Visits
175 Clinics
Visits
180 Satellite Clinics
Visits
180
185 Satellite Ambulatory Surgery Center
Operating Minutes
185
190 Outpatient Chemical Dependency Svcs
Visits
190
195 Observation Care
Observation Hours
195
200 Partial Hospitalization - Psychiatric
Day-Night Care Days
200
205 Home Health Care Services
Home Health Visits
205
210 Hospice - Outpatient
Visits
210
215 Adult Day Health Care
Visits
215
ANCILLARY SERVICES
230 Labor and Delivery Services
Deliveries
235 Surgery and Recovery Services
Operating Minutes
240 Ambulatory Surgery Services
Operating Minutes
245 Anesthesiology
Anesthesia Minutes
250 Medical Supplies Sold to Patients
CS & S Adj. Inpatient Days
255 Durable Medical Equipment
Adjusted Inpatient Days
260 Clinical Laboratory Services
Tests
265 Pathological Laboratory Services
Tests
265
270 Blood Bank
Units of Blood Issued
270
275 Echocardiology
Procedures
275
280 Cardiac Catheterization Services
Procedures
280
285 Cardiology Services
Procedures
285
290 Electromyography
Procedures
290
295 Electroencephalography
Procedures
300 Radiology - Diagnostic
Procedures
305 Radiology - Therapeutic
Procedures
305
Procedures
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
15,853
330
335 Respiratory Therapy
Respiratory Therapy Adj. Inpatient

Days
13,949
335
340 Pulmonary Function Services
Procedures
345 Renal Dialysis
Hours of Treatment
350 Lithotripsy
Procedures
355 Gastro-Intestinal Services
Procedures
360 Physical Therapy
Sessions
365 Speech-Language Pathology
Sessions
365
370 Occupational Therapy
Sessions
370
380 Electroconvulsive Therapy
Treatments
380
385 Psychiatric/Psychological Testing
Sessions
385
390 Psychiatric Individual/Group Therapy
Sessions
390
395 Organ Acquisition
Organs acquired
395
24,813
165
170
11,838
11,838
565
565
194,994
112,391
175
230
82,603
235
240
245
21,123
250
255
186,970
90,519
96,451
260
295
35,219
7,380
27,839
300
325
340
1,184
1,168
16
345
350
355
33,136
20,938
12,198
360

4
Report Period End:
OTHER STATISTICS
(1)
Total Units of
Service
(7)
Inpatient Units of
Service
1,619
06/30/2014
(13)
Outpatient Units of
Service
Surgeries
Satellite Operating Rooms
1,619
510
Surgeries
515
Open Heart Surgery Minutes
520
Open Heart Surgeries
525
Inpatient Operating Rooms
530
Surgeries
535
Outpatient Operating Rooms
540
545 Observation Care Days
505
545
550 Renal Dialysis Care Visits
550
555 Referred Visits
18,385
18,385
555
560 Total Outpatient Visits(a)
56,659
56,659
560
LIVE BIRTH SUMMARY
(1)
Total Births [Sum of
columns (7) and
(13)]
(7)
Natural Births
(13)
Cesarean Sections
566
439
127
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
566
439
127
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
4,776
591
1,503
1,010
(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
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
45
Purchased Inpatient Services
30
4,776
591
1,503
1,010
35
452
342
40
45
PATIENT (CENSUS ) DAYS

TYPE OF CARE
Line
No
(7)
Other Third
Parties
Traditional
77
(8)
(9)
Other Third
Other Indigent
Parties
Managed Care
2,338
(10)
Other Payors
(11)
Total Patient
Days
256
10,551
Line
No
Acute Care
10
Psychiatric Care
10
15
15
20
Rehabilitation Care
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
45
30
77
2,338
256
299
10,551
35
1,093
40
45
DISCHARGES
TYPE OF CARE
Line
No
(12)
(13)
(14)
(15)
1,153
137
498
412
(16)
County
Indigent
(17)
County
Line
Indigent
No
Programs Managed Care
Acute Care
10
Psychiatric Care
10
15
15
20
Rehabilitation Care
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
45
30
1,153
137
498
412
35
219
172
40
45
DISCHARGES
TYPE OF CARE
Line
No
(18)
Other Third
Parties
Traditional
18
(19)
(20)
Other Third
Other Indigent
Parties
Managed Care
738
(21)
Other Payors
89
(22)
Total
Discharges
Line
No
Acute Care
10
Psychiatric Care
3,045
10
15
15
20
Rehabilitation Care
20
25
Long-Term Care
25
30
Other Care
35
Total
40
Nursery Acute
45
30
18
738
140
89
3,045
35
531
40
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)
2,796
452
2,894
9,239
60
65
Clinic (incl. Satellite Clinics)
1,815
59
3,201
279
65
70
Observation Care Days
70
75
Psychiatric Day-Night Care Days
75
80
Home Health Care Services
80
85
Hospice - Outpatient
90
Outpatient Surgeries
95
Private Referred
85
706
88
18
68
5,934
395
1,031
1,867
90
95
100 Other *
100
105 Total
11,251
994
7,144
11,453
105
OUTPATIENT VISITS
TYPE OF OUTPATIENT VISIT
(7)
Other Third
Parties Traditional
(8)
Other Third
Parties Managed Care
(9)
Other Indigent
(10)
Other Payors
(11)
Total
OutPatient
Visits
Line
No
Line
No
60
Emergency Svcs. (incl. Psych ER)
562
6,120
2,750
24,813
60
65
Clinic (incl. Satellite Clinics)
115
5,946
423
11,838
65
70
Observation Care Days
70
75
Psychiatric Day-Night Care Days
75
80
80
85
Hospice - Outpatient
90
Outpatient Surgeries
36
698
1,619
95
Private Referred
194
8,529
435
18,385
95
100
56,659
105
85
100 Other *
105 Total
4
907
21,297
Includes Chemical Dependency Services, Adult Day Health Care, & Renal Dialysis Visits
3,613
90

5
BALANCE SHEET - UNRESTRICTED FUND

Line
No
ASSETS
Report Period End:
06/30/2014
Account No
(1) Current Year
(2) Prior Year
$2,758,564
$2,533,426
Line
No
CURRENT ASSETS
5
Cash
1000
10
Marketable securities
1010
15
Accounts and notes receivable
1020
$66,817,916
$60,861,264
15
20
Less allowance for uncollectible receivables and thrid-party contractual withholds
1040
($54,057,581)
($49,662,173)
20
25
Receivables from third-party payors
1050
25
30
Pledges and other receivables
1060
30
35
Due from restricted funds
1070
40
Inventory
1080
$1,229,308
$1,103,753
40
45
Intercompany receivables
1090
$5,693,274
$6,991,137
45
50
Prepaid expenses and other current assets
1100
$347,041
$3,701,420
50
55
TOTAL CURRENT ASSETS (Sum of lines 5 through 50)
$22,788,522
$25,528,827
55
10
35
ASSETS WHOSE USE IS LIMITED

60
Limited use cash
1110
65
Limited use investments
1120
$43,955
$13,436
60
65
70
Limited use other assets
1130
$234,015
$235,115
70
75
TOTAL ASSETS WHOSE USE IS LIMITED (Sum of lines 60 through 70)
$277,970
$248,551
75
PROPERTY, PLANT AND EQUIPMENT - AT COST

80
Land
1200
$6,512,933
$6,511,544
80
85
Land improvements
1210
$4,547,286
$4,547,286
85
90
Buildings and improvements
1220
$28,121,852
$28,121,852
90
95
Leasehold improvements
1230
$12,627,768
$12,627,768
95
1240
$31,930,206
$29,796,927
100
$83,740,045
$81,605,377
105
1260
($59,852,975)
($53,965,746)
195
$23,887,070
$27,639,631
200
$204,666
$317,440
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
$47,158,228
$53,734,449
270
(1) Current Year
(2) Prior Year
Line
No
405 Current market value - current assets marketable securities (Line 10)
405
410 Current market value - limited use investments (Line 65)
410
415 Current market value - other investments (Line 220)
415
420 Total cost to complete construction in progress (Line 205)
$204,666
$317,440
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
$365,003
$565,030
10
Accounts payable
2020
$2,537,451
$909,120
10
15
Accrued compensation and related liabilities
2030
$3,830,969
$3,938,438
15
20
Other accrued expenses
2040
$359,998
$390,500
20
25
Advances from third-party payors
2050
30
Payable to third-party payors
2060
$425,295
$3,890,299
35
Due to restricted funds
2070
40
Income Taxes payable
2080
$758,602
$787,258
40
45
Intercompany payables
2090
$34,252,748
$25,703,223
45
50
Current maturities of long-term debt (Must agree with line 125)
55
Other current liabilities
2100
$8,635,474
$9,583,205
55
60
TOTAL CURRENT LIABILITIES (Sum of lines 5 through 55)
$51,165,540
$45,767,073
60
25
30
35
50
DEFERRED CREDITS
65
Deferred income taxes
2110
65
70
Deferred third-party income
2120
70
75
Other deferred credits
2130
75
80
TOTAL DEFERRED CREDITS (Sum of lines 65 through 75)
80
LONG-TERM DEBT Unpaid Principal(a)

85
Mortgages payable
2210
85
90
Construction loans
2220
90
95
Notes under revolving credit
2230
95
100 Capital lease obligations
2240
100
105 Bonds payable
2250
110 Intercompany payables
2260
115 Other non-current liabilities
2270
120 TOTAL LONG-TERM DEBT (Sum of lines 85 through 115)
$30,596,239
$46,465,430
105
110
115
$30,596,239
$46,465,430
130 NET TOTAL LONG-TERM DEBT(Sum of lines 120 and 125)
$30,596,239
$46,465,430
130
135 TOTAL LIABILITIES (Sum of lines 60,80 and 130)
$81,761,779
$92,232,503
135
($34,603,551)
($38,498,054)
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
($34,603,551)
($38,498,054)
205
$47,158,228
$53,734,449
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
(7) Due Date

(Year Only*)
2040

Report Period End:

(8) Interest
Rate (a)
7.45
(9) Unpaid Principal

Balance at Year End
$30,596,239
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
$1,389
Donation
Transfers
Disposals and
Retirements
Ending
Balance (b)
No
Land
$6,511,544
$6,512,933
10
Land Improvements
$4,547,286
$4,547,286
10
15
Buildings and Improvements
$28,121,852
$28,121,852
15
20
Leasehold Improvements
$12,627,768
$12,627,768
20
25
Equipment
$29,796,927
$31,930,206
25
30
Construction-in-progress
($112,774)
$204,666
30
35
TOTAL
($112,774)
$83,944,711
35
$2,133,279
$317,440
$81,922,817
$2,134,668
(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
($38,498,054)
20
20
25
25
30
30
35
35
40
40
45
45
50
BALANCE AT BEGINNING OF YEAR, AS

RESTATED
($38,498,054)
50
55
ADDITIONS (DEDUCTIONS):
Net Income (Loss)
($10,446,883)
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) EQUITY TRANSFER
105
$14,341,386
110
115
115
120
120
125
TOTAL ADDITIONS (DEDUCTIONS)
130
TRANSFERS:
Property and equipment additions
$3,894,503
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
($34,603,551)
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
$85,917,358
$87,821,359
10
Ambulatory services
$87,920,968
$90,256,444
10
15
Ancillary services
$257,073,285
$243,379,269
15
30
GROSS PATIENT REVENUE (Sum of lines 5 through 15)
$430,911,611
$421,457,072
30
105
DEDUCTIONS FROM REVENUE (From line 395) (a)
$350,675,329
$343,084,286
105
107
CAPITATION PREMIUM REVENUE (From line 450) (b)
110
NET PATIENT REVENUE (Line 30 minus line 105 plus line 107)
$80,236,282
$78,372,786
110
135
TOTAL OTHER OPERATING REVENUE
$2,030,636
$307,498
135
140
TOTAL OPERATING REVENUE (Sum of lines 110 and 135)
$82,266,918
$78,680,284
140
146
OPERATING EXPENSES:
Daily Hospital Services
$18,468,877
$19,661,383
146
151
Ambulatory Services
$7,649,597
$7,761,065
151
156
Ancillary Services
$21,552,894
$21,805,957
156
161
Research Costs
166
Education Costs
171
General Services
$13,910,476
$13,548,272
171
176
Fiscal Services
$2,417,561
$2,943,978
176
181
Administrative Services
$20,295,222
$19,184,366
181
186
Unassigned Costs
$9,133,718
$4,360,876
186
190
195
Purchased Outpatient Services
200
TOTAL OPERATING EXPENSES (Sum of Lines 146 through 195)
$93,428,345
$89,265,897
200
205
NET FROM OPERATIONS (Line 140 minus line 200)
($11,161,427)
($10,585,613)
205
210
NET NON-OPERATING REVENUE AND EXPENSE (From Line 700) (c)
$714,544
($3,936,176)
210
215
NET INCOME BEFORE TAXES AND EXTRAORDINARY ITEMS: (Sum of lines

205 and 210)
($10,446,883)
($14,521,789)
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
($10,446,883)
($14,521,789)
230
EXTRAORDINARY ITEMS:(Specify)
235
235
240
245
240
NET INCOME (Line 230 minus lines 235 and 240)
($10,446,883)
(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.
($14,521,789)
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
$3,399,094
$2,208,871
300
305
Contractual adjustments - Medicare - traditional
$132,473,801
$136,303,298
305
310
Contractual adjustments - Medicare - managed care
$16,924,623
$16,363,834
310
315
Contractual adjustments - Medi-Cal - traditional
$36,714,212
$27,202,498
315
320
Contractual adjustments - Medi-Cal - managed care
$52,947,935
$45,854,723
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
$4,507,051
$4,193,517
340
345
Contractual adjustments - Other third parties - managed care
$81,997,186
$82,182,888
345
350
Charity discounts - Hill Burton
355
Charity discounts - other
$9,647,418
$28,774,657
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
375
380
Administrative adjustments
385
Other deductions from revenue
$12,064,009
395
TOTAL DEDUCTIONS FROM REVENUE (Sum of lines 300 thru 385)
$350,675,329
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
350
355
380
(d) Disproportionate share funds transferred back to a related public entity must be reported on page 7, column(1), line 105.
385
$343,084,286
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
545
550
County allocation of taxes revenue (e)
9160
550
555
Special district augmentation revenue (e)
9170
555
560
Debt service taxes revenue (e)
9180
560
565
State homeowner's property tax relief (e)
9190
565
570
State appropriation
9200
570
575
County appropriation - Realignment funds
9210
575
580
County appropriation - County general funds
9220
580
585
County appropriation - Other county funds
9230
590
Physician's offices and other rentals - revenue
9250
595
Medical office building revenue
9260
595
600
Child care services revenue (non-employee)
9270
600
605
Family housing revenue
9280
605
610
Retail operations revenue
9290
615
Other non-operating revenue
9400
625
TOTAL NON-OPERATING REVENUE (Sum of lines 500 thru 615)
640
NON-OPERATING EXPENSES:
Loses on sale of hospital property
9020
645
Maintenance of restricted funds expense
9030
650
Physician's offices and other rentals expense
9510
655
Medical office building expense
9520
655
660
Child care services expense (non-employee)
9530
660
665
Family housing expense
9540
665
670
Retail operations expense
9550
675
Other non-operating expense
9800
685
500
505
$976,789
$883,246
$41,921
$62,370
510
515
520
585
$425,360
$406,411
590
610
$54,718
$83,642
615
$1,498,788
$1,435,669
625
640
645
$915,378
650
670
$784,244
$4,456,467
675
TOTAL NON-OPERATING EXPENSE (Sum of lines 640 thru 675)
$784,244
$5,371,845
685
700
NET NON-OPERATING REVENUE AND EXPENSE (Line 625

minus line 685)
$714,544
($3,936,176)
700
705
Interest on long-term debt (e)
(e) District Hospital only.
705

9
STATEMENT OF CASH FLOWS - UNRESTRICTED FUND
Line
No

Report Period End:
06/30/2014
(1) Current Year
(2) Prior Year
Line
No
($10,446,883)
($14,521,789)
$5,887,230
$4,308,777
15
CASH FLOW FROM OPERATING ACTIVITIES AND NON-OPERATING REVENUE:

Net income (loss)
15
Adjustments to reconcile net income to net cash provided by (used for) operating activities and
non-operating revenue :
Depreciation and amortization
17
Amortization of intangible assets
20
Change in marketable securities
30
Change in accounts and notes receivable, net of allowance for uncollectible receivables and
third-party contractual withholds
35
Change in receivables from third-party payors
35
40
Change in pledges and other receivables
40
45
Change in due from restricted funds
50
Change in inventory
($125,555)
($176,142)
50
55
Change in intercompany receivables
$1,297,863
$164,107
55
57
Change in Prepaid expenses and other current assets
$3,354,379
$228,647
57
60
Change in accounts payable
$1,628,331
($432,669)
60
65
Change in accrued compensation and related liabilities
($107,469)
$361,478
65
70
Change in other accrued expenses
($30,502)
($237,800)
70
75
Change in advances from third-party payors
80
Change in payable to third-party payors
($3,465,004)
$268,710
85
Change in due to restricted funds
87
Change in income taxes payable
($28,656)
$92,517
87
90
Change in intercompany payables
$8,549,525
$16,555,565
90
95
Change in other current liabilities
($947,731)
($1,215,035)
17
20
($1,561,244)
$948,239
30
45
75
80
85
95
100 Change in deferred credits
100
102 Other (Describe):
102
103
104
105 TOTAL ADJUSTMENTS (Sum of lines 15 through 104)
$14,451,167
$20,866,394
105
115 NET CASH PROVIDED BY (USED FOR) OPERATING ACTIVITIES (Sum of lines 5 and 105)
$4,004,284
$6,344,605
115
($29,419)
($22,203)
130
($2,134,668)
($10,094,041)
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)
($2,164,087)
CASH FLOW FROM FINANCING ACTIVITIES:

160 Proceeds from issuance of long-term debt
($15,869,191)
165 Principal payments on long-term debt

170 Proceeds from issuance of short-term notes and loans
($200,027)
($10,116,244)
145
160
($565,030)
165
$565,030
170
175 Principal payments on short-term notes and loans
175
180 Dividends paid
180
185 Proceeds from issuance of common stock

190 Other (Describe): CY EQUITY TRANSFER; PY UNLOCAT
185
$14,454,159
$2,889,824
190
191
192
NET CASH PROVIDED BY (USED FOR) FINANCING ACTIVITIES (Sum of lines 160 through
195 192)
($1,615,059)
$2,889,824
195
$225,138
($881,815)
205
215 CASH AT BEGINNING OF YEAR
$2,533,426
$3,415,238
215
225 CASH AT END OF YEAR (Sum of lines 205 and 215)
$2,758,564
$2,533,423
225
205 NET INCREASE (DECREASE) IN CASH (Sum of lines 115, 145 and 195)

10
(OPTIONAL) SUMMARY OF REVENUES AND COSTS

Line
No
REVENUE PRODUCING CENTERS
(1)Units of
Service
from Page 17,
Column (13)
(2)Adjusted
Direct Expenses
from Page 20,
Column (1)

Report Period End:

(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)
(2)Adjusted
Direct Expenses
from Page 20,
Column (1)

Report Period End:

(3)Allocated
Costs
Column
(4) minus (2)
06/30/2014
(4)Total Patient
Care Costs from
Page 20, Column
(16),Lines 505 - 915
(5)Average Unit
Patient Care
Costs, Column
(4) (1)
Line
No
ANCILLARY SERVICES:
230
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375 Other Physical Medicine
375
380
385
390
395
400 Other Ancillary Services
400
405 TOTAL ANCILLARY SERVICES
405
410 Purchased Inpatient Services
410
411 Purchased Outpatient Services
411
415 TOTAL OPERATING REV. & EXP. (A)
415
420 Non-Operating Cost Centers/Revenue
420
425 Provision for Income Taxes
425
430 Extraordinary Items
430
435 TOTALS/NET PROFIT (LOSS) (B)
435
(A) Sum of lines 150, 225, 405, and 410.

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

10

Line
No

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

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


10

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

Report Period End:
(12)Deductions (13)Adjustment
(14)Net Revenue
from Revenue for Professional Column (11) - (12) from Page 12,
Component
(13)
Column 23 Line from Page 15,
455 - 457
Columns (9) &
(13)
06/30/2014
(15)Average Unit Line
Net Revenue
No
Column (14) (1)
ANCILLARY SERVICES:
230
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405
410
411
415
420
425
430
435
(A) Sum of lines 150, 225, 405, and 410.


10

Line
No

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

06/30/2014

12
SUPPLEMENTAL PATIENT REVENUE INFORMATION
Report Period End:
06/30/2014
MEDICARE
Traditional
(1) Gross
Inpatient Revenue
Line
No
PATIENT
Managed Care
(2) Gross
Outpatient
Revenue
(3) Gross
Inpatient Revenue
(4) Gross
Outpatient
Revenue
Account
No
Revenue Subclassifications
Line
No
.04
.44
.14
.54

3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
Psychiatric Acute - Adolescent and Child
3360
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
$11,030,794
$1,257,033
40
$27,874,129
$3,527,489
45
60
$10,248
65
90
$8,453
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
110 Psychiatric - Long Term Care
3610
110
3630
115
3680
120
3780
125
3900
145
$38,923,624
$4,784,522
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
190 Outpatient Chemical Dependency Services
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$5,399,861
$9,920,776
$751,567
$1,771,718
160
165
170
$4,354,585
$455,018
175
220
$5,399,861
$14,275,361
$751,567
$2,226,736
225

12

Report Period End:
06/30/2014
MEDI-CAL
Traditional
(5) Gross
Inpatient Revenue
Line
No
PATIENT
Managed Care
(6) Gross
Outpatient
Revenue
(7) Gross
Inpatient Revenue
(8) Gross
Outpatient
Revenue
Account
No
Line
No
.05
.45
.15
.55

3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
$2,930,132
$1,577,995
40
$5,517,080
$3,116,095
45
60
$2,328,292
$1,854,379
65
90
$1,920,313
$1,529,442
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
$12,695,817
$8,077,911
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$1,474,980
$7,774,955
$1,124,969
$21,204,463
160
165
170
$369,584
$1,111,682
175
220
$1,474,980
$8,144,539
$1,124,969
$22,316,145
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
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
$70,224
$5,240,843
40
$483,540
$10,476,946
45
60
$1,835,561
65
90
$1,513,922
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
$553,764
$19,067,272
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$79,719
$1,325,240
$2,264,612
$17,205,233
160
165
170
$291,361
$3,489,142
175
220
$79,719
$1,616,601
$2,264,612
$20,694,375
225

12

Report Period End:
OTHER INDIGENT
(17) Gross
Inpatient Revenue
Line
No
PATIENT
(18) Gross
Outpatient
Revenue
06/30/2014
OTHER PAYORS
(19) Gross
Inpatient Revenue
(20) Gross
Outpatient
Revenue
Account
No
Line
.08
.48
.00, .09
.40, .49
No

3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
$514,127
40
$1,277,440
45
60
$12,539
65
90
$10,342
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
$1,814,448
150
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$360,890
$7,021,468
160
165
170
$169,145
175
220
$360,890
$7,190,613
225

12

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

Revenue
Account
No
Line

3010
10
Coronary Care
3030
10
15
3050
15
20
3070
20
25
3090
25
30
Burn Care
3110
30
35
3130
35
40
3150
45
3170
50
Pediatric Acute
3290
50
55
3340
55
60
3360
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
$22,621,148
$22,621,148
40
$52,272,719
$52,272,719
45
60
$6,041,019
$6,041,019
65
90
$4,982,472
$4,982,472
95
100 Sub-Acute Care
3560
100
3570
101
3580
105
3610
110
3630
115
3680
120
3780
125
3900
145
$85,917,358
$85,917,358
150
$77,680,451
160
4010
4040
4060
175 Clinics
4070
4180
180
4200
185
4220
190
4230
195
4260
200
4290
205
4310
210
4320
215
4390
$11,456,598
$66,223,853
165
170
$10,240,517
$10,240,517
175
220
$11,456,598
$76,464,370
$87,920,968
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
(4) Gross
Outpatient
Revenue
.44
.14
.54
$9,571,584
$658,874
$1,029,849
Line
No
ANCILLARY SERVICES:
4400
$7,542
4420
$6,953,532
4430
245 Anesthesiology
4450
250 Medical Supplies sold to Patients
4470
4480
4500
4520
265
270 Blood Bank
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
4610
290
4620
4630
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$7,241,430
$3,085,022
$805,228
$312,240
330
4720
$10,280,786
$2,268,547
$1,310,792
$332,043
335
4730
345 Renal Dialysis
4740
$623,254
$15,650
$94,690
350 Lithotripsy
4750
4760
4770
365 Speech- Language Pathology
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
230
240
245
$3,537,788
$2,235,716
$540,986
$330,289
$13,286,142
$10,556,285
$1,735,220
$1,355,699
$16,898,386
$996,553
$2,181,175
300
325
340
345
350
355
$2,791,638
$1,260,551
$396,925
$64,503
360
400
415 TOTAL PATIENT REVENUE
$96,303,850
$60,167,102
MEDICARE
Traditional
Inpatient
Outpatient
425 Contractual Adjustments (exclude capitation revenue)
260
295
$7,258,253
$51,980,365
420 Provision for Bad Debts
250
255
DEDUCTIONS FROM REVENUE
235
$45,891,741
$6,539,268
$5,605,798
405
$12,075,357
MEDICARE
Managed Care
Total
$7,832,534
415
$108,664
$68,408
$289,108
420
$81,295,599
$51,178,202
$16,924,623
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
$81,404,263
$51,246,610
$17,213,731
$14,899,587
$8,920,492
$2,694,160
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
Line
No
ANCILLARY SERVICES:
4400
$1,713,420
4420
$1,809,346
4430
245 Anesthesiology
4450
4470
4480
4500
4520
265
270 Blood Bank
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
4610
290
4620
4630
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$2,090,382
$348,814
$1,225,564
$681,210
330
4720
$2,230,012
$429,438
$1,056,217
$841,246
335
4730
345 Renal Dialysis
4740
350 Lithotripsy
4750
4760
4770
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
$1,364,661
$471,253
$1,690,261
230
$1,234,211
235
240
245
$1,664,242
$1,044,064
$1,536,918
$1,940,982
$3,526,717
$3,577,919
$2,270,362
$6,684,177
250
255
260
295
$1,735,310
$4,178,081
$1,053,186
$7,470,582
300
325
340
$247,996
$107,215
345
350
355
$333,644
$113,660
$133,707
$225,197
360
400
$15,351,069
$10,163,229
$10,438,091
$19,077,605
405
$29,521,866
$18,307,768
$19,640,971
$41,393,750
415
MEDI-CAL
Traditional
Total
MEDI-CAL
Managed Care
Total
$853,962
420
$36,714,212
$52,947,935
425
$423,375
$541,367

430 Charity
426
430

(Credit Balance)
435
440
445

450
$37,137,587
$54,343,264
$10,692,047
$6,691,457

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
$340,225
$769,942
Line
No
ANCILLARY SERVICES:
4400
4420
4430
245 Anesthesiology
4450
4470
4480
4500
4520
265
270 Blood Bank
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
4610
290
4620
4630
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$104,551
$105,512
$3,410,474
$2,749,792
330
4720
$84,111
$43,659
$3,618,365
$1,705,815
335
4730
345 Renal Dialysis
4740
350 Lithotripsy
4750
4760
4770
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870

$1,350,812
230
$11,466,412
235
240
245
$27,483
$129,128
$2,374,254
$3,214,373
$158,660
$214,598
$5,516,407
$10,234,293
250
255
260
295
$115,642
$1,224,752
$3,390,564
$21,265,681
300
325
340
$232,467
345
350
355
$24,687
$4,370
$670,794
$1,014,530
360
400
$855,359
$2,491,961
$1,488,842
$4,108,562
OTHER THIRD PARTIES
Traditional
Inpatient
$5,332,559
Outpatient
$25,896,696
$47,228,580
OTHER THIRD
PARTIES
Managed Care
Total
$51,650,896
405
$72,345,271
415
$21,257
$58,352
$1,717,411
420
$1,203,470
$3,303,581
$81,997,186
425

426
430 Charity
430

(Credit Balance)
435
440
445

$12,064,009
450
455
$1,224,727
$3,361,933
$95,778,606
$264,115
$746,629
$23,795,245

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
Line
No
ANCILLARY SERVICES:
4400
$9,228
4420
$161,425
4430
245 Anesthesiology
4450
4470
4480
4500
4520
265
270 Blood Bank
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
4610
290
4620
4630
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$285,080
$336,736
330
4720
$116,185
$400,377
335
4730
340
345 Renal Dialysis
4740
345
350 Lithotripsy
4750
350
4760
4770
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
230
$132,479
235
240
245
$497,989
$1,305,612
$651,606
$3,188,312
250
255
260
295
$438,923
$3,573,042
300
325
355
$34,213
360
400
$2,194,649
$8,936,558
405
$4,369,987
$16,127,171
OTHER PAYORS
415
OTHER INDIGENT
Inpatient
Outpatient
Inpatient
Outpatient
$61,592
$220,340
425

430 Charity
420
426
$1,896,863
$6,785,813
430

(Credit Balance)
435
440
445

450
$1,958,455
$7,006,153
$2,411,532
$9,121,018

455
457
460

12

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

Revenue
Line
No
ANCILLARY SERVICES:
4400
$4,445,663
4420
$16,946,222
4430
245 Anesthesiology
4450
4470
4480
4500
4520
265
270 Blood Bank
4540
270
275 Echocardiology
4560
275
4570
280
4590
285
4610
290
4620
4630
4640
305
4650
310
4660
315
320 Ultrasonography
4670
320
4680
4710
$15,162,709
$7,619,326
$22,782,035
330
4720
$18,696,468
$6,021,125
$24,717,593
335
4730
345 Renal Dialysis
4740
$1,305,622
$15,650
$1,321,272
350 Lithotripsy
4750
4760
4770
4780
365
4790
370
4800
375
4820
380
4830
385
4840
390
4860
395
4870
$24,675,730
$4,445,663
230
$41,621,952
235
240
245
$10,179,660
$10,200,164
$20,379,824
$27,145,114
$35,811,283
$62,956,397
250
255
260
295
$14,988,431
$56,791,699
$71,780,130
300
325
340
345
350
355
$4,385,608
$2,682,811
$7,068,419
360
400
$113,255,497
$143,817,788
$257,073,285
405

$210,629,453
$220,282,158
$430,911,611
415
Total Inpatient
Total Outpatient

Total
$3,399,094
420
$325,564,808
425

430 Charity
426
$9,647,418
430

(Credit Balance)
435
440
445
$12,064,009
450
$350,675,329
455

457
$80,236,282
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
$689
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
75
Vending Machine Commissions
5690
80
Television/Radio Rentals
5720
85
Finance Charges on Patient Accounts Receivable
5520
90
Child Care Services Revenue - Employees
5760
95
Other (Specify)
65
70
$1,571
75
80
($21,333)
85
90
95
100
100
105
105
110
110
115
115
120
TOTAL PARTS I AND II
($19,073)
120
130
PART III: OTHER OPERATING REVENUE ALLOCATED

Non-Patient Food Sales
5320
135
Laundry and Linen Revenue
5340
$149,760
130
135
140
Social Work Services Revenue
5350
140
145
Supplies sold to Non-Patients Revenue
5370
145
150
Drugs Sold to Non-Patients Revenue
5380
150
155
Purchasing Services Revenue
5390
155
160
Parking Revenue
5430
160
165
Housekeeping & Maintenance Services Revenue
5440
165
170
Data Processing Services Revenue
5480
175
Medical Records Abstracts Sales
5700
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 REVENUE
170
$14,190
175
196
$1,885,759
200
205
205
210
210
215
215
220
TOTAL PART III
$2,049,709
225
PART IV: RESEARCH & EDUCATION REVENUES AND TRANSFERS

Transfers from Restricted Funds for Research Expense
220
5010
225
230
School of Nursing Tuition
5220
230
235
Licensed Vocational Nurse Program Tuition
5230
235
240
Medical Postgraduate Education Tuition
5240
240
245
Paramedical Education Tuition
5250
245
250
Student Housing Revenue
5260
250
255
Other Health Profession Education Revenue
5270
255
260
Transfers from Restricted Funds for Education Expense
5280
260
270
Transfers from Restricted Funds for Operations (Revenue Centers)
5790
270
275
TOTAL PART IV
280
TOTAL OTHER OPERATING REVENUE (Sum of Lines 120,220 and 275)
275
$2,030,636
280

15
RECLASSIFICATION WORKSHEET- PHYSICIAN AND STUDENT

COMPENSATION -PATIENT REVENUE PRODUCING CENTERS

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

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
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
$55,225
$55,225
60
$108,193
$108,193
65
145
$163,418
$163,418
150
$2,263,564
$2,263,564
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
$460,163
$460,163
175
220
$2,723,727
$2,723,727
225

15


Report Period End:
06/30/2014
PERCENT OF TIME SPENT BY FUNCTION
Line
No
PATIENT
Account
No
(5)
Research
Supported by
Hospital
(6)
Medical
Education
Supported by
Hospital (NonInservice)
(7)
General
Administration
and Hospital
Committees
(8)
Nursing and
Paramedical Care Line
of Hospital
No
Patients

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
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
$55,225
60
$108,193
65
145
$163,418
150
$2,263,564
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
$460,163
175
220
$2,723,727
225

15


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

FUNCTION
Line
No
PATIENT
Account
No
(9)
Physician and
Intern/Resident
Care of Hospital
Patients
(10)
(13)
Supervision and
Allocation of
Other Functions
Page 16, Column Line
of the Cost Center (9), to Revenue
No
Centers (See
Instructions)

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
145
150
AMBULATORY SERVICES
7010
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
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
7630
7640
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
$865,031
$865,031
245
250
255
$95,024
$95,024
260
295
$121,428
$121,428
300
330
$102,261
$102,261
335
400
$1,183,744
$1,183,744
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
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
7630
7640
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
$865,031
245
250
255
$95,024
260
295
$121,428
300
330
$102,261
335
400
$1,183,744
405

15


Report Period End:
06/30/2014

FUNCTION
Line
No
PATIENT
Account
No
(9)
Physician and
Intern/Resident
Care of Hospital
Patients
(10)
(13)
Supervision and
Allocation of
Other Functions
Page 16, Column Line
of the Cost Center (9), to Revenue
No
Centers (See
Instructions)
ANCILLARY SERVICES
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
345 Renal Dialysis
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405

16
RECLASSIFICATION WORKSHEET - PHYSICIAN AND STUDENT

COMPENSATION - NON-REVENUE PRODUCING CENTERS

Report Period End:
06/30/2014
COMPENSATION
Line
No
NON-REVENUE PRODUCING CENTERS
Account
No
(1)
Salaries
and Wages
(2)
Employee
Benefits
(3)
Professional
Fees
(4)
Total
Compensation
Line
No
.07,.09
.10-.19
.20
RESEARCH COSTS
5
Research Projects and Administration
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
Education Administration Office
8210
15
20
School of Nursing
8220
20
25
Licensed Vocational Nurse Program
8230
25
30
Medical Postgraduate Education
8240
30
35
Paramedical Education
8250
35
40
Student Housing
8260
40
45
Other Health Profession Education
8290
45
50
TOTAL EDUCATION
50
205 Hospital Administration
8610
205
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
280
295 Other Administrative Services
8790
300 TOTAL ADMINISTRATIVE SERVICES
225
$4,013
$4,013
230
250
$76,520
$76,520
255
295
$80,533
$80,533
300
$4,151,422
$4,151,422
305
TOTAL
305 TOTAL PAGES 15 AND 16
DO NOT INCLUDE ANY COMPENSATION LISTED ABOVE ON PAGE 17 OR

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

16


Report Period End:
06/30/2014
Line
No
(5)
Research
Supported by
Hospital
PATIENT
Account
No
(6)
Medical
Education
Supported by
(7)
General
Administration
and Hospital
Committees
(8)
Nursing and
of Hospital
No
Patients
RESEARCH COSTS
5
10
TOTAL RESEARCH
8010
5
10
EDUCATION COSTS
15
8210
15
20
School of Nursing
8220
20
25
8230
25
30
8240
30
35
8250
35
40
Student Housing
8260
40
45
8290
45
50
TOTAL EDUCATION
50
8610
205
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
280
8790
225
$4,013
230
250
$76,520
255
295
$80,533
300
TOTAL
$4,151,422
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
(1)
Salaries
and Wages

Report Period End:

(2)
Employee
Benefits
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
$3,749,518
$1,292,264
06/30/2014
(3)
Reclassified
Physician and
Student
Compensation
Pages 15 &16,
Cols. (8) & (10)
(4)
Professional Fees
.07,.10-.19,.20
.21-.29
Line
No

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
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
$3,118
40
$7,039,797
$2,426,252
$38,376
45
60
$2,357,807
$812,614
$11,063
65
145
$13,147,122
$4,531,130
$52,557
150
$4,849,548
$1,671,387
$36,773
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
$553,597
$190,796
175
220
$5,403,145
$1,862,183
$36,773
225

17

Line
No
PATIENT
(5)
Supplies
Account
No

Report Period End:

(6)
Purchased
Services
.31-.50,.93,.97
.61-.69
$160,127
$1,246
(7)
Depreciation
.71-.74
06/30/2014
(8)
Leases
and Rentals
Line
No
.75-.76

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
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
40
$282,914
$162,459
45
60
$68,228
$39,509
65
145
$511,269
$203,214
150
$70,166
$80,082
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
$118,116
$46,301
175
220
$188,282
$126,383
225

17

Line
No

(9)
Other Direct
Expenses
PATIENT
Account
No

Report Period End:

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

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
45
6170
50
Pediatric Acute
6290
50
55
6340
55
60
6360
65
Obstetrics Acute
6380
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
$1,890
$5,208,163
40
$14,654
$9,964,452
45
60
$7,041
$3,296,262
65
145
$23,585
$18,468,877
150
$31,428
$6,739,384
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
$1,403
$910,213
175
220
$32,831
$7,649,597
225

17

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

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

5
6010
10
Coronary Care
6030
10
15
6050
15
20
6070
20
25
6090
25
30
Burn Care
6110
30
35
6130
35
40
6150
40
45
6170
45
50
Pediatric Acute
6290
50
55
6340
55
60
6360
60
65
Obstetrics Acute
6380
65
70
6400
70
75
6420
75
80
6440
80
85
6470
85
90
Other Acute Care
6510
90
95
Nursery Acute
6530
95
100 Sub-Acute Care
6560
100
6570
101
6580
105
6610
110
6630
115
6680
120
6780
125
6900
145
150
AMBULATORY SERVICES
7010
160
7040
165
7060
170
175 Clinics
7070
175
7180
180
7200
185
7220
190
7230
195
7260
200
7290
205
7310
210
7320
215
7390
220
225
06/30/2014

17

Line
No
PATIENT
Account
No
(1)
Salaries
and Wages

Report Period End:

(2)
Employee
Benefits
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
06/30/2014
(3)
Reclassified
Physician and
Student
Compensation
Pages 15 &16,
Cols. (8) & (10)
(4)
Professional
Fees
.07,.10-.19,.20
.21-.29
Line
No
ANCILLARY SERVICES
7400
$1,534,455
$528,847
230
7420
$2,725,342
$939,284
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
7500
7520
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
7630
7640
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
7770
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
255
$1,933,693
$666,444
260
295
$2,621,727
$903,573
$49,899
300
330
$1,455,325
$501,575
$3,316
335
355
$753,592
360
400
$10,270,542
$3,539,723
$806,807
405
PATIENT CARE SERVICES

7900
7950
415 TOTAL PATIENT CARE SERVICES
410
411
$28,820,809
$9,933,036
$896,137
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
$84,262
$223
7420
($30,272)
$24,312
7430
245 Anesthesiology
7450
7470
7480
7500
7520
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
7630
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
7710
$1,559,653
7720
$24,460
$2,837
7730
345 Renal Dialysis
7740
$97
$207,682
350 Lithotripsy
7750
7760
7770
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
230
$20,751
235
240
245
$2,956,920
250
255
$1,076,486
$345,712
260
295
$279,497
$72,098
$217,846
300
325
330
335
340
345
350
355
$315
360
400
$5,951,418
$652,864
$238,597
405

7900
7950
410
411
$6,650,969
$982,461
$238,597
415

17

Line
No

(9)
Other Direct
Expenses
PATIENT
Account
No

Report Period End:

(10)
Total Direct
Expenses
Columns (1) thru
(9)
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
06/30/2014
(12) (Optional)
Adjusted Direct
Page 20, Column
(1)
.77-.90,.94-.98
ANCILLARY SERVICES
7400
7420
7430
245 Anesthesiology
7450
7470
7480
7500
7520
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
7630
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
7710
7720
7730
345 Renal Dialysis
7740
350 Lithotripsy
7750
7760
7770
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
$6,150
$2,147,787
230
$3,685,567
235
240
245
$2,956,920
250
255
$17,526
$4,039,861
260
295
$57,218
$4,201,858
300
325
$10,541
$1,559,653
330
$1,998,054
335
340
$207,779
345
350
355
$1,508
$755,415
360
400
$92,943
$21,552,894
405

7900
7950
410
411
$149,359
$47,671,368
415

17

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

(14)(Optional)
Adjusted Direct
Expenses Per
Unit Column (12)
(13)
Line
No
ANCILLARY SERVICES
7400
230
7420
235
7430
240
245 Anesthesiology
7450
245
7470
250
7480
255
7500
260
7520
265
270 Blood Bank
7540
270
275 Echocardiology
7560
275
7570
280
7590
285
7610
290
7620
295
7630
300
7640
305
7650
310
7660
315
320 Ultrasonography
7670
320
7680
325
7710
330
7720
335
7730
340
345 Renal Dialysis
7740
345
350 Lithotripsy
7750
350
7760
355
7770
360
7780
365
7790
370
7800
375
7820
380
7830
385
7840
390
7860
395
7870
400
405

7900
7950
410
411
415
06/30/2014

18

INFORMATION NON-REVENUE PRODUCING CENTERS
NON-REVENUE
PRODUCING CENTERS
Line
No
Account
No
(1)
Salaries
and Wages
.00-.06,.08,
.09,.91,.95

Report Period End:

(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
55
60
Kitchen
8320
60
65
Non-Patient Food Services
8330
70
Dietary
8340
75
Laundry and Linen
8350
80
8360
85
Central Transportation
8370
90
Central Services and Supplies
8380
95
Pharmacy
8390
$892,226
$307,504
95
100 Purchasing and Stores
8400
$436,246
$150,351
100
105 Grounds
8410
110 Security
8420
$114,881
$39,594
115 Parking
8430
120 Housekeeping
8440
$804,314
$277,205
125 Plant Operations
8450
130 Plant Maintenance
8460
$952,859
$328,401
130
135 Communications
8470
$181,797
$62,656
135
140 Data Processing
8480
$71,956
$24,799
140
145 Other General Services
8490
$4,643,836
$1,600,488
$360,774
150
$158,147
$54,505
$8,383
155
150 TOTAL GENERAL SERVICES
65
$1,091,152
$376,063
$98,405
$33,915
70
75
80
85
90
105
$360,774
110
115
120
125
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
$1,084,230
$373,678
170
175
195
$1,242,377
$428,183
$8,383
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
55
60
Kitchen
8320
60
65
8330
70
Dietary
8340
75
Laundry and Linen
8350
80
8360
85
8370
90
8380
$60,040
95
Pharmacy
8390
$220,093
$142,383
95
8400
$193,641
$2,636
100
105 Grounds
8410
110 Security
8420
$8,230
$7,836
110
115 Parking
8430
120 Housekeeping
8440
$180,488
$270,920
120
8450
$3,536
8460
$172,121
$1,548,287
135 Communications
8470
$220
$46,634
140 Data Processing
8480
$11,125
$2,953,723
$91,013
8490
$28,140
$1,167,098
$4,972,527
$181,005
$123
$548,009
65
$288,881
$108
70
75
$583
80
85
$89,992
90
105
115
125
130
135
140
145
150
FISCAL SERVICES
8510
8530
8550
170 Admitting
8560
8570
8590
155
160
165
$21,001
$5,662
170
175
195
$21,124
$553,671
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
55
60
Kitchen
8320
60
65
8330
70
Dietary
8340
75
Laundry and Linen
8350
80
8360
85
8370
90
8380
95
Pharmacy
8390
$16,903
$1,579,109
95
8400
$26,113
$808,987
100
105 Grounds
8410
110 Security
8420
$2,614
$533,929
110
115 Parking
8430
120 Housekeeping
8440
$9,321
$1,542,248
120
8450
$3,536
125
8460
$811,254
$3,812,922
130
135 Communications
8470
$116,241
$407,548
135
140 Data Processing
8480
$3,152,616
140
8490
$28,140
65
$2,231
$1,758,435
$71
$132,974
$1,571
70
75
80
85
$150,032
90
105
115
145
$984,748
$13,910,476
$1,571
150
$162,079
$931,246
($21,333)
155
FISCAL SERVICES
8510
8530
8550
170 Admitting
8560
8570
8590
160
165
$1,744
$1,486,315
170
175
195
$163,823
$2,417,561
($21,333)
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
55
60
Kitchen
8320
60
65
8330
70
Dietary
8340
75
Laundry and Linen
8350
80
8360
85
8370
90
8380
21,123
95
Pharmacy
8390
15,853
95
8400
8,007
100
105 Grounds
8410
110 Security
8420
115 Parking
8430
120 Housekeeping
65
36,112
70
75
2,129
80
85
90
105
372
110
8440
105,453
120
8450
120,619
125
8460
120,619
130
135 Communications
8470
372
135
140 Data Processing
8480
430,912
140
8490
115
145
150
FISCAL SERVICES
8510
8530
8550
170 Admitting
8560
8570
175
8590
195
372
155
160
165
2,893
170
200
06/30/2014

18

NON REVENUE
PRODUCING CENTERS
Line
No
Account
No
(1)
Salaries
and Wages

Report Period End:

(2)
Employee
Benefits
.00-.06,.08,
.09,.91,.95
.10-.19,.92-.96
$2,227,235
$767,614
$26,322
$9,072
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
$126,476
$43,590
$51,917
225
8660
$179,113
$61,731
$11,339
230
8670
$31,239
$10,766
235
8680
$115,142
$39,683
240
245 Medical Library
8690
250 Medical Records
8700
$816,950
$281,560
$207,244
250
8710
$152,163
$52,443
$232,440
255
8720
$570,924
$196,768
$26,604
260
8730
8740
$77,645
$26,760
8750
$1,152,278
$397,130
8770
$404,692
$139,476
8790
$371,449
205
210
215
220
245
265
270
$251,856
280
$4,151,422
$5,880,179
$2,026,593
275
$4,151,422
295
$1,152,849
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)
$40,587,201
$13,988,300
$4,151,422
370 Non-Operating Cost Centers

375 TOTAL COSTS
$40,587,201
$13,988,300
$4,151,422
$2,418,143
365
$146,926
370
$2,565,069
375

18

INFORMATION -NON-REVENUE PRODUCING CENTERS
NON REVENUE
PRODUCING CENTERS
Line
No
Report Period End:
(5)
Supplies
Account
No
(6)
Purchased
Services
.31-.50,.93,.97
.61-.69
$36,790
$3,056,730
$1,549
$18,774
$11,391
(7)
Depreciation
.71-.74
06/30/2014
(8)
Leases and
Rentals
Line
No
.75-.76
8610
8620
8630
8640
225 Personnel
8650
$8,666
8660
$10,846
8670
$10,019
8680
$108
245 Medical Library
8690
250 Medical Records
8700
$24,913
$101,023
8710
$4,739
$44,565
255
8720
$2,294
$341
260
8730
8740
$8,406
$56
8750
$5,603
$27,897
8770
$10,516
$418
$49,927
8790
$124,449
$3,274,587
$127,217
($1,770)
205
210
215
220
$47,788
225
$30,775
230
$13,392
235
240
245
$497
250
265
270
275
280
295
300
UNASSIGNED COSTS
8810
8820
$5,641,101
305
310
8830
315
8840
320
8850
325
8860
330
8870
345
8880
350
8890
355
$5,641,101
360
TOTAL
375 TOTAL COSTS
$7,963,640
$9,783,246
$5,641,101
$546,819
365
$43,660
$192,403
$246,129
($7,109)
370
$8,007,300
$9,975,649
$5,887,230
$539,710
375

18


(9)
Other Direct
Expenses
NON REVENUE
PRODUCING CENTERS
Line
No
Report Period End:

(10)
Total Direct
Expenses
Columns (1) thru
(9)
(11)
Adjustments of
Direct Expenses
from Page 14,
Parts I & II
$2,181,919
$8,639,967
$689
$440,820
$496,537
Account
No
06/30/2014
(12) (Optional)
Adjusted Direct
Page 20, Column
(1)
.77-.90,.94-.98
8610
8620
8630
8640
225 Personnel
8650
$306,959
$596,787
225
8660
$8,320
$302,124
230
8670
$2,684
$68,100
235
8680
$5,552
$160,485
240
245 Medical Library
8690
250 Medical Records
8700
$8,432
$1,440,619
250
8710
$468,300
$954,650
255
8720
$1,009
$797,940
260
8730
8740
$56,640
$169,507
270
8750
$26,538
$1,861,302
275
8770
$50,753
$655,782
280
8790
205
210
215
220
245
265
$4,151,422
$3,557,926
$20,295,222
295
$689
300
UNASSIGNED COSTS
8810
8820
8830
$310,671
$310,671
315
8840
$168,074
$168,074
320
8850
$284,523
$284,523
325
8860
8870
$1,984,617
$1,984,617
345
8880
$744,732
$744,732
350
8890
$3,492,617
$9,133,718
$8,348,473
$93,428,345
$162,235
$784,244
$8,510,708
$94,212,589
$5,641,101
305
310
330
355
360
TOTAL
375 TOTAL COSTS
($19,073)
365
370
($19,073)
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
372
205
8630
8640
225 Personnel
8650
372
225
8660
372
230
8670
11,100
235
8680
10,551
240
245 Medical Library
8690
250 Medical Records
8700
21,586
250
8710
186
255
8720
111
260
8730
8740
1,307
270
8750
2,893
275
8770
1,553
280
8790
210
432,942
215
220
245
265
295
300
UNASSIGNED COSTS
8810
8820
8830
430,912
315
8840
120,619
320
8850
120,619
325
8860
8870
120,619
345
8880
372
350
8890
120,619
305
310
330
355
360
TOTAL
365
370
375 TOTAL COSTS
375
06/30/2014

19
COST ALLOCATION - STATISTICAL BASIS

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

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

Pages 17 & 18
column (5)
(7) Square
Feet Serviced
105
110
Line
No
Interest - Other
10
Insurance - Other
10
15
Licenses and Taxes (Other than on income)
15
20
Depreciation and Amortization
20
25
Leases and Rentals
25
30
Interest - Working Capital
35
Hospital Administration
40
Governing Board Expense
40
45
Public Relations
45
50
Management Engineering
55
Community Health Education
60
Other Administrative Services
60
65
General Accounting
65
70
Communications
70
75
Other Fiscal Services
75
80
85
Personnel
90
Employee Health Services
95
Employee Benefits (Non-Payroll Related)
30
5,514
35
50
1,400
55
80
1,480
85
943
90
100 Non-Patient Food Services
1,761
100
2,194
105
110 Housekeeping
1,686
110
95
115 Grounds
120 Security
115
32
32
2,348
2,348
130
129
129
135
3,332
3,332
125 Parking
125

145 Dietary
140
150 Laundry and Linen
155
2,461
2,461
160
165

145
150

160 Data Processing
120
170
725
725
1,010
1,010
185
391
391
190
195 Social Work Services
97
97
195
712
524
200
609
609
180 Medical Library

185 Medical Records
180
205 Insurance - Hospital and Professional Malpractice

210 Admitting
175
205
215 Other Unassigned Costs
210
215
220
190
190
225
230 Inservice Education-Nursing
84
84
230
1,778
1,778
235
850
850
240
235 Central Services and Supplies

240 Pharmacy
245 Research Projects and Administration
245
250 Education Administration Office
250
255 Student Housing
255
260 Licensed Vocational Nurse Program
260
265 School of Nursing
265
270 Paramedical Education
270
275 Other Health Profession Education
275
280 Medical Postgraduate Education
280

19

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

(12)Gross
from Column
Processed
Revenue from
Outpatient
(2)
Page 12,Column Revenue from Pg
(23)
12,Col(22)
115-140
145
150
155-215
Line
No
220
Interest - Other
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230

240 Pharmacy
235
69
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
4,297
30-80
85-100
(6) Supplies from

Pages 17 & 18
column (5)
(7) Square
Feet Serviced
105
110
Line
No
4,297
505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535

540
17,735
17,735
545
550 Pediatric Acute
550
555
560 Psychiatric Acute - Adolescent & Child

560
6,864
6,864
565
570
575
580
585
590 Other Acute Care

595 Nursery Acute
590
1,579
1,579
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
3,399
3,399
665

675 Clinics
660
670
5,280
5,280
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
2,291
2,291
730
8,053
8,053
735
740
745 Anesthesiology
745
750

755
3,246
3,246
760
765
770 Blood Bank
770
775 Echocardiology
775
780

19

BASIS OF ALLOCATION
Line
No

(12)Gross
from Column
Processed
Revenue from
Outpatient
(2)
(23)
12,Col(22)
115-140
145
150
3,327
18,873
155-215
Line
No
220
505
510 Coronary Care
510
515
520
525
530 Burn Care
530
535

540
27,835
108,630
545
550 Pediatric Acute
550
555

560
4,950
16,032
565
570
575
580
585

595 Nursery Acute
590
7,235
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
44,700
665

675 Clinics
660
670
2,740
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
13,982
730
89,176
735
740
745 Anesthesiology
745
750
755
760
765
770 Blood Bank
770
775 Echocardiology
775
780

19

BASIS OF ALLOCATION
(13)Nursing
FTE's
(14) Central
Service and
Supply Costed
Requisitions
(15) Pharmacy
Costed
Requisitions
225-230
235
240
$150,653
$9,474
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
$264,294
$18,523
545
550 Pediatric Acute
550
555

560
$67,622
$606
565
570
575
580
585
590
595 Nursery Acute
595
600 Sub-Acute Care
600
601
605
610
615
620
625
645
AMBULATORY SERVICES
$45,494
$24,672
665

675 Clinics
660
670
$93,636
$152
675
680
685
690
695
700
705
710
715
720
ANCILLARY SERVICES
$78,845
$5,417
730
$219,149
$19,041
735
740
745 Anesthesiology
745
$2,956,920

$8
750
755
$1,076,493
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)

785
790
795
7,900
7,900
800
805
810
815
820 Ultrasonography
820
825

830
917
917
835
840
845 Renal Dialysis
845
850 Lithotripsy
850

855
1,277
1,277
860
865 Speech - Language Pathology
865
870
875
880
885
890
895
900
910
911
28,055
28,055
915
920 Total Statistical Units (Lines 5-915)
120,619
105,453
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
17,586
800
805
810
815
820 Ultrasonography
820
825
830
835
840
845 Renal Dialysis
845
850 Lithotripsy
850
855
221
860
865
870
875
880
885
890
895
900
910
911
915
36,112
319,244
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
$278,467
$1,184
800
805
810
815
820 Ultrasonography
820
825

$1,559,653
830
$24,277
$183
835
$3
$94

845 Renal Dialysis
840
850 Lithotripsy
850

845
855
$315
860
865
870
875
880
885
890
895
900
910
911
915
$5,256,168
$1,639,007
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
($1,885,759)
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
$1,885,759
35
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250

20a.
Line
No
(1) Transfers for

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

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

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

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

20a.

Line
No
(5)Other Operating Revenue

Page 14, Column (1), Line
215

Report Period End:

(6)Transfers for Education
Page 14,Column (1), Line Line
260
No
Cost Recovery
Interest - Other
1
5
10
Insurance - Other
10
15
15
20
20
25
Leases and Rentals
25
30
30
35
35
40
40
45
Public Relations
45
50
50
55
55
60
60
65
General Accounting
65
70
Communications
70
75
75
80
80
85
Personnel
85
90
90
95
95
100
105
110 Housekeeping
110
115 Grounds
115
120 Security
120
125 Parking
125
130
135
140
145 Dietary
145
150
155
160 Data Processing
160
165
170
175
180 Medical Library
180
185 Medical Records
185
190
195
200
205
210 Admitting
210
215
220
225
230
235
240 Pharmacy
240
245
250
06/30/2014

20a.
Line
No

Report Period End:
(5)Other Operating Revenue

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

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

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

20a.

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

14, Column(1), Line 270]
505

Report Period End:

(7)Transfers for
Operations (Revenue
Line
Centers) Page
No
14,Column (1), Line 270
500
6010
505
510 Coronary Care
6030
510
6050
515
6070
520
6090
525
530 Burn Care
6110
530
6130
535
6150
540
6170
545
550 Pediatric Acute
6290
550
6340
555
6360
560
6380
565
6400
570
6420
575
6440
580
6470
585
6510
590
595 Nursery Acute
6530
595
600 Sub-Acute Care
6560
600
6570
601
6580
605
6610
610
6630
615
6680
620
6780
625
6900
645
650
AMBULATORY SERVICES
7010
660
7040
665
7060
670
675 Clinics
7070
675
7180
680
7200
685
7220
690
7230
695
7260
700
7290
705
7310
710
7320
715
7390
720

725
06/30/2014

20a.

Line
No
Account No
Report Period End:

(7)Transfers for
Operations
(Revenue
Centers) Page
14,Column (1),
Line 270
Line
No
ANCILLARY SERVICES
7400
730
7420
735
7430
740
745 Anesthesiology
7450
745
7470
750
7480
755
7500
760
7520
765
770 Blood Bank
7540
770
775 Echocardiology
7560
775
7570
780
7590
785
7610
790
7620
795
7630
800
7640
805
7650
810
7660
815
820 Ultrasonography
7670
820
7680
825
7710
830
7720
835
7730
840
845 Renal Dialysis
7740
845
850 Lithotripsy
7750
850
7760
855
7770
860
7780
865
7790
870
7800
875
7820
880
7830
885
7840
890
7860
895
7870
900

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

21
DETAIL OF DIRECT PAYROLL COSTS

PATIENT REVENUE PRODUCING CENTERS

(1)
CLASSIFICATION DESCRIPTION
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
.02
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$70.02
1,717
$39.46
562
$81.05
36,641
No

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
$70.80
403
$32.11
1,446
$71.20
64,234
45
60
$83.56
135
$83.22
19,423
65
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
2,255
2,008
120,298
150
44,310
160
AMBULATORY SERVICES
$78.66
1,229
$51.74
2,948
$79.85
165

175 Clinics
170
$73.91
2,044
$31.60
3,349
$77.21
318
175
180
185
190
195
200
205
210
215

220
3,273
6,297
44,628
225

21


(7)
Line
No
Report Period End:

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

Administrative
.05
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$32.01
731
$29.00
1,496
No

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
$44.55
9,838
$28.21
17,361
$27.20
5,314
45
60
$30.46
1,840
65
95
100 Sub-Acute Care
100
101
105
110
115
120
125

145
9,838
18,092
8,650
150
10,956
160
AMBULATORY SERVICES
$30.51
165

175 Clinics
170
$33.12
5,725
175
180
185
190
195
200
205
210
215

220
16,681
225

21


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

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

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
40
45
45
50
Pediatric Acute
50
55
55
60
60
65
Obstetrics Acute
65
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
150
AMBULATORY SERVICES
160
165
170
175 Clinics
175
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
10
Coronary Care
$73.82
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
90
95
Nursery Acute
95
100
Sub-Acute Care
100
101
Sub-Acute Care - Pediatric
101
105
Skilled Nursing Care
105
110
Psychiatric Long-Term Care
110
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
40
$56.55
45
60
$72.72
65
AMBULATORY SERVICES
160
Emergency Services
165
Medical Transportation Services
$67.01
160
170
Psychiatric Emergency Rooms
175
Clinics
180
Satellite Clinics
180
185
Satellite Ambulatory Surgery Center
185
190
Outpatient Chemical Dependency Svcs.
190
195
Observation Care
195
200
Partial Hospitalization - Psychiatric
200
205
205
210
Hospice - Outpatient Services
210
215
Adult Day Health Care Services
215
220
Other Ambulatory Services
220
225
TOTAL AMBULATORY SERVICES
225
165
170
$40.70
175
06/30/2014

21

(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
Total Paid
Hours
41,147
9,649
50,796
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No

Line
No
Column (22)
2080

5
10
Coronary Care
10
15
15
20
20
25
25
30
Burn Care
30
35
35
40
45
50
Pediatric Acute
50
55
55
60
65
Obstetrics Acute
70
70
75
75
80
80
85
85
90
Other Acute Care
90
95
Nursery Acute
40
98,596
25,888
124,484
45
60
21,398
11,023
32,421
65
95
100 Sub-Acute Care
100
101
105
110
115
120
125

145
161,141
46,560
207,701
150
59,443
12,925
72,368
160
AMBULATORY SERVICES
165

175 Clinics
170
11,436
2,167
13,603
175
180
185
190
195
200
205
210
215

220
70,879
15,092
85,971
225

21


(1)
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
Average
Hourly Rate
Productive
Hours
$72.05
1,558
$72.16
1,452
.02
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
No
$75.84
18,399
230
$80.43
5,525
$101.09
14,557
235
ANCILLARY SERVICES
240
245 Anesthesiology
245
250

255
$64.03
1,805
$56.53
17,801
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
$67.07
1,438
$64.92
31,357
300
305
310
315
320 Ultrasonography
320
325

330
$57.29
1,493
$52.99
21,337
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395

400
7,746
76,020
32,956
405

21


(7)
Line
No
Report Period End:

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

Administrative
.05
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
$25.60
1,795
$33.48
1,734
No
ANCILLARY SERVICES
230
235
240
245 Anesthesiology
245
250
255
$29.69
19,174
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
$26.05
7,014
300
305
310
315
320 Ultrasonography
320
325
330
$31.76
389
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395

400
1,795
28,311
405

21


(13)
Line
No
Report Period End:

(14)
Environmental and
Food Service
(15)
(16)
Productive
Hours
(17)
(18)
Physicians
(Salaried)
Non-Physicians Medical
Practitioners
.07
.08
.06
Average
Hourly Rate
06/30/2014
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
ANCILLARY SERVICES
230
235
240
245 Anesthesiology
245
250
255
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
300
305
310
315
320 Ultrasonography
320
325
330
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395
400
405

21

Line
No

Report Period End:
(19)
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Average Hourly
Rate
Line
Productive
Hours
No
ANCILLARY SERVICES
230
Labor and Delivery Services
$75.02
230
235
Surgery and Recovery Services
$76.00
235
240
Ambulatory Surgery Services
240
245
Anesthesiology
245
250
Medical Supplies Sold to Patients
250
255
Durable Medical Equipment
260
Clinical Laboratory Services
265
Pathological Laboratory Services
265
270
Blood Bank
270
275
Echocardiology
275
280
Cardiac Catheterization Services
280
285
Cardiology Services
285
290
Electromyography
290
295
Electroencephalography
300
Radiology - Diagnostic
305
Radiology - Therapeutic
305
310
Nuclear Medicine
310
315
Magnetic Resonance Imaging
315
320
Ultrasonography
320
325
Computed Tomographic Scanner
325
330
Drugs Sold to Patients
335
Respiratory Therapy
340
340
345
Renal Dialysis
345
350
Lithotripsy
350
355
Gastro-Intestinal Services
355
360
Physical Therapy
360
365
Speech-Language Pathology
365
370
Occupational Therapy
370
375
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
$42.76
260
295
$55.67
300
330
$50.92
335
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
19,957
496
20,453
230
25,063
10,797
35,860
235
240
245 Anesthesiology
245
250

255
38,780
6,439
45,219
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
39,809
7,287
47,096
300
305
310
315
320 Ultrasonography
320
325

330
23,219
5,363
28,582
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
360
365
370
375
380
385
390
395

400
146,828
30,382
177,210
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
$79.95
39
Average Hourly
Rate
Productive Hours
No

5
10
Coronary Care
39
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
90
95
Nursery Acute
40
$74.52
515
515
45
60
$75.77
146
146
65
95
100 Sub-Acute Care
100
101
105
110
115
120
125
145
700
700
150
451
451
160
AMBULATORY SERVICES
$81.54
165
170
175 Clinics
175
180
185
190
195
200
205
210
215

220
451
451
225

21.1


Report Period End:
(1)
(2)
(3)
06/30/2014
(4)
Registry Nursing
Personnel
Other Contracted
Services
.25
.21, .26
(5)
Total Contracted
Hours
Line
No
Line
Average Hourly
Rate
Productive Hours
Average Hourly
Rate
Productive Hours
No
ANCILLARY SERVICES
230
235
240
245 Anesthesiology
245
250

255
$69.78
720
720
260
265
270 Blood Bank
270
275 Echocardiology
275
280
285
290
295
$75.38
662
662
300
305
310
315
320 Ultrasonography
320
325

330
$82.90
40
40
335
340
345 Renal Dialysis
345
350 Lithotripsy
350
355
$92.08
8,184
8,184
360
365
370
375
380
385
390
395

400
1,422
8,184
9,606
405

22


(1)
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
Average
Hourly Rate
06/30/2014
(5)
(6)
Registered
Nurses
.01
Productive
Hours
Average
Hourly Rate
.02
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
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
70
Dietary
75
Laundry and Linen
80
85
90
95
Pharmacy
65
$49.56
1,742
$38.90
4,299
$48.60
1,753
75
90
$87.39
1,837
$68.45
6,589
95
$45.90
1,738
$27.54
8,647
100
$52.38
1,876
110
$67.23
1,601
120
105
115 Parking
120 Housekeeping
80
85
105 Grounds
110 Security
70
115
125
130
135 Communications
$55.12
1,272
140 Data Processing
135
140
145
8,794
22,560
150
3,333
155
FISCAL SERVICES
$41.01
160

170 Admitting
165
$47.44
1,307
$28.33
6,823
175

170
195
1,307
10,156
200

22


(1)
Line
No
Report Period End:

(2)
Management and
Supervision
(3)
(4)
Technical and
Specialist
.00
06/30/2014
(5)
(6)
Registered
Nurses
.01
.02
Average
Hourly Rate
Line
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Productive
Hours
No
$79.60
12,434
$41.21
9,582
$41.66
487
225 Personnel
$40.42
2,128
$30.00
817
225
$67.19
1,372
$33.47
83
230
$23.93
1,227
235
240
210
215
220

205
$54.73
680
$33.19
2,026
250 Medical Records
$67.75
1,422
$32.36
10,903
250
$54.23
2,147
$29.74
703
255
$70.41
364
$40.06
186
260
245 Medical Library
245
265
270
$72.62
3,491
$49.96
8,903
275
$39.98
3,994
$18.15
1,317
280

295
28,519
35,747
300
350
370

22


(7)
Line
No
Report Period End:

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

Administrative
.05
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
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
70
Dietary
75
Laundry and Linen
75
80
80
85
85
90
95
Pharmacy
65
$29.94
1,625
70
90
$29.66
5,316
95
$29.43
1,531
100
105 Grounds
105
110 Security
110
115 Parking
115
120 Housekeeping
120
125
$31.18
218
130
135 Communications
$27.54
5,704
135
140 Data Processing
140
145
14,394
150
FISCAL SERVICES
155
160

170 Admitting
165
$28.10
23,706
175

170
195
23,706
200

22


(7)
Line
No
Report Period End:

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

Administrative
.04
.05
.03
Average
Hourly Rate
06/30/2014
Average
Hourly Rate
Productive
Hours
Line
Average
Hourly Rate
Productive
Hours
No
$28.26
16,708
205
210
215
220
225 Personnel
225
$26.17
230
235
240
245 Medical Library

250 Medical Records
245
$25.63
8,347
250
255
260
265
270
$37.03
7,713
275
$18.27
10,192
280

295
42,966
300
350
370

22


(13)
Report Period End:

(14)
(15)
(16)
06/30/2014
(17)
(18)
Environmental and
Food Service
Physicians
(Salaried)
Non-Physician Medical
Practitioners
Line
.06
.07
.08
No
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
70
Dietary
75
Laundry and Linen
75
80
80
85
85
90
90
95
Pharmacy
65
$25.53
24,546
70
95
100
105 Grounds
105
110 Security
110
115 Parking
120 Housekeeping
115
$25.24
22,816
120
125
130
135 Communications
135
140 Data Processing
140

145
47,362
150
FISCAL SERVICES
155
160
165
170 Admitting
170
175
195
200

22


(13)
Line
No
Report Period End:

(14)
Environmental and
Food Service
(15)
(16)
Physicians
(Salaried)
.06
Average
Hourly Rate
06/30/2014
(17)
.07
Productive
Hours
Average
Hourly Rate
(18)
Non-Physician Medical
Practitioners
.08
Productive
Hours
Average
Hourly Rate
Line
Productive
Hours
No
205
210
215
220
225 Personnel
225
$23.70
76
230
235
240
245 Medical Library
245
250 Medical Records
250
255
260
265
270
275
280

295
76
300
350
370

22

Line
No

Report Period End:
(19)
(20)
Other Salaries
and Wages
(21)
Cost Center
Average Hourly
Rate
.09
Average Hourly
Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
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
70
Dietary
75
Laundry and Linen
80
85
90
95
Pharmacy
$55.48
95
100
Purchasing and Stores
$31.83
100
105
Grounds
110
Security
115
Parking
120
Housekeeping
125
Plant Operations
130
Plant Maintenance
135
Communications
140
Data Processing
145
Other General Services
150
TOTAL GENERAL SERVICES
65
$28.67
70
75
$46.22
80
85
90
105
$55.10
110
$28.40
120
115
125
$49.65
15,857
$50.87
130
$32.18
135
140
145
15,857
150
FISCAL SERVICES
155
General Accounting
160
Patient Accounting
$40.88
155
165
Credit and Collection
170
Admitting
175
Outpatient Registration
175
195
195
200
TOTAL FISCAL SERVICES
200
160
165
$28.86
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
215
Public Relations
220
225
Personnel
230
235
$49.25
205
210
$48.74
215
220
$39.57
225
$60.94
230
Auxiliary Groups
$23.88
235
240
Chaplaincy Services
$37.71
240
245
Medical Library
250
Medical Records
$32.38
250
255
Medical Staff Administration
$48.94
255
260
Nursing Administration
260
265
Nursing Float Personnel
270
$57.96
1,072
245
$72.13
6,536
$70.05
Inservice Education - Nursing
$58.48
1,157
$60.95
270
275
Utilization Management
$50.97
821
$49.95
275
280
$23.93
280
295
300
TOTAL ADMINISTRATIVE SERVICES
350
350
370
Non-Operating Cost Centers
370
265
295
9,586
300
06/30/2014

22


(22)
Report Period End:

(23)
(24)
HOURS SUMMARY
Productive
Hours
NonProductive
Hours
Total Paid
Hours
06/30/2014
(25)
(Optional)
Full
Time
Equivalent
Employees
Line
No
Line
No
Column (22)
2080
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
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
70
Dietary
75
Laundry and Linen
80
85
90
95
Pharmacy
65
32,212
5,842
38,054
1,753
376
2,129
70
75
80
85
90
13,742
2,341
16,083
95
11,916
1,788
13,704
100
1,876
209
2,085
110
24,417
3,904
28,321
120
16,075
2,657
18,732
130
135 Communications
6,976
909
7,885
135

105 Grounds
110 Security
105
115 Parking
120 Housekeeping
115
125
140 Data Processing
140

145
108,967
18,026
126,993
150
3,333
536
3,869
155
FISCAL SERVICES
160

170 Admitting
165
31,836
5,735
37,571
175

170
195
35,169
6,271
41,440
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
38,724
6,498
45,222
487
53
540
225 Personnel
2,945
251
3,196
225
2,609
330
2,939
230
1,227
81
1,308
235
2,706
347
3,053
240
250 Medical Records
20,672
4,560
25,232
250
2,850
259
3,109
255
7,086
1,064
8,150
260
1,157
117
1,274
270
20,928
2,142
23,070
275
15,503
1,408
16,911
280
116,894
17,110
134,004
210
215
220
245 Medical Library
245
265

205
295
300
350
370

22.1


(3)
Line
No
Report Period End:

(4)
Other Contracted
Services
.26
Average
Hourly Rate
Line
Productive
Hours
No
RESEARCH COSTS
5
10
TOTAL RESEARCH
10
EDUCATION COSTS
15
15
20
School of Nursing
20
25
25
30
30
35
35
40
Student Housing
40
45
45
50
TOTAL EDUCATION
50
GENERAL SERVICES
55
55
60
Kitchen
60
65
65
70
Dietary
70
75
Laundry and Linen
75
80
80
85
85
90
90
95
Pharmacy
95
100
105 Grounds
110 Security
105
$23.15
15,583
110
115 Parking
115
120 Housekeeping
120
125
130
135 Communications
135
140 Data Processing
140

145
15,583
150
FISCAL SERVICES
155
160
165
170 Admitting
170
175
195
200
06/30/2014

22.1


(3)
Line
No
Report Period End:

(4)
Other Contracted
Services
.26
Line
Average
Hourly Rate
Productive
Hours
No
$41.37
1,777
205
210
215
220
225 Personnel
$33.54
676
225
$73.15
155
230
235
240
245 Medical Library
245
250 Medical Records
$47.49
4,364
250
$56.20
3,880
255
$77.11
345
260
265

270
$63.15
3,988
295
15,185

275
280

300
350
$50.96
2,883
370
06/30/2014

OSHPD Reports

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HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

USING DATA SUBMITTED BY FACILITY

*EXCLUDES BEDS IN SUSPENSE

FINANCIAL AND UTILIZATION DATA BY PAYER

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

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

ACID TEST RATIO

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

DAYS IN ACCOUNTS RECEIVABLE

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

BAD DEBT RATE

DEBT, RISK, AND LEVERAGE RATIOS

INTEREST EXPENSE AS A PERCENTAGE

64.88% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100

NET RETURN ON EQUITY

FIXED ASSET RATIOS

AVERAGE AGE OF PLANT

7.23% ((CURRENT YEAR GROSS PROPERTY, PLANT AND EQUIPMENT +

SUMMARY OF FINANCIAL AND UTILIZATION DATA FOR SELECTED COST CENTERS

PSYCHIATRIC ACUTE - ADULT

ALTERNATE BIRTHING CENTER

CHEMICAL DEPENDENCY SERVICES

SKILLED NURSING CARE

HOME HEALTH CARE SERVICES

USING DATA SUBMITTED BY FACILITY

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

NON-REVENUE PRODUCING COST CENTERS

UNIT CODE DESCRIPTIONS

DATE PREPARED: 6/24/2015

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

USING DATA SUBMITTED BY FACILITY

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

PERCENTAGE OF HOURS AND AVERAGE HOURLY RATE BY EMPLOYEE CLASSIFICATION

TOTAL OPERATING COST CTRS

AVERAGE HOURLY RATE

COST CENTER GROUP

HOSPITAL PERSONNEL PROFILE

* EXCLUDES REGISTRY NURSES AND TEMPORARY HELP

TOTAL NUMBER OF NURSING FTE'S**

HOSPITAL DISCLOSURE REPORT FACSIMILE

Date Prepared: 6/24/2015

GENERAL INFORMATION AND CERTIFICATION

( Page 0 Submitted Data )

1.Health Care Institution(Legal Name):

2. OSHPD Facility Number:

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