oshpd reports (1)

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORTUSING DATA SUBMITTED BY FACILITYFACILITY NO:106430837O'CONNOR HOSPITAL

PAGE: 1 OF 5REPORT PERIOD: 07/01/2013 THRU 06/30/2014

DATE PREPARED: 6/24/2015

2105 FOREST AVENUESAN JOSE CA 95128

PHONE NO: (408)947-2500OWNER: DAUGHTERS OF CHARITY HEALTH SYSTEM

TYPE OF CONTROL: ChurchTYPE OF CARE: General

INTENSIVE 32ACUTE 302LONG-TERM 24OTHER TOTAL 358OCCUPANCY RATE 38.00%*EXCLUDES BEDS IN SUSPENSE

LICENSED BEDS* INTENSIVE 32ACUTE 289LONG-TERM 24OTHER TOTAL 345OCCUPANCY RATE 39.40%NO. BASSINETS 25

AVAILABLE BEDS X EMERGENCY ROOM

TRAUMA CENTER DESIGNATIONX OBSERVATIONX ORTHOPEDICX PSYCHIATRICX HELICOPTER

EMERGENCY SERVICES

FINANCIAL AND UTILIZATION DATA BY PAYER TOTAL MEDICARETRADITIONAL

MEDICAREMANAGED CARE

MEDI-CALTRADITIONAL

Patient (Census) Days 49,663 18,848 4,079 9,675 Hospital Discharges (Excluding Nursery) 10,971 3,272 950 1,812 Average Length of Stay (Including L-T Care) 4.5 5.8 4.3 5.3 Average Length of Stay (Excluding L-T Care) 3.8 5.3 4.2 2.9 Outpatient Visits (Incl. ER Visits) 183,538 68,988 14,078 8,417 Outpatient Emergency Services Visits 51,640 9,084 1,993 4,398 Gross Inpatient Revenue $870,695,041 $347,817,535 $93,402,505 $113,143,876 Gross Outpatient Revenue $555,671,302 $186,407,073 $48,851,604 $30,534,511 Deductions From Revenue $1,177,156,750 $443,582,393 $120,460,786 $127,694,459 Net Inpatient Revenue $152,635,064 $59,014,413 $14,309,259 $12,587,026 Net Outpatient Revenue $96,574,529 $31,627,802 $7,484,064 $3,396,902 Net Inpatient Revenue Per Day $3,073 $3,131 $3,508 $1,301 Net Inpatient Revenue Per Discharge $13,913 $18,036 $15,062 $6,946 Net Outpatient Revenue Per Visit $526 $458 $532 $404

Adjusted Patient Days 81,358 Net Revenue Per Adj Patient Day $3,063 Purchased Inpatient Days

FINANCIAL AND UTILIZATION DATA BY PAYER THIRD PARTYMANAGED CARE

OTHERINDIGENT

OTHERPAYERS

Patient (Census) Days 10,549 922 Hospital Discharges (Excluding Nursery) 2,783 273 Average Length of Stay (Including L-T Care) 3.8 3.4 Average Length of Stay (Excluding L-T Care) 3.3 3.4 Outpatient Visits (Incl. ER Visits) 53,039 8,726 Outpatient Emergency Services Visits 14,428 5,937 Gross Inpatient Revenue $190,277,043 $16,266,300 Gross Outpatient Revenue $159,981,040 $29,577,208 Deductions From Revenue $243,957,472 $54,825,063 Net Inpatient Revenue $57,747,606 ($3,186,857) Net Outpatient Revenue $48,553,005 ($5,794,698) Net Inpatient Revenue Per Day $5,474 ($3,456) Net Inpatient Revenue Per Discharge $20,750 ($11,673) Net Outpatient Revenue Per Visit $915 ($664)

Adjusted Patient Days Net Revenue Per Adj Patient Day Purchased Inpatient Days

FINANCIAL AND UTILIZATION DATA BY PAYER MEDI-CALMANAGED CARE

CO. INDIGENTTRADITIONAL

CO. INDIGENTMANAGED CARE

THIRD PARTYTRADITIONAL

Patient (Census) Days 5,452 138 Hospital Discharges (Excluding Nursery) 1,841 40 Average Length of Stay (Including L-T Care) 3 3.5 Average Length of Stay (Excluding L-T Care) 2.8 3.5 Outpatient Visits (Incl. ER Visits) 28,114 2,176 Outpatient Emergency Services Visits 14,771 1,029 Gross Inpatient Revenue $104,781,252 $5,006,530 Gross Outpatient Revenue $93,941,545 $6,378,321 Deductions From Revenue $177,674,673 $8,961,904 Net Inpatient Revenue $11,098,117 $1,065,500 Net Outpatient Revenue $9,950,007 $1,357,447 Net Inpatient Revenue Per Day $2,036 $7,721 Net Inpatient Revenue Per Discharge $6,028 $26,638 Net Outpatient Revenue Per Visit $354 $624

Adjusted Patient Days Net Revenue Per Adj Patient Day Purchased Inpatient Days

COUNTY: Santa ClaraHSA NO: 07 HFPA NO: 0431

GENERAL INFORMATION

HOSPITAL SUMMARY INDIVIDUAL DISCLOSURE REPORT

GROSS PATIENT REVENUE BY REVENUE CENTER PERCENT OF TOTAL DAILY HOSPITAL SERVICES $344,179,417 24.1 AMBULATORY SERVICES $213,791,518 15.0 ANCILLARY SERVICES $868,395,408 60.9 TOTAL GROSS PATIENT REVENUE $1,426,366,343 100.0

LIVE BIRTH SUMMARY NATURAL BIRTHS 2,143 CESAREAN SECTIONS 889 TOTAL LIVE BIRTHS 3,032

SUMMARY STATEMENT OF INCOME GROSS PATIENT REVENUE $1,426,366,343 PROVISION FOR BAD DEBT $11,612,383 MEDICARE TRAD. CONTRACTUAL ADJ $441,680,405 MEDICARE MANAGED CONTRACTUAL ADJ $118,615,213 MEDI-CAL TRAD. CONTRACTUAL ADJ $126,886,774 MEDI-CAL MANAGED CONTRACTUAL ADJ $173,979,371 DISPROPORTIONATE SHARE FUNDS REC'D CO. INDIGENT TRAD. CONTRACTUAL ADJ CO. INDIGENT MANAGED CONTRACTUAL ADJ THIRD PARTY TRAD. CONTRACTUAL ADJ $8,814,199 THIRD PARTY MANAGED CONTRACTUAL ADJ $239,413,303 CHARITY OTHER $19,248,021 ALL OTHER DEDUCTIONS $36,907,081 TOTAL DEDUCTIONS FROM REVENUE $1,177,156,750 CAPITATION PREMIUM REVENUE NET PATIENT REVENUE $249,209,593

OTHER OPERATING REVENUE $4,680,678 TOTAL OPERATING EXPENSES $310,603,352 NET FROM OPERATIONS ($56,713,081)

NON-OPERATING REVENUE + $17,060,225 NON-OPERATING EXPENSES - $3,430,208 PROVISION FOR INCOME TAXES - EXTRAORDINARY ITEMS - NET INCOME ($43,083,064)

OPERATING EXPENSES BY CLASSIFICATION SALARIES AND WAGES $139,681,459 EMPLOYEE BENEFITS $49,070,395 PHYSICIANS PROFESSIONAL FEES $8,841,865 OTHER PROFESSIONAL FEES $2,181,637 SUPPLIES $42,793,309 PURCHASED SERVICES $34,269,305 DEPRECIATION $12,525,335 LEASES AND RENTALS $3,178,577 INTEREST $3,163,811 ALL OTHER EXPENSES $14,897,659 TOTAL OPERATING EXPENSES $310,603,352

ADJUSTED PATIENT REVENUE ADJUSTED INPATIENT REVENUE REVENUE PER DAY REVENUE PER DISCHARGE

ADJUSTED OUTPATIENT REVENUE REVENUE PER VISIT

ADJUSTED PATIENT EXPENSES ADJUSTED INPATIENT EXPENSES EXPENSES PER DAY EXPENSES PER DISCHARGE

ADJUSTED OUTPATIENT EXPENSES EXPENSES PER VISIT


DATE PREPARED: 6/24/2015USING DATA SUBMITTED BY FACILITYFACILITY NO:106430837O'CONNOR HOSPITAL

OPERATING EXPENSES BY COST CENTER GROUP DAILY HOSPITAL SERVICES $68,898,411 AMBULATORY SERVICES $21,727,708 ANCILLARY SERVICES $94,109,288 PURCHASED INPATIENT SERVICES PURCHASED OUTPATIENT SERVICES RESEARCH EDUCATION $2,460,816 GENERAL SERVICES $46,319,287 FISCAL SERVICES $4,748,805 ADMINISTRATIVE SERVICES $54,835,328 UNASSIGNED COSTS $17,503,709 TOTAL OPERATING EXPENSES $310,603,352



TOTAL CURRENT ASSETS $49,741,559LIMITED USE ASSETS $200,466NET PROPERTY, PLANT, AND EQUIPMENT $46,809,076CONSTRUCTION-IN-PROGRESS $3,061,988OTHER ASSETS $53,513INTANGIBLE ASSETSTOTAL ASSETS $99,866,602

TOTAL CURRENT LIABILITIES $61,071,361DEFERRED INCOME $56,833,000NET LONG-TERM DEBT $51,114,881TOTAL LIABILITIES $169,019,242

EQUITY ($69,152,640)TOTAL LIABILITIES AND EQUITY $99,866,602

BALANCE SHEET SUMMARY

FINANCIAL RATIO FORMULAS

LIQUIDITY RATIOS FORMULAS

CURRENT RATIO .82 (TOTAL CURRENT ASSETS + BOARD DESIG. CASH + BOARD DESIG. INVESTMENTS) / TOTAL CURRENT LIABILITIES

ACID TEST RATIO .02 (CASH + MARKETABLE SECURITIES + BOARD DESIG. CASH + BOARD DESIG. INVESTMENTS) / TOTAL CURRENT LIABILITIES

DAYS IN ACCOUNTS RECEIVABLE 49.26 NET ACCOUNTS RECEIVABLE / (NET PATIENT REVENUE / DAYS IN REPORT PERIOD)

BAD DEBT RATE 0.81% (PROVISION FOR BAD DEBTS / TOTAL GROSS PATIENT REVENUE) X 100

DEBT, RISK, AND LEVERAGE RATIOS

LONG-TERM DEBT TO ASSETS RATE 51.18% (NET LONG-TERM DEBT / TOTAL ASSETS) X 100

DEBT SERVICE COVERAGE RATIO ( 8.66) (NET INCOME + INTEREST-WORKING CAPITAL + INTEREST-OTHER + DEPRECIATION EXPENSE) / PRINCIPAL PAYMENTS ON SHORT-TERM AND LONG-TERM DEBT, NOTES, AND LOANS + INTEREST-WORKING CAPITAL + INTEREST-OTHER)

INTEREST EXPENSE AS A PERCENTAGE OF OPERATING EXPENSE

1.02% ((INTEREST-WORKING CAPITAL + INTEREST-OTHER) / TOTAL OPERATING EXPENSE) X 100

PROFITABILITY RATIOS

NET RETURN ON OPERATING ASSETS ( 55.46%) ((NET FROM OPERATIONS + INTEREST-WORKING CAPITAL + INTEREST-OTHER) / (TOTAL CURRENT ASSETS + NET PROPERTY, PLANT AND EQUIPMENT)) X 100

NET RETURN ON EQUITY 62.30% (NET INCOME / EQUITY) X 100

OPERATING MARGIN ( 22.34%) (NET FROM OPERATIONS / TOTAL OPERATING REVENUE) X 100

TURNOVER ON OPERATING ASSETS 2.63 TOTAL OPERATING REVENUE / (TOTAL CURRENT ASSETS + NET PROPERTY, PLANT, AMD EQUIPMENT)

FIXED ASSET RATIOS

FIXED ASSET GROWTH RATE 15.68% ((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

AVERAGE AGE OF PLANT 18.14 ACCUMULATED DEPRECIATION / DEPRECIATION EXPENSE

NET PPE ASSETS PER BED 139,305 (NET PROPERTY, PLANT, AND EQUIPMENT + CONSTRUCTION-IN-PROGRESS) / LICENSED BEDS (END OF PERIOD)

REVENUE-PRODUCING COST CENTERS UNITS OFSERVICE

UNITCODE

GROSS REVPER UNIT

ADJ REVPER UNIT

ADJ DIRECTEXP PER UNIT

ADJ TOTALEXP PER UNIT

PROFIT/LOSSPER UNIT

DAILY HOSPITAL SERVICESMEDICAL/SURGICAL INTENSIVE CARE 4,484 1 $13,901.30 $2,815.42

CORONARY CARE 1

BURN CARE 1

DEFINITIVE OBSERVATION 1

MEDICAL/SURGICAL ACUTE 26,872 1 $6,627.87 $1,195.28

PEDIATRIC ACUTE 1,294 1 $6,723.87 $2,308.17

PSYCHIATRIC ACUTE - ADULT 1

OBSTETRICS ACUTE 7,706 1 $8,674.96 $770.11

ALTERNATE BIRTHING CENTER 1

CHEMICAL DEPENDENCY SERVICES 1

SKILLED NURSING CARE 1

TOTAL PATIENT CARE SERVICES 49,663 2 $6,930.30 $1,292.82

NURSERY ACUTE 6,094 3 $770.11

AMBULATORY SERVICESEMERGENCY SERVICES 57,868 4 $2,881.88 $226.28

CLINICS 9,546 4 $2,091.21 $385.88

OBSERVATION CARE 89,863 5 $301.13 $54.60

HOME HEALTH CARE SERVICES 6

SUMMARY OF FINANCIAL AND UTILIZATION DATA FOR SELECTED COST CENTERS





REVENUE-PRODUCING COST CENTERS UNITS OFSERVICE

UNITCODE

GROSS REVPER UNIT

ADJ REVPER UNIT


ADJ TOTALEXP PER UNIT

PROFIT/LOSSPER UNIT

ANCILLARY SERVICESLABOR AND DELIVERY SERVICES 3,019 7 $14,214.35 $3,464.01SURGERY AND RECOVERY SERVICES 630,125 8 $209.30 $18.68MEDICAL SUPPLIES SOLD TO PATIENTS 80,242 9 $1,425.86 $274.57CLINICAL LABORATORY SERVICES 592,649 10 $241.36 $21.04CARDIAC CATHETERIZATION SERVICES 2,680 11 $27,980.38 $1,557.40RADIOLOGY - DIAGNOSTIC 40,907 11 $687.83 $51.44MAGNETIC RESONANCE IMAGING 4,132 11 $2,075.29 $158.54COMPUTED TOMOGRAPHIC SCANNER 13,109 11 $4,598.92 $255.27DRUGS SOLD TO PATIENTS 80,360 14 $1,176.72 $62.04RESPIRATORY THERAPY 52,678 12 $744.68 $81.36LITHOTRIPSY SERVICES 11PHYSICAL THERAPY 161,836 27 $82.43 $30.32

COST CENTER UNITS OFSERVICE

UNITCODE


DIETARY 141,267 16 $14.96 LAUNDRY AND LINEN 1,194,651 17 $0.74 SOCIAL WORK SERVICES 18,170 18 $38.63 HOUSEKEEPING 365,159 19 $14.22 PLANT OPERATIONS & MAINTENANCE 20 PATIENT ACCOUNTING 1,426,366 21 $0.79 ADMITTING 10,991 22 $262.17

NON-REVENUE PRODUCING COST CENTERS

COST CENTER UNITS OFSERVICE

UNITCODE*


HOSPITAL ADMINISTRATION 1,232 23 $21,091.79 MEDICAL RECORDS 81,358 24 $36.80 NURSING ADMINISTRATION 440 25 $5,472.98 UTILIZATION MANAGEMENT 10,991 22 $591.45 COMMUNITY HEALTH EDUCATION 4 26 $140.25 INSURANCE - MALPRACTICE 1,426,366 21 $0.73 INTEREST - OTHER 397,248 20 $7.96

UNIT CODE DESCRIPTIONS

UNIT CODE <-----------------STANDARD UNIT OF MEASURE ------------------>1 NUMBER OF PATIENT DAYS2 TOTAL PATIENT DAYS (EXCLUDING NEWBORN)3 NUMBER OF NEWBORN DAYS4 NUMBER OF VISITS5 NUMBER OF OBSERVATION HOURS6 NUMBER OF HOME HEALTH CARE VISITS7 NUMBER OF DELIVERIES8 NUMBER OF OPERATING MINUTES9 NUMBER OF CS & S ADJUSTED INPATIENT DAYS10 NUMBER OF TESTS11 NUMBER OF PROCEDURES12 NUMBER OF RESPIRATORY THERAPY ADJUSTED INPATIENT DAYS14 NUMBER OF PHARMACY ADJUSTED INPATIENT DAYS16 NUMBER OF PATIENT MEALS17 NUMBER OF DRY AND CLEAN POUNDS PROCESSED18 NUMBER OF PERSONAL CONTACTS19 NUMBER OF SQUARE FEET SERVICED20 NUMBER OF GROSS SQUARE FEET21 $ 1,000 OF GROSS PATIENT REVENUE22 NUMBER OF ADMISSIONS23 NUMBER OF HOSPITAL FULL-TIME EQUIVALENT (FTE) EMPLOYEES24 NUMBER OF ADJUSTED INPATIENT DAYS25 NUMBER OF NURSING SERVICE FULL-TIME EQUIVALENT PERSONNEL26 NUMBER OF PARTICIPANTS27 NUMBER OF SESSIONS




PERCENTAGE OF HOURS AND AVERAGE HOURLY RATE BY EMPLOYEE CLASSIFICATION

COST CENTER GROUP MANAGEMENT ANDSUPERVISION

TECHNICAL ANDSPECIALIST

REGISTERED NURSES

LICENSEDVOCATIONAL NURSES

AIDES ANDORDERLIES

DAILY HOSPITAL SERVICES 2.72% 6.98% 67.22% 4.64% 11.42% AMBULATORY SERVICES 3.09% 13.12% 66.87% 0.97% 2.78% ANCILLARY SERVICES 3.47% 43.63% 27.53% % 18.22% TOTAL PATIENT CARE SERVICES 3.10% 23.52% 50.21% 2.13% 13.10%

COST CENTER GROUP ENVIRON. AND FOOD SERV.

CLERICALAND OTHEREMPLOYEES

REGISTRY ANDTEMP HELP

TOTALPRODUCTIVE HOURS

TOTAL PAIDHOURS

DAILY HOSPITAL SERVICES % 5.75% 1.26% 593,149 725,566 AMBULATORY SERVICES % 10.93% 2.23% 196,055 234,710 ANCILLARY SERVICES % 6.35% 0.80% 588,987 717,250 TOTAL PATIENT CARE SERVICES % 6.74% 1.20% 1,378,191 1,677,526

RESEARCH % % % % % EDUCATION 1.81% 1.71% % % % GENERAL SERVICES 6.14% 34.56% % % % FISCAL SERVICES 12.69% 2.91% % % % ADMINISTRATIVE SERVICES 21.51% 44.68% % % %

RESEARCH % % % EDUCATION % 96.48% % 52,080 57,673 GENERAL SERVICES 53.70% 5.60% 8.15% 339,193 419,402 FISCAL SERVICES % 84.40% % 62,809 72,999 ADMINISTRATIVE SERVICES 0.51% 33.29% 2.58% 324,629 386,739

TOTAL OPERATING COST CTRS 6.49% 26.86% 31.56% 1.34% 8.23% NON-OPERATING COST CENTERS % % % % %

AVERAGE HOURLY RATE $0.00 $0.00 $0.00 $0.00 $0.00

TOTAL OPERATING COST CTRS 8.38% 14.74% 2.40% 2,192,898 2,614,339 NON-OPERATING COST CENTERS % % %

AVERAGE HOURLY RATE $0.00 $0.00 $0.00

HOSPITAL PERSONNEL PROFILE

TOTAL NUMBER OF PRODUCTIVE HOSPITAL FTE'S* 1,029 NUMBER OF NURSING REGISTRY AND TEMP HELP FTE'S 8

TOTAL NUMBER OF NURSING FTE'S** 440NUMBER OF NURSING REGISTRY FTE'S 6

* EXCLUDES REGISTRY NURSES AND TEMPORARY HELP**INCLUDES NURSING REGISTRY

GENERAL INFORMATION AND CERTIFICATION

12. City: REDWOOD CITY

13. Zip Code: 940651175

1.Health Care Institution(Legal Name): O'CONNOR HOSPITAL

2. OSHPD Facility Number: 106430837

3. D. B.A. (Doing Business As) Name: O'CONNOR HOSPITAL

4. Hospital Business Phone: (408) 947-2500

5.Medi-Cal Contract Provider Number: HSC00153F

6. Medi-Cal Non-Contract Provider Number: ZZR00153F

7.Medicare Provider Number: 05-0153

8. Street Address: 2105 FOREST AVENUE

9. City: SAN JOSE

10.Zip Code: 95128

14. Chief Executive Officer: JIM DOVER

15. Title: CEO

16. Hospital Web Site Address: HTTP://WWW.OCONNORHOSPITAL.ORG

17. Name of Owner: DAUGHTERS OF CHARITY HEALTH SYSTEM

18.Previous Name of Institution if Changed Since Previous Report:

23. Person Completing Report: PAUL HOLDEN

11. Mailing Address (if different) - Street or P.O. Box: 203 REDWOOD SHORES PKWY-8TH FL

24. Organization Name: MOSS ADAMS LLP

25. Phone Number: (503) 478-2108 Ext: -

26. FAX Phone Number: (503) 274-2789

28. Mailing Address - Street or P.O. Box: 805 SW BROADWAY, SUITE 1200

29. City: PORTLAND

30. State : OR

31. Zip Code: 97205

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

40. Was this disclosure report completed after an independent financial audit ?

41. Are audit adjustments made by the independent auditor reflected in this report ?

__X__ Yes ____ No

__X__ Yes ____ No

( Page 0 Submitted Data )

Date Prepared: 6/24/2015 HOSPITAL DISCLOSURE REPORT FACSIMILE

Line No MISC INFORMATION (1)

5 Licensed Beds (End of Period) 358

10 Available Beds 345

15 Staffed Beds (Average) 144

20 HSA No 7

25 If Designated Trauma Center

30 Indicate Level (1,2 or 3)

35 If CCS approved NICU,

40 indicate the standard below:

45 Regional

50 Community

55 Intermediate

TYPE OF CONTROL (2)

Church X

Non-Profit Corporation

Non-Profit Other

Investor - Individual

Investor - Partnership

Investor - Corporation

State

County

City/County

City

District

TYPE OF CARE (3) Line No

Short-Term - General X 5

Short-Term - Childrens 10

Short-Term - Psychiatric 15

Short-Term - Specialty 20

Long-Term - General 25

Long-Term - Childrens 30

Long-Term - Psychiatric 35

Long-Term - Specialty 40

45

50

55

Line No GOVERNMENT PROGRAMS (1)

60 Medicare X

65 Medi-Cal X

70 Children's Medical Services

75 Short-Doyle

80 CHAMPUS X

85 County Indigent

90 Other (Specify)

95

100

105

PREPAID PROGRAMS (2) No.of

Each Type

HospitalBased

Parent Organization Based

State Contracts

Federal Contracts

Medical Foundation Contracts

Commercial Plan Contracts

Other (Specify)

24 HR. ON PREMISES COVERAGE (3) Line

No

Emergency Services X 60

Psychiatric ER 65

Physician X 70

Pharmacist X 75

Operating Room X 80

Laboratory Services X 85

Radiology Services X 90

Anesthesiologist X 95

100

105

Line No

CLINICAL SPECIALTY HOSPITAL BASED NON-HOSPITAL BASED RESIDENTS/FELLOWS(Enter FTEs)

Line No

Board Certified

(1)

Board Eligible

(2) Other

(3)

Board Certified

(4)

Board Eligible

(5) Other

(6) Residents

(7)Fellows

(8)

110 Aerospace Medicine 110

115 Allergy and Immunology 7 1 2 115

120 Anesthesiology 21 2 5 120

125 Cardiovascular Diseases 28 3 5 125

130 Child Psychiatry 2 130

135 Colon and Rectal Surgery 8 2 135

140 Dental 1 140

145 Dermatology 5 145

150 Diagnostic Radiology 1 150

155 Forensic Pathology 155

160 Gastroenterology 14 160

165 General/Family Practice 37 5 6 24.00 165

170 General Preventive Medicine 170

175 General Surgery 19 2 5 175

180 Internal Medicine 73 8 31 180

185 Neurological Surgery 6 3 185

190 Neurology 6 3 3 190

195 Nuclear Medicine 1 1 1 195

200 Obstetrics and Gynecology 29 6 1 200

205 Occupational Medicine 205

210 Oncology 7 3 210

215 Ophthalmology 11 2 1 215

220 Oral Surgery 1 4 220

ACTIVE MEDICAL STAFF PROFILE - MD's, DO's, Podiatrists and Dentists (Enter No)

1. HOSPITAL DESCRIPTION

O'CONNOR HOSPITAL 06/30/2014Facility D.B.A. Name : Report Period End:

( Page 1 (1 of 2) Submitted Data )


Line No

CLINICAL SPECIALTY HOSPITAL BASED NON-HOSPITAL BASED RESIDENTS/FELLOWS(Enter FTEs)

Line No

Board Certified

(1)

Board Eligible

(2) Other

(3)

Board Certified

(4)

Board Eligible

(5) Other

(6) Residents

(7)Fellows

(8)

225 Orthopaedic Surgery 22 3 225

230 Otolaryngology 11 3 230

235 Pathology 4 1 235

240 Pediatric-Allergy 3 240

245 Pediatric-Cardiology 2 245

250 Pediatric-Surgery 3 250

255 Pediatrics 36 14 5 255

260 Physical Medicine/Rehabilitation 3 260

265 Plastic Surgery 7 4 3 265

270 Podiatry 5 8 270

275 Psychiatry 2 1 275

280 Public Health 280

285 Pulmonary Disease 9 6 285

290 Radiology 8 21 290

295 Therapeutic Radiology 295

300 Thoracic Surgery 7 3 300

305 Urology 8 305

310 Vascular Surgery 4 2 1 310

315 Other Specialties 42 7 1 315

320 TOTAL 55 1 426 76 83 24.00 320

1. HOSPITAL DESCRIPTION




CODE

1- Service is available at the hospital. 3 - Service not available.

2- Service is available through arrangement at 4 - Clinic services are commonly provided in the emergency suite to another health care entity. non-emergency outpatients by hospital-based physicians or residents. *

* Code 4 used only for Clinic Services.

Line No

(1)Code

(2) Code

(3)Code

5 INTENSIVE CARE SERVICES Microbiology 1 Dental 3

10 Burn 3 Necropsy 1 Dermatology 3

15 Coronary 1 Serology 1 Diabetes 3

20 Medical 1 Surgical Pathology 1 Drug Abuse 3

25 Neonatal 1 DIAGNOSTIC IMAGING SERVICES Family Therapy 3

30 Neurosurgical 1 Computed Tomography 1 Group Therapy 3

35 Pediatric 3 Cystoscopy 1 Hypertension 3

40 Pulmonary 1 Magnetic Resonance Imaging 1 Metabolic 3

45 Surgical 1 Positron Emission Tomography 1 Neurology 3

50 Definitive Observation Care 1 Ultrasonography 1 Neonatal 3

55 ACUTE CARE SERVICES X-Ray - Radiology 1 Obesity 3

60 Alternate Birthing Center (Licensed Beds) 3 DIAGNOSTIC/THERAPEUTIC SERVICES

Obstetrics 3

65 Geriatric 1 Audiology 3 Ophthalmology 3

70 Medical 1 Biofeedback Therapy 1 Orthopedic 3

75 Neonatal 1 Cardiac Catheterization 1 Otolaryngology 3

80 Oncology 1 Cobalt Therapy 3 Pediatric 1

85 Orthopedic 1 Diagnostic Radioisotope 1 Pediatric Surgery 3

90 Pediatric 1 Echocardiology 1 Podiatry 3

95 Physical Rehabilitation 3 Electrocardiology 1 Psychiatric 3

100 Post Partum 1 Electroencephalography 1 Renal 3

105 Surgical 1 Electromyography 1 Rheumatic 3

107 Transitional Inpatient Care (Acute Beds) 3

110 NEWBORN CARE SERVICES Endoscopy 1 Rural Health 3

115 Developmentally Disabled Nursery Care 3 Gastro-Intestinal Laboratory 1 Surgery 1

120 Newborn Nursery Care 1 Hyperbaric Chamber Services 1

125 Premature Nursery Care 1 Lithotripsy 3 HOME CARE SERVICES

130 Hospice Care 3 Nuclear Medicine 1 Home Health Aide Services 3

135 Inpatient Care Under Custody (Jail) 3 Occupational Therapy 1 Home Nursing Care (Visiting Nurse) 3

140 LONG-TERM CARE Physical Therapy 1 Home Physical Medicine Care 3

145 Behavioral Disorder Care 3 Peripheral Vascular Laboratory 1 Home Social Service Care 3

150 Developmentally Disabled Care 3 Pulmonary Function Services 1 Home Dialysis Training 3

155 Intermediate Care 3 Radiation Therapy 1 Home Hospice Care 3

160 Residential/Self Care 3 Radium Therapy 1 Home IV Therapy Services 3

165 Self Care 3 Radioactive Implants 1 Jail Care 3

170 Skilled Nursing Care 1 Recreational Therapy 1 Psychiatric Foster Home Care 3

175 Sub-Acute Care 3 Respiratory Therapy Services 1

177 Sub-Acute Care-Pediatric 1

179 Transitional Inpatient Care (SNF Beds) 1

180 CHEMICAL DEPENDENCY - DETOX Speech-Language Pathology 1 AMBULATORY SERVICES

185 Alcohol 3 Spotcare Medicine 1 Adult Day Health Care Center 3

190 Drug 3 Stress Testing 1 Ambulatory Surgery Services 1

195 CHEMICAL DEPENDENCY - REHAB Therapeutic Radioisotope 1 Comprehensive Outpatient Rehab Facility

1

200 Alcohol 3 X-Ray Radiology Therapy 1 Observation (Short Stay) Care 3

205 Drug 3 PSYCHIATRIC SERVICES Satellite Ambulatory Surgery Center 3

2. SERVICES INVENTORY




CODE

1- Service is available at the hospital. 3 - Service not available.

2- Service is available through arrangement at 4 - Clinic services are commonly provided in the emergency suite to another health care entity. non-emergency outpatients by hospital-based physicians or residents. *

* Code 4 used only for Clinic Services.

Line No

(1)Code

(2) Code

(3)Code

210 PSYCHIATRIC SERVICES Clinic Psychologist Services 3 Satellite Clinic Services 1

215 Psychiatric Acute- Adult 3 Child Care Services 3

220 Psychiatric - Adolescent and Child 3 Electroconvulsive Therapy (Shock) 3 OTHER SERVICES

225 Psychiatric Intensive (Isolation) Care 3 Milieu Therapy 3 Diabetic Training class 1

230 Psychiatric Long-Term Care 3 Night Care 3 Dietetic Counseling 1

235 Psychiatric Therapy 3 Drug Reaction Information 1

240 OBSTETRIC SERVICES Psychopharmacological Therapy 3 Family Planning 1

245 Abortion Services 3 Sheltered Workshop 3 Genetic Counseling 1

250 Combined Labor/Delivery Birthing Room 1 RENAL DIALYSIS Medical Research 3

255 Delivery Room Services 1 Hemodialysis 1 Parent Training Class 1

260 Infertility Services 1 Home Dialysis Support Services 1 Patient Representative 1

265 Labor Room Services 1 Peritoneal 1 Public Health Class 1

270 SURGERY SERVICES Self-Dialysis Training 3 Social Work Services 1

275 Dental 1 Organ Acquisition 3 Toxicology/Antidote Information 1

280 General 1 Blood Bank 1 Vocational Services 1

285 Gynecological 1 Extracorporeal Membrane Oxygenation 1

290 Heart 1 Pharmacy 1 MEDICAL EDUCATION PROGRAMS

295 Kidney 1 Approved Residency 1

300 Neurosurgical 1 EMERGENCY SERVICES Approved Fellowship 1

305 Open Heart 1 Emergency Communications Systems 3 Non-Approved Residency 3

310 Ophthalmologic 1 Emergency Helicopter Service 3 Associate Records Technician 3

315 Organ Transplant 3 Emergency Observation Service 1 Diagnostic Radiologic Technologist 3

320 Orthopedic 1 Emergency Room Service 1 Dietetic Intern Program 3

325 Otolaryngologic 1 Heliport 3 Hospital Administration Program 3

330 Pediatric 1 Medical Transportation 2 Hospital Administration Program 3

335 Plastic 1 Mobile Cardiac Care Services 1 Licensed Vocational Nurse 3

340 Podiatry 1 Orthopedic Emergency Services 1 Medical Technologist Program 3

345 Thoracic 1 Psychiatric Emergency Services 3 Medical Records Administrator 3

350 Urologic 1 Radioisotope Decontamination Room 3 Nurse Anesthetist 3

355 Anesthesia Services 1 Trauma Treatment E. R. 3 Nurse Practitioner 3

360 Nurse Midwife 3

365 LABORATORY SERVICES CLINIC SERVICES Occupational Therapist 3

370 Anatomical Pathology 1 AIDS 3 Pharmacy Intern 3

375 Chemistry 1 Alcoholism 3 Physician's Assistant 3

380 Clinical Pathology 1 Allergy 3 Physical Therapist 3

385 Cytogenetics 1 Cardiology 3 Registered Nurse 3

390 Cytology 1 Chest Medical 3 Respiratory Therapist 3

395 Hematology 1 Child Diagnosis 3 Social Worker Program 3

400 Histocompatibility 1 Child Treatment 3

405 Immunology 1 Communicable Disease 3

2. SERVICES INVENTORY




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.

A. Are any costs included which are a result of transactions with a related organizations as defined in 42 CFR 413.17?

1.

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.)X

Yes No (If "Yes", complete item C.)X

Line No

Code(1)

Name of Individual - (Complete for Codes C- G)

(2)

Percent Ownership of

Hospital (3)

Related Organizations

Name (4) Percent Ownership(5)

Type of Business (6)

3 A DAUGHTERS OF CHARITY HEALTH SYSTEM

100 CORPORATE OFFICE

4

5

6

7

8

9

10

11

12

Line Nature of Service or Supply Amount Expense Included on

No (7) (8) Page (9) Column (10) Line (11)

3 ADMINISTRATION $8,671,317 18 6 205

4

5

6

7

8

9

10

11

12

COMMENTS:

13

14

15

16

3.1 RELATED HOSPITAL INFORMATION

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.


( Page 3.1 Submitted Data )


Sole Pro-

prietorship

Partners Corporation Officers

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


(5)

Percent of Provider's

Stock Owned

(6)

Percentage of


(7)

Compensation Included in Costs for the Period

(8) *

17

18

19

20

21

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 ?X

Financial Arrangement

Line No

Hospital Cost Center (1)

Joint (2)

Contracted (3)

Rental (4)

Independent (5)

Agency (6)

Salaried (7)

Other (8)

23 Clinical and Pathological Laboratory Services X

24 Radiology - Diagnostic and Therapeutic X

25 Nuclear Medicine

26 Cardiology Services X

27 Emergency Services X

28 Gastro-Intestinal Services

29 Pulmonary Function Services

30 Psychiatric Therapy

31 Anesthesiology

32 Other (Specify)

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

COMMENTS:

33

34

35

36


* 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.


D. STATEMENT OF COMPENSATION OF OWNERS AND THEIR RELATIVES



* Compensation paid to the individual from all sources for services rendered personally to or on behalf of the hospital.

Line No Name (1)

Occupation (2)

Check if Owner

(3)

Percentage of Hospital

Ownership (4)

Check if Board Member

(5) Compensation*

(6)

37 SISTER EILEEN KENNY NUN, BOARD CHAIR X $0

38 SISTER MARION BILL HEALTH COUNCILOR X $0

39 SISTER CATARINA CHU NUN X $0

40 SISTER CAMILE CUADRA NUN X $0

41 SISTER MARGARET KEAVENEY NUN X $0

42 ROBERT ISSAI PRESIDENT & CEO DCHS X $0

43 SISTER WILLIAM EILEEN DUNN NUN X $0

44 JEFFREY ANDERSON, MD PHYSICIAN X $0

45 MARIO CORDERO, MD PHYSICIAN X $0

46 GERRY DEYOUNG RETIRED X $0

47 N. THAD PADUA, MD PHYSICIAN X $0

48 HUGH WALSH, MD PHYSICIAN X $0

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66


G. HOSPITAL OWNERS AND GOVERNMENT BOARD MEMBERS




Facility D.B.A. Name :

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 ? (This excludes related parties, e.g, management by a parent corporation.)

Yes X 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.

80.

88

89

90

91

92

M. Are the amounts paid to the management firm functionally accounted and reported as required ?

Yes No. (If "No", complete lines 99 through 102.)98.

Please explain why amounts paid to the management firm are not functionally accounted and reported.

99

100

101

102

I. 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.


O'CONNOR HOSPITAL 06/30/2014Report Period End:

93

94

95

96

97



BEDS PATIENT (CENSUS) DAYS DISCHARGES

Line No

DAILY HOSPITAL SERVICES (1) Licensed (End of Period)

(2) Available

(Average)

(3) Staffed

(Average)

(4) Adult

(5) Pediatric

(11) Service

(12) Total

Line No

5 Medical/Surgical Intensive Care 22 22 13 4,484 1,087 5

10 Coronary Care 10

15 Pediatric Intensive Care 15

20 Neonatal Intensive Care 10 10 5 1,391 107 20

25 Psychiatric Intensive ( Isolation ) Care 25

30 Burn Care 30

35 Other Intensive Care 35

40 Definitive Observation 40

45 Medical/Surgical Acute 236 223 79 26,872 6,406 45

50 Pediatric Acute 27 27 4 1,294 313 50

55 Psychiatric Acute - Adult 55

60 Psychiatric Acute - Adolescent & Child 60

65 Obstetrics Acute 39 39 23 7,706 3,034 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

100 Sub-Acute Care 24 24 20 7,916 24 100

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 358 345 144 46,978 2,685 10,971 150

155 Nursery Acute 43 25 25 155

4 PATIENT UTILIZATION STATISTICS

Facility D.B.A. Name : O'CONNOR HOSPITAL 06/30/2014Report Period End:



Line No

ACCOUNT DESCRIPTION STANDARD UNIT OF MEASURE (1) Total Units of

Service [Sum of columns (7) and

(13)]

(7) Total Inpatient Units

of Service

(13) Total Outpatient Units of Service

Line No.

160AMBULATORY SERVICES Emergency Services Visits 57,868 6,228 51,640 160

165 Medical Transportation Services Occasions of Service 165

170 Psychiatric Emergency Rooms Visits 170

175 Clinics Visits 9,546 9,546 175

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 89,863 7,947 81,916 195

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

230ANCILLARY SERVICESLabor and Delivery Services Deliveries 3,019 3,019 230

235 Surgery and Recovery Services Operating Minutes 630,125 334,395 295,730 235

240 Ambulatory Surgery Services Operating Minutes 121,950 121,950 240

245 Anesthesiology Anesthesia Minutes 630,125 334,395 295,730 245

250 Medical Supplies Sold to Patients CS & S Adj. Inpatient Days 80,242 250

255 Durable Medical Equipment Adjusted Inpatient Days 255

260 Clinical Laboratory Services Tests 592,649 355,035 237,614 260

265 Pathological Laboratory Services Tests 17,427 5,988 11,439 265

270 Blood Bank Units of Blood Issued 5,800 4,359 1,441 270

275 Echocardiology Procedures 275

280 Cardiac Catheterization Services Procedures 2,680 1,166 1,514 280

285 Cardiology Services Procedures 28,093 12,073 16,020 285

290 Electromyography Procedures 290

295 Electroencephalography Procedures 483 230 253 295

300 Radiology - Diagnostic Procedures 40,907 15,172 25,735 300

305 Radiology - Therapeutic Procedures 7,411 456 6,955 305

310 Nuclear Medicine Procedures 3,161 555 2,606 310

315 Magnetic Resonance Imaging Procedures 4,132 1,067 3,065 315

320 Ultrasonography Procedures 9,841 2,561 7,280 320

325 Computed Tomographic Scanner Procedures 13,109 4,730 8,379 325

330 Drugs Sold to Patients Pharmacy Adj. Inpatient Days 80,360 330

335 Respiratory Therapy Respiratory Therapy Adj. Inpatient Days

52,678 335

340 Pulmonary Function Services Procedures 340

345 Renal Dialysis Hours of Treatment 7,072 6,308 764 345

350 Lithotripsy Procedures 350

355 Gastro-Intestinal Services Procedures 355

360 Physical Therapy Sessions 161,836 97,511 64,325 360

365 Speech-Language Pathology Sessions 365

370 Occupational Therapy Sessions 370

380 Electroconvulsive Therapy Treatments 380

385 Psychiatric/Psychological Testing Sessions 385

390 Psychiatric Individual/Group Therapy Sessions 390

395 Organ Acquisition Organs acquired 395





(a) Sum of column 13, lines 160,170,175,180,190,200,205,210,215,505,515,535,545,550, and 555.

OTHER STATISTICS (1) Total Units of

Service

(7) Inpatient Units of

Service

(13) Outpatient Units of

Service

505 Satellite Ambulatory Surgery Center Surgeries 505

510 Satellite Ambulatory Surgery Center Satellite Operating Rooms 510

515 Surgery and Recovery Services Surgeries 14,815 3,832 10,983 515

520 Surgery and Recovery Services Open Heart Surgery Minutes 520

525 Surgery and Recovery Services Open Heart Surgeries 525

530 Surgery and Recovery Services Inpatient Operating Rooms 530

535 Ambulatory Surgery Services Surgeries 535

540 Ambulatory Surgery Services Outpatient Operating Rooms 540

545 Observation Care Days 3,744 331 3,413 545

550 Renal Dialysis Care Visits 191 191 550

555 Referred Visits 107,765 107,765 555

560 Total Outpatient Visits(a) 183,538 183,538 560

LIVE BIRTH SUMMARY (1) Total Births [Sum of

columns (7) and (13)]

(7) Natural Births

(13) Cesarean Sections

600 Labor and Delivery Services 3,032 2,143 889 600

605 Surgery and Recovery Services 605

610 Alternate Birthing Services 610

615 Obstetrics Acute 615

620 Emergency Services and other areas within the hospital 620

625 Total Births (Sum of Lines 600 through 620) 3,032 2,143 889 625





PATIENT (CENSUS ) DAYS

Line No

TYPE OF CARE (1) Medicare -Traditional

(2) Medicare -

Managed Care

(3) Medi-Cal -Traditional

(4) Medi-Cal-

Managed Care

(5) County Indigent

Programs - Traditional

(6) County Indigent

Programs -Managed Care

Line No

5 Acute Care 17,173 4,018 5,211 5,229 5

10 Psychiatric Care 10

15 Chemical Dependency Care 15

20 Rehabilitation Care 20

25 Long-Term Care 1,675 61 4,464 223 25

30 Other Care 30

35 Total 18,848 4,079 9,675 5,452 35

40 Nursery Acute 1,781 2,156 40

45 Purchased Inpatient Services 45

DISCHARGES

Line No

TYPE OF CARE (12) Medicare - Traditional

(13) Medicare -

Managed Care


(15) Medi-Cal-

Managed Care

(16) County Indigent


(17) County Indigent


Line

No

5 Acute Care 3,267 948 1,803 1,839 5




25 Long-Term Care 5 2 9 2 25

30 Other Care 30

35 Total 3,272 950 1,812 1,841 35

40 Nursery Acute 926 926 40


4.1 PATIENT UTILIZATION STATISTICS BY PAYER

PATIENT (CENSUS ) DAYS

Line No

TYPE OF CARE (7) Other Third

Parties Traditional

(8) Other Third

Parties Managed Care

(9) Other Indigent

(10) Other Payors

(11) Total Patient

Days

Line No

5 Acute Care 138 9,060 918 41,747 5




25 Long-Term Care 1,489 4 7,916 25

30 Other Care 30

35 Total 138 10,549 922 49,663 35

40 Nursery Acute 2,075 82 6,094 40


DISCHARGES

Line No

TYPE OF CARE (18) Other Third

Parties Traditional

(19) Other Third

Parties Managed Care

(20) Other Indigent

(21) Other Payors

(22) Total Discharges

Line

No

5 Acute Care 40 2,778 272 10,947 5




25 Long-Term Care 5 1 24 25

30 Other Care 30

35 Total 40 2,783 273 10,971 35

40 Nursery Acute 976 50 2,878 40



( Page 4.1 (1 of 2) Submitted Data )


OUTPATIENT VISITS

Line No

TYPE OF OUTPATIENT VISIT (1) Medicare - Traditional

(2) Medicare -

Managed Care


(4) Medi-Cal-

Managed Care

(5) County Indigent


(6) County Indigent


Line No

60 Emergency Svcs. (incl. Psych ER) 9,084 1,993 4,398 14,771 60

65 Clinic (incl. Satellite Clinics) 4,363 873 295 951 65

70 Observation Care Days 1,177 340 43 544 70

75 Psychiatric Day-Night Care Days 75

80 Home Health Care Services 80

85 Hospice - Outpatient 85

90 Outpatient Surgeries 5,020 1,004 340 1,094 90

95 Private Referred 49,257 9,851 3,335 10,735 95

100 Other * 87 17 6 19 100

105 Total 68,988 14,078 8,417 28,114 105

4.1 PATIENT UTILIZATION STATISTICS BY PAYER


OUTPATIENT VISITS

Line No

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

60 Emergency Svcs. (incl. Psych ER) 1,029 14,428 5,937 51,640 60

65 Clinic (incl. Satellite Clinics) 78 2,779 207 9,546 65

70 Observation Care Days 96 1,202 11 3,413 70

75 Psychiatric Day-Night Care Days 75


85 Hospice - Outpatient 85

90 Outpatient Surgeries 90 3,198 237 10,983 90

95 Private Referred 881 31,376 2,330 107,765 95

100 Other * 2 56 4 191 100

105 Total 2,176 53,039 8,726 183,538 105

Includes Chemical Dependency Services, Adult Day Health Care, & Renal Dialysis Visits



Line No

ASSETS Account No (1) Current Year (2) Prior Year Line No

CURRENT ASSETS

5 Cash 1000 $1,198,501 $22,942,103 5

10 Marketable securities 1010 10

15 Accounts and notes receivable 1020 $201,795,787 $208,448,943 15

20 Less allowance for uncollectible receivables and thrid-party contractual withholds 1040 ($168,159,503) ($171,401,392) 20

25 Receivables from third-party payors 1050 25

30 Pledges and other receivables 1060 30

35 Due from restricted funds 1070 35

40 Inventory 1080 $5,096,040 $4,884,557 40

45 Intercompany receivables 1090 $8,419,579 $8,143,607 45

50 Prepaid expenses and other current assets 1100 $1,391,155 $9,499,391 50

55 TOTAL CURRENT ASSETS (Sum of lines 5 through 50) $49,741,559 $82,517,209 55

ASSETS WHOSE USE IS LIMITED

60 Limited use cash 1110 $200,466 $9,850,221 60

65 Limited use investments 1120 65

70 Limited use other assets 1130 70

75 TOTAL ASSETS WHOSE USE IS LIMITED (Sum of lines 60 through 70) $200,466 $9,850,221 75

PROPERTY, PLANT AND EQUIPMENT - AT COST

80 Land 1200 $727,429 $727,429 80

85 Land improvements 1210 $5,034,875 $5,034,875 85

90 Buildings and improvements 1220 $83,086,479 $83,332,307 90

95 Leasehold improvements 1230 $69,586,784 $69,609,889 95

100 Equipment 1240 $115,588,277 $106,853,958 100

105 TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 80 through 100) $274,023,844 $265,558,458 105

195 Less accumulated depreciation and amortization 1260 ($227,214,768) ($215,640,537) 195

200 NET TOTAL PROPERTY, PLANT AND EQUIPMENT (Sum of lines 105 & 195) $46,809,076 $49,917,921 200

205 Construction in progress 1250 $3,061,988 $3,200,959 205

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 $53,513 $1,962,506 230

235 TOTAL INVESTMENTS IN OTHER ASSETS (Sum of lines 210 through 230) $53,513 $1,962,506 235

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) $99,866,602 $147,448,816 270

Line No

OTHER INFORMATION (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) $3,061,988 $3,200,959 420

5 BALANCE SHEET - UNRESTRICTED FUND




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 $932,826 5

10 Accounts payable 2020 $11,135,359 $5,278,150 10

15 Accrued compensation and related liabilities 2030 $16,489,360 $16,737,600 15

20 Other accrued expenses 2040 20

25 Advances from third-party payors 2050 25

30 Payable to third-party payors 2060 $1,066,635 $620,332 30

35 Due to restricted funds 2070 35

40 Income Taxes payable 2080 $1,649,021 40

45 Intercompany payables 2090 $23,102,054 $10,268,667 45

50 Current maturities of long-term debt (Must agree with line 125) 50

55 Other current liabilities 2100 $7,628,932 $10,134,180 55

60 TOTAL CURRENT LIABILITIES (Sum of lines 5 through 55) $61,071,361 $43,971,755 60

DEFERRED CREDITS

65 Deferred income taxes 2110 65

70 Deferred third-party income 2120 70

75 Other deferred credits 2130 $56,833,000 $57,914,000 75

80 TOTAL DEFERRED CREDITS (Sum of lines 65 through 75) $56,833,000 $57,914,000 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 $51,114,881 $76,711,183 105

110 Intercompany payables 2260 110

115 Other non-current liabilities 2270 115

120 TOTAL LONG-TERM DEBT (Sum of lines 85 through 115) $51,114,881 $76,711,183 120

125 Less amount shown as current maturities (Must agree with line 50) 125

130 NET TOTAL LONG-TERM DEBT(Sum of lines 120 and 125) $51,114,881 $76,711,183 130

135 TOTAL LIABILITIES (Sum of lines 60,80 and 130) $169,019,242 $178,596,938 135

EQUITY (Non Profit)

140 Unrestricted Fund Balance 2310 ($69,152,640) ($31,148,122) 140

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

EQUITY (Investor-Owned - Partnership)

170 Capital - unrestricted 2310 170

175 Less Partner's draw 2320 175

EQUITY (Investor-Owned - Division of a Corporation)

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 200

205 TOTAL EQUITY(Sum of lines 140 through 200) ($69,152,640) ($31,148,122) 205

TOTAL

270 TOTAL LIABILITIES AND EQUITY (Sum of lines 135 and 205) $99,866,602 $147,448,816 270

(a) Complete Report Page 5.1 to provide detailed 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*)

(8) Interest Rate (a)

(9) Unpaid Principal Balance at Year End

Line No

5 105 2002 2031 7.45 $51,114,881 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

5.1 SUPPLEMENTAL LONG - TERM DEBT INFORMATION


*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.



*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.

Line No

(5) Detail For Page 5, column(3), Line No

(6)Date Obligation Incurred (Year Only*)

(7) Due Date (Year Only*)

(8) Interest Rate (a)

(9) Unpaid Principal Balance at Year End

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

5.1 SUPPLEMENTAL LONG - TERM DEBT INFORMATION




Line

(1) (2) (3)

Additions

(4) (5) (6)

Line

No Description Beginning Balance(a)

Purchase Donation Transfers Disposals and Retirements

Ending Balance (b)

No

5 Land $727,429 $727,429 5

10 Land Improvements $5,034,875 $5,034,875 10

15 Buildings and Improvements $83,332,307 ($245,828) $83,086,479 15

20 Leasehold Improvements $69,609,889 ($23,105) $69,586,784 20

25 Equipment $106,853,958 $8,734,319 $115,588,277 25

30 Construction-in-progress $3,200,959 ($138,971) $3,061,988 30

35 TOTAL $268,759,417 $8,734,319 ($407,904) $277,085,832 35

5.2 STATEMENT OF CHANGES IN PROPERTY, PLANT AND EQUIPMENT


(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.



Line No

ASSETS Account No

(1) Current Year

(2) Prior Year

Line No

SPECIFIC PURPOSE FUNDS

5 Cash 1510 5

10 Investments Marketable Securities 1521 10


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


115 Mortgages investments 1422 115

120 Real property (net of accumulated depreciation) 1423 1424

120





170 TOTAL PLANT REPLACEMENT AND EXPANSION FUND ASSETS (Sum of lines 105 through 140)

170

ENDOWMENT FUNDS

205 Cash 1610 205


215 Mortgages 1622 215

220 Real property (net of accumulated depreciation) 1623 1624

220

225 Other investments 1629 225




275 TOTAL ENDOWMENT FUND ASSETS (Sum of lines 205 through 240) 275

Line No

OTHER INFORMATION (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




6 BALANCE SHEET - RESTRICTED FUND

Line No

LIABILITIES AND FUND BALANCES Account No

(3) Current Year

(4) Prior Year

Line No

SPECIFIC PURPOSE FUNDS

5 Due to unrestricted fund 2510 5

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


110 Due to specific purpose fund 2420 110

115 Due to endowment fund 2430 115


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


220 Due to plant replacement and expansion fund 2640 220

225 Due to specific purpose fund 2650 225


275 TOTAL ENDOWMENT FUND LIABILITIES AND FUND BALANCE (Sum of lines 205 through 270)

275




(a) District Hospitals. Include bond interest and redemption.

RESTRICTED FUNDS

Line No

ASSETS (1) Funds Unrestricted

(2) Specific Purpose (a)

(3) Plant Replacement and Expansion

(4) Endowment Line No

5BALANCE AT BEGINNING OF YEAR, AS PREVIOUSLY REPORTED ($31,148,122) 5

10 Prior period audit adjustment 10

15 Restatement (describe) MISC ADJUSTMENTS 15

20 20

25 25

30 30

35 35

40 40

45 45

50BALANCE AT BEGINNING OF YEAR, AS RESTATED ($31,148,122) 50

55ADDITIONS (DEDUCTIONS):Net Income (Loss) ($43,083,064) 55

60 Acquisitions of pooled companies 60

65 Proceeds from sale of stock 65

70 Stock options exercised 70

75 Restricted contributions and grants 75

80 Restricted investment income 80

85 Expenditures for specific purposes 85

90 Dividends declared 90

95 Donated property, plant and equipment 95

100 Intercompany transfers 100

105 Dispo. Share funds transferred to public entity 105

110 Other (Describe) MISC ADJUSTMENTS $5,078,546 110

115 115

120 120

125 TOTAL ADDITIONS (DEDUCTIONS) ($38,004,518) 125

130TRANSFERS:Property and equipment additions 130

135 Principal payments on long-term debt 135

140 Other (Describe) CHANGE IN EQUITY 140

145 145

150 150

155 155

160 160

165 165

170 170

175TOTAL TRANSFERS (Sum of columns (1) through (4) must equal 0) 175

185BALANCE AT END OF YEAR (Sum of lines 50,125 and 175) ($69,152,640) 185

7 STATEMENT OF CHANGES IN EQUITY




(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.

Line No

SECTION I (1) Current Year

(2) Prior Year

Line No

5OPERATING REVENUES:Daily hospital services $344,179,417 $365,232,495 5

10 Ambulatory services $213,791,518 $232,593,158 10

15 Ancillary services $868,395,408 $866,603,926 15

30 GROSS PATIENT REVENUE (Sum of lines 5 through 15) $1,426,366,343 $1,464,429,579 30

105 DEDUCTIONS FROM REVENUE (From line 395) (a) $1,177,156,750 $1,179,993,046 105

107 CAPITATION PREMIUM REVENUE (From line 450) (b) 107

110 NET PATIENT REVENUE (Line 30 minus line 105 plus line 107) $249,209,593 $284,436,533 110

135 TOTAL OTHER OPERATING REVENUE $4,680,678 $2,384,212 135

140 TOTAL OPERATING REVENUE (Sum of lines 110 and 135) $253,890,271 $286,820,745 140

146OPERATING EXPENSES:Daily Hospital Services $68,898,411 $71,526,385 146

151 Ambulatory Services $21,727,708 $22,519,125 151

156 Ancillary Services $94,109,288 $91,741,642 156

161 Research Costs 161

166 Education Costs $2,460,816 $2,786,695 166

171 General Services $46,319,287 $45,932,706 171

176 Fiscal Services $4,748,805 $5,549,693 176

181 Administrative Services $54,835,328 $66,249,075 181

186 Unassigned Costs $17,503,709 $10,707,393 186


195 Purchased Outpatient Services 195

200 TOTAL OPERATING EXPENSES (Sum of Lines 146 through 195) $310,603,352 $317,012,714 200

205 NET FROM OPERATIONS (Line 140 minus line 200) ($56,713,081) ($30,191,969) 205

210 NET NON-OPERATING REVENUE AND EXPENSE (From Line 700) (c) $13,630,017 $7,337,228 210

215NET INCOME BEFORE TAXES AND EXTRAORDINARY ITEMS: (Sum of lines 205 and 210) ($43,083,064) ($22,854,741) 215

220PROVISION FOR INCOME TAXES:Current 220

225 Deferred 225

230NET INCOME BEFORE EXTRAORDINARY ITEMS: (Line 215 minus 220 and 225) ($43,083,064) ($22,854,741) 230

235EXTRAORDINARY ITEMS:(Specify)

235

240 240

245 NET INCOME (Line 230 minus lines 235 and 240) ($43,083,064) ($22,854,741) 245

8 STATEMENT OF INCOME- UNRESTRICTED FUND




8 STATEMENT OF INCOME- UNRESTRICTED FUND (DEDUCTIONS FROM REVENUE AND CAPITATION PREMIUM REVENUE)

Line No

SECTION II (1) Current Year

(2) Prior Year

Line No

300DEDUCTIONS FROM REVENUE:Provision for bad debt $11,612,383 $10,721,209 300

305 Contractual adjustments - Medicare - traditional $441,680,405 $460,120,788 305

310 Contractual adjustments - Medicare - managed care $118,615,213 $97,483,421 310

315 Contractual adjustments - Medi-Cal - traditional $126,886,774 $124,997,896 315

320 Contractual adjustments - Medi-Cal - managed care $173,979,371 $163,409,900 320

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 335

340 Contractual adjustments - Other third parties - traditional $8,814,199 $10,115,916 340

345 Contractual adjustments - Other third parties - managed care $239,413,303 $246,561,737 345

350 Charity discounts - Hill Burton $23,897,306 350

355 Charity discounts - other $19,248,021 ($1) 355

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 $42,684,874 380

385 Other deductions from revenue $36,907,081 385

395 TOTAL DEDUCTIONS FROM REVENUE (Sum of lines 300 thru 385) $1,177,156,750 $1,179,993,046 395

430CAPITATION 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

Facility D.B.A. Name : O'CONNOR HOSPITAL Report Period End: 06/30/2014

(d) Disproportionate share funds transferred back to a related public entity must be reported on page 7, column(1), line 105.



Line No

SECTION III Account No

(1) Current Year

(2) Prior Year

Line No

500NON-OPERATING REVENUES:Gains on sale of hospital property 9010 $10,124,020 $66,679 500

505 Maintenance of restricted funds revenue 9030 505

510 Unrestricted contributions 9040 $1,458,552 $1,582,449 510

515 Donated services 9050 515

520 Income, gains and losses from unrestricted investments 9060 $271,086 $2,210,017 520

525 Unrestricted income from endowment funds 9070 525

530 Unrestricted income from other restricted funds 9080 530

535 Term endowment funds becoming unrestricted 9090 535

540 Transfers from restricted funds for non-operating expenses 9100 540

545 Assessment revenue (e) 9150 545

550 County allocation of taxes revenue (e) 9160 550

555 Special district augmentation revenue (e) 9170 555

560 Debt service taxes revenue (e) 9180 560

565 State homeowner's property tax relief (e) 9190 565

570 State appropriation 9200 570

575 County appropriation - Realignment funds 9210 575

580 County appropriation - County general funds 9220 580

585 County appropriation - Other county funds 9230 585

590 Physician's offices and other rentals - revenue 9250 $1,981,387 $2,384,972 590

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 $211,740 $309,316 610

615 Other non-operating revenue 9400 $3,013,440 $2,755,346 615

625 TOTAL NON-OPERATING REVENUE (Sum of lines 500 thru 615) $17,060,225 $9,308,779 625

640NON-OPERATING EXPENSES:Loses on sale of hospital property 9020 640

645 Maintenance of restricted funds expense 9030 645

650 Physician's offices and other rentals expense 9510 $919,504 $1,425,822 650

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 $642,867 $190,065 670

675 Other non-operating expense 9800 $1,867,837 $355,664 675

685 TOTAL NON-OPERATING EXPENSE (Sum of lines 640 thru 675) $3,430,208 $1,971,551 685

700NET NON-OPERATING REVENUE AND EXPENSE (Line 625 minus line 685) $13,630,017 $7,337,228 700

705 Interest on long-term debt (e) 705

8 STATEMENT OF INCOME- UNRESTRICTED FUND (NON-OPERATING REVENUE AND EXPENSE)

06/30/2014Facility D.B.A. Name : O'CONNOR HOSPITAL Report Period End:

(e) District Hospital only.



Line No

(1) Current Year (2) Prior Year Line No

5CASH FLOW FROM OPERATING ACTIVITIES AND NON-OPERATING REVENUE:Net income (loss) ($43,083,064) ($22,854,741) 5

15

Adjustments to reconcile net income to net cash provided by (used for) operating activities and non-operating revenue :Depreciation and amortization $12,543,209 $14,144,314 15

17 Amortization of intangible assets 17

20 Change in marketable securities 20

30 Change in accounts and notes receivable, net of allowance for uncollectible receivables and third-party contractual withholds

$3,411,267 $1,180,181 30

35 Change in receivables from third-party payors 35

40 Change in pledges and other receivables 40

45 Change in due from restricted funds 45

50 Change in inventory ($211,483) ($93,501) 50

55 Change in intercompany receivables ($275,972) $318,349 55

57 Change in Prepaid expenses and other current assets $8,108,236 $894,546 57

60 Change in accounts payable $5,857,209 ($57,165) 60

65 Change in accrued compensation and related liabilities ($248,240) $1,153,791 65

70 Change in other accrued expenses 70

75 Change in advances from third-party payors 75

80 Change in payable to third-party payors $446,303 ($616,745) 80

85 Change in due to restricted funds 85

87 Change in income taxes payable $1,649,021 87

90 Change in intercompany payables $12,833,387 $6,058,830 90

95 Change in other current liabilities ($2,505,248) ($6,465,603) 95

100 Change in deferred credits ($1,081,000) ($3,333,777) 100

102 Other (Describe): FUND VARIANCE 102

103 Other (Describe): DEPRECIATION 103

104 Other (Describe): CHANGE IN OTHER ASSETS 104

105 TOTAL ADJUSTMENTS (Sum of lines 15 through 104) $40,526,689 $13,183,220 105

115 NET CASH PROVIDED BY (USED FOR) OPERATING ACTIVITIES (Sum of lines 5 and 105) ($2,556,375) ($9,671,521) 115

130CASH FLOW FROM INVESTING ACTIVITIES: Change in assets whose use is limited $9,649,755 $28,220,731 130

135 Purchase of plant, property and equipment and construction-in-progress ($8,734,319) ($1,490,514) 135

140 Other (Describe): 140



145NET CASH PROVIDED BY (USED FOR) INVESTING ACTIVITIES (Sum of lines 130 through 142) $915,436 $26,730,217 145

160CASH FLOW FROM FINANCING ACTIVITIES:Proceeds from issuance of long-term debt ($25,596,302) ($932,826) 160

165 Principal payments on long-term debt 165

170 Proceeds from issuance of short-term notes and loans ($932,826) $932,826 170

175 Principal payments on short-term notes and loans 175

180 Dividends paid 180

185 Proceeds from issuance of common stock 185

190 Other (Describe): FUND BALANCE VARIANCE $5,078,546 ($324,333) 190

191 Other (Describe): MISC ADJUSTMENTS $1,347,919 191


195NET CASH PROVIDED BY (USED FOR) FINANCING ACTIVITIES (Sum of lines 160 through 192) ($20,102,663) ($324,333) 195

205 NET INCREASE (DECREASE) IN CASH (Sum of lines 115, 145 and 195) ($21,743,602) $16,734,363 205

215 CASH AT BEGINNING OF YEAR $22,942,103 $6,207,740 215

225 CASH AT END OF YEAR (Sum of lines 205 and 215) $1,198,501 $22,942,103 225

9 STATEMENT OF CASH FLOWS - UNRESTRICTED FUND




Line No

REVENUE PRODUCING CENTERS (1)Units ofService

from Page 17,Column (13)

(2)AdjustedDirect Expenses


(3)AllocatedCosts

Column(4) minus (2)

(4)Total PatientCare Costs fromPage 20, Column

(16),Lines 505 - 915

(5)Average UnitPatient Care

Costs, Column (4) ÷ (1)

Line No

5DAILY HOSPITAL SERVICES:Medical/Surgical Intensive Care 5

10 Coronary Care 10


20 Neonatal Intensive Care 20

25 Psychiatric Intensive (Isolation) Care 25

30 Burn Care 30



45 Medical/Surgical Acute 45

50 Pediatric Acute 50


60 Psychiatric Acute - Adol & Child 60







95 Nursery Acute 95

100 Sub-Acute Care 100








150 TOTAL DAILY HOSPITAL SERVICES 150

160AMBULATORY SERVICES:Emergency Services 160

165 Medical Transportation Services 165

170 Psychiatric Emergency Rooms 170

175 Clinics 175

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


210 Hospice - Outpatient Services 210

215 Adult Day Health Care Services 215

220 Other Ambulatory Services 220

225 TOTAL AMBULATORY SERVICES 225

10 (OPTIONAL) SUMMARY OF REVENUES AND COSTS




Line No

REVENUE PRODUCING CENTERS (6) Reallocated Net Research Costs from

Page 20, Col.(17), Lines 505-

915

(7) Reallocated Net Education

Costs from Page 20, Cols.

(18) + (19) + (20) +(21), Lines 505

- 915

(8) Transfers for Operating Costs from

Page 20, Column (22),

Lines 505 - 915

(9) Net Costs as Reallocated Column

(4) + (6) +(7) - (8)

(10) Average Unit Cost Column (9)

÷ (1)

Line No


10 Coronary Care 10




30 Burn Care 30













95 Nursery Acute 95













175 Clinics 175
















Line No

REVENUE PRODUCING CENTERS (11) Gross Revenue from Page 12, Columns (21) + (22)

(12)Deductions from Revenue from Page 12,

Column 23 Line 455 - 457

(13)Adjustment for Professional

Component from Page 15, Columns (9) &

(13)

(14)Net Revenue Column (11) - (12) -

(13)

(15)Average Unit Net Revenue

Column (14) ÷ (1)

Line No


10 Coronary Care 10




30 Burn Care 30













95 Nursery Acute 95













175 Clinics 175















Line No

REVENUE PRODUCING CENTERS (16) Net Revenue Minus

Net Costs Column (14)

minus (9)

(17) Average Unit Net

Column (16) ÷ (1)

Line No


10 Coronary Care 10




30 Burn Care 30













95 Nursery Acute 95













175 Clinics 175














Line No

REVENUE PRODUCING CENTERS (1)Units ofService


(2)AdjustedDirect Expenses


(3)AllocatedCosts

Column(4) minus (2)

(4)Total PatientCare Costs fromPage 20, Column

(16),Lines 505 - 915

(5)Average UnitPatient Care

Costs, Column (4) ÷ (1)

Line No

230ANCILLARY SERVICES:Labor and Delivery Services 230


240 Ambulatory Surgery Services 240

245 Anesthesiology 245

250 Medical Supplies Sold to Patients 250

255 Durable Medical Equipment 255

260 Clinical Laboratory Services 260

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 295

300 Radiology - Diagnostic 300

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 330

335 Respiratory Therapy 335

340 Pulmonary Function Services 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



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.



Line No

REVENUE PRODUCING CENTERS (6) Reallocated Net Research Costs from

Page 20, Col.(17), Lines 505-

915

(7) Reallocated Net Education

Costs from Page 20, Cols.

(18) + (19) + (20) +(21), Lines 505

- 915

(8) Transfers for Operating Costs from

Page 20, Column (22),

Lines 505 - 915

(9) Net Costs as Reallocated Column

(4) + (6) +(7) - (8)

(10) Average Unit Cost Column (9)

÷ (1)

Line No









270 Blood Bank 270
















350 Lithotripsy 350

























Line No

REVENUE PRODUCING CENTERS (11) Gross Revenue from Page 12, Columns (21) + (22)

(12)Deductions from Revenue from Page 12,

Column 23 Line 455 - 457

(13)Adjustment for Professional

Component from Page 15, Columns (9) &

(13)

(14)Net Revenue Column (11) - (12) -

(13)

(15)Average Unit Net Revenue Column (14) ÷ (1)

Line No









270 Blood Bank 270
















350 Lithotripsy 350
























Line No

REVENUE PRODUCING CENTERS (16) Net Revenue Minus

Net Costs Column (14)

minus (9)

(17) Average Unit Net Column (16) ÷

(1)

Line No









270 Blood Bank 270
















350 Lithotripsy 350























MEDICARE

Traditional Managed Care

Line No

PATIENT REVENUE PRODUCING CENTERS Account

No

(1) Gross Inpatient Revenue

(2) Gross Outpatient Revenue



Line No

Revenue Subclassifications .04 .44 .14 .54

5DAILY HOSPITAL SERVICES:Medical/Surgical Intensive Care 3010 $31,778,620 $9,060,539 5

10 Coronary Care 3030 10

15 Pediatric Intensive Care 3050 15

20 Neonatal Intensive Care 3070 $379 20

25 Psychiatric Intensive (Isolation) Care 3090 25

30 Burn Care 3110 30

35 Other Intensive Care 3130 35

40 Definitive Observation 3150 40

45 Medical/Surgical Acute 3170 $95,521,678 $21,967,120 45

50 Pediatric Acute 3290 50

55 Psychiatric Acute - Adult 3340 55

60 Psychiatric Acute - Adolescent and Child 3360 60

65 Obstetrics Acute 3380 $27,697 $18,753 65

70 Alternate Birthing Center 3400 70

75 Chemical Dependency Services 3420 75

80 Physical Rehabilitation Care 3440 80

85 Hospice - Inpatient Services 3470 85

90 Other Acute Care 3510 90

95 Nursery Acute 3530 95

100 Sub-Acute Care 3560 $2,350,708 $118,728 100

101 Sub-Acute Care - Pediatric 3570 101

105 Skilled Nursing Care 3580 105

110 Psychiatric - Long Term Care 3610 110

115 Intermediate Care 3630 115

120 Residential Care 3680 120

125 Other Long-Term Care Services 3780 125

145 Other Daily Hospital Services 3900 145

150 TOTAL DAILY HOSPITAL SERVICES $129,678,703 $31,165,519 150

160AMBULATORY SERVICES:Emergency Services 4010 $16,322,284 $21,953,564 $4,418,601 $6,319,583 160

165 Medical Transportation Services 4040 165

170 Psychiatric Emergency Rooms 4060 170

175 Clinics 4070 $132,700 $14,626,886 $2,277 $1,539,836 175

180 Satellite Clinics 4180 180

185 Satellite Ambulatory Surgery Center 4200 185

190 Outpatient Chemical Dependency Services 4220 190

195 Observation Care 4230 $2,136,301 $8,320,266 $541,180 $3,485,060 195

200 Partial Hospitalization - Psychiatric 4260 200

205 Home Health Care Services 4290 205

210 Hospice - Outpatient Services 4310 210

215 Adult Day Health Care Services 4320 215

220 Other Ambulatory Services 4390 220

225 TOTAL AMBULATORY SERVICES $18,591,285 $44,900,716 $4,962,058 $11,344,479 225

12 SUPPLEMENTAL PATIENT REVENUE INFORMATION




Report Period End: 06/30/2014


Facility D.B.A. Name : O'CONNOR HOSPITAL

MEDI-CAL


Line No


No





Line No





20 Neonatal Intensive Care 3070 $2,748,080 $7,174,583 20






50 Pediatric Acute 3290 $1,578,180 $3,989,211 50



65 Obstetrics Acute 3380 $20,353,492 $20,806,339 65







100 Sub-Acute Care 3560 $8,560,819 $874,753 100









160AMBULATORY SERVICES:Emergency Services 4010 $4,298,734 $12,726,946 $3,725,426 $38,608,536 160



175 Clinics 4070 $1,060 $11,320 $247,880 175




195 Observation Care 4230 $451,349 $1,264,611 $450,714 $2,230,285 195






225 TOTAL AMBULATORY SERVICES $4,751,143 $14,002,877 $4,176,140 $41,086,701 225






COUNTY INDIGENT PROGRAMS


Line No


No





Line No


5DAILY HOSPITAL SERVICES:Medical/Surgical Intensive Care 3010 5



20 Neonatal Intensive Care 3070 20





45 Medical/Surgical Acute 3170 45




65 Obstetrics Acute 3380 65







100 Sub-Acute Care 3560 100









160AMBULATORY SERVICES:Emergency Services 4010 160



175 Clinics 4070 175




195 Observation Care 4230 195









OTHER THIRD PARTIES


Line No


No





Line

Revenue Subclassifications .02, .03, .06 .42, .43, .46 .12,.13,.16 .52, .53, .56 No

5DAILY HOSPITAL SERVICES:Medical/Surgical Intensive Care 3010 $723,827 $8,708,428 5



20 Neonatal Intensive Care 3070 $3,779,353 20





45 Medical/Surgical Acute 3170 $843,852 $30,759,162 45

50 Pediatric Acute 3290 $2,840,719 50



65 Obstetrics Acute 3380 $24,480,947 65







100 Sub-Acute Care 3560 $2,582,014 100









160AMBULATORY SERVICES:Emergency Services 4010 $111,795 $2,379,187 $6,684,520 $33,675,464 160



175 Clinics 4070 $221,150 $2,914 $3,170,538 175




195 Observation Care 4230 $19,319 $143,024 $908,870 $5,959,023 195






225 TOTAL AMBULATORY SERVICES $131,114 $2,743,361 $7,596,304 $42,805,025 225





OTHER INDIGENT OTHER PAYORS

Line No


No





Line

Revenue Subclassifications .08 .48 .00, .09 .40, .49 No

5DAILY HOSPITAL SERVICES:Medical/Surgical Intensive Care 3010 $1,379,288 5



20 Neonatal Intensive Care 3070 $2,509 20





45 Medical/Surgical Acute 3170 $3,523,466 45

50 Pediatric Acute 3290 $292,584 50



65 Obstetrics Acute 3380 $1,161,997 65















150 TOTAL DAILY HOSPITAL SERVICES $6,359,844 150

160AMBULATORY SERVICES:Emergency Services 4010 $1,081,997 $14,461,992 160



175 Clinics 4070 $6,104 175




195 Observation Care 4230 $152,004 $998,218 195






225 TOTAL AMBULATORY SERVICES $1,234,001 $15,466,314 225





TOTAL

Line No


No



(23) Gross Patient Revenue

Line




20 Neonatal Intensive Care 3070 $13,704,904 $13,704,904 20






50 Pediatric Acute 3290 $8,700,694 $8,700,694 50



65 Obstetrics Acute 3380 $66,849,225 $66,849,225 65







100 Sub-Acute Care 3560 $14,487,022 $14,487,022 100









160AMBULATORY SERVICES:Emergency Services 4010 $36,643,357 $130,125,272 $166,768,629 160



175 Clinics 4070 $138,951 $19,823,714 $19,962,665 175




195 Observation Care 4230 $4,659,737 $22,400,487 $27,060,224 195






225 TOTAL AMBULATORY SERVICES $41,442,045 $172,349,473 $213,791,518 225






DEDUCTIONS FROM REVENUE MEDICARE

Traditional MEDICARE

Managed CareInpatient Outpatient Total

420 Provision for Bad Debts $1,238,327 $663,661 $1,845,573 420

425 Contractual Adjustments (exclude capitation revenue) $287,564,795 $154,115,610 $118,615,213 425

426Disproportionate share payments for Medi-Cal patient days (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 450

455 TOTAL DEDUCTIONS FROM REVENUE $288,803,122 $154,779,271 $120,460,786 455

457 CAPITATION PREMIUM REVENUE 457

460 NET PATIENT REVENUE (Line 415 - 455 + 457) $59,014,413 $31,627,802 $21,793,323 460


MEDICARE


Line No


No




(4) Gross Outpatient Revenue Line

No


230ANCILLARY SERVICES:Labor and Delivery Services 4400 $24,114 $8,011 $9,365 $1,676 230

235 Surgery and Recovery Services 4420 $31,244,412 $19,431,686 $12,804,916 $6,665,764 235

240 Ambulatory Surgery Services 4430 $6,506 $1,924,091 $8,824 $592,347 240

245 Anesthesiology 4450 $3,297,831 $2,291,580 $1,226,834 $770,878 245

250 Medical Supplies sold to Patients 4470 $27,137,545 $15,845,580 $9,059,761 $4,615,685 250

255 Durable Medical Equipment 4480 255

260 Clinical Laboratory Services 4500 $39,166,874 $15,035,445 $10,288,857 $4,695,687 260

265 Pathological Laboratory Services 4520 $787,157 $929,267 $292,737 $267,491 265

270 Blood Bank 4540 $615,788 $217,827 $194,719 $64,525 270

275 Echocardiology 4560 275

280 Cardiac Catheterization Services 4570 $17,308,927 $19,145,149 $5,434,770 $4,710,695 280

285 Cardiology Services 4590 $7,924,659 $5,499,724 $2,015,580 $1,553,387 285

290 Electromyography 4610 290

295 Electroencephalography 4620 $215,275 $109,940 $61,265 295

300 Radiology - Diagnostic 4630 $6,900,887 $6,745,606 $1,923,622 300

305 Radiology - Therapeutic 4640 $5,102,306 $1,613,765 305

310 Nuclear Medicine 4650 $4,713,509 $394,102 $1,004,991 310

315 Magnetic Resonance Imaging 4660 $2,831,739 $691,981 $309,205 315

320 Ultrasonography 4670 $1,744,855 $1,651,477 $471,166 $343,859 320

325 Computed Tomographic Scanner 4680 $10,907,633 $12,159,762 $3,257,191 $3,188,756 325

330 Drugs Sold to Patients 4710 $27,185,835 $16,515,958 $5,793,391 $2,692,627 330

335 Respiratory Therapy 4720 $18,428,409 $795,294 $4,296,769 $269,306 335

340 Pulmonary Function Services 4730 340

345 Renal Dialysis 4740 $349,870 $487,144 $86,992 345

350 Lithotripsy 4750 350

355 Gastro-Intestinal Services 4760 355

360 Physical Therapy 4770 $4,322,848 $3,083,505 $2,981 $282,138 360

365 Speech- Language Pathology 4780 365

370 Occupational Therapy 4790 370

375 Other Physical Medicine 4800 375

380 Electroconvulsive Therapy 4820 380

385 Psychiatric/Psychological Testing 4830 385

390 Psychiatric Individual/Group Therapy 4840 390

395 Organ Acquisition 4860 395

400 Other Ancillary Services 4870 $2,327,992 $7,119,031 $543,840 $1,792,464 400

405 TOTAL ANCILLARY SERVICES $199,547,547 $141,506,357 $57,274,928 $37,507,125 405

415 TOTAL PATIENT REVENUE $347,817,535 $186,407,073 $93,402,505 $48,851,604 415



DEDUCTIONS FROM REVENUE

MEDI-CAL Traditional

Total

MEDI-CAL Managed Care

Total

420 Provision for Bad Debts $2,578,185 420

425 Contractual Adjustments (exclude capitation revenue) $126,886,774 $173,979,371 425


430 Charity $807,685 $1,117,117 430


435




455 TOTAL DEDUCTIONS FROM REVENUE $127,694,459 $177,674,673 455


460 NET PATIENT REVENUE (Line 415 - 455 + 457) $15,983,928 $21,048,124 460




MEDI-CAL


Line No


No





Line No


230ANCILLARY SERVICES:Labor and Delivery Services 4400 $11,281,457 $2,112,369 $11,607,292 $2,550,170 230

235 Surgery and Recovery Services 4420 $3,507,640 $1,096,786 $5,053,471 $7,185,458 235

240 Ambulatory Surgery Services 4430 $63,183 $1,063 $880,031 240

245 Anesthesiology 4450 $455,795 $148,236 $628,596 $1,018,432 245

250 Medical Supplies sold to Patients 4470 $7,008,328 $1,551,771 $7,510,327 $6,578,369 250


260 Clinical Laboratory Services 4500 $10,623,913 $4,796,129 $9,265,453 $10,300,452 260


270 Blood Bank 4540 $98,130 $1,989 $79,921 $11,897 270


280 Cardiac Catheterization Services 4570 $3,828,940 $424,046 $3,144,973 $3,743,832 280

285 Cardiology Services 4590 $1,408,508 $670,803 $1,018,722 $1,851,057 285



300 Radiology - Diagnostic 4630 $871,396 $3,645,571 300

305 Radiology - Therapeutic 4640 $42,793 $393,087 305

310 Nuclear Medicine 4650 $121,998 $165,646 $415,794 310

315 Magnetic Resonance Imaging 4660 $637,877 $99,030 $274,577 315

320 Ultrasonography 4670 $630,384 $873,127 $605,699 $1,655,433 320

325 Computed Tomographic Scanner 4680 $2,333,749 $2,354,260 $1,737,549 $4,742,917 325

330 Drugs Sold to Patients 4710 $6,088,503 $832,892 $6,070,858 $3,861,773 330

335 Respiratory Therapy 4720 $5,648,471 $88,300 $3,168,790 $427,697 335


345 Renal Dialysis 4740 $572,548 $12,975 $324,678 $43,177 345



360 Physical Therapy 4770 $530,358 $42,328 $262,773 $693,087 360








400 Other Ancillary Services 4870 $664,641 $279,179 $388,976 $2,318,506 400






COUNTY INDIGENT PROGRAMS Traditional

CO. INDIGENT PROGRAMS


420 Provision for Bad Debts 420

425 Contractual Adjustments (exclude capitation revenue) 425


430 Charity 430


435




455 TOTAL DEDUCTIONS FROM REVENUE 455


460 NET PATIENT REVENUE (Line 415 - 455 + 457) 460




COUNTY INDIGENT PROGRAMS


Line No

PATIENT REVENUE PRODUCING CENTERS

Account No





Line No


230ANCILLARY SERVICES:Labor and Delivery Services 4400 230

235 Surgery and Recovery Services 4420 235

240 Ambulatory Surgery Services 4430 240

245 Anesthesiology 4450 245

250 Medical Supplies sold to Patients 4470 250


260 Clinical Laboratory Services 4500 260

265 Pathological Laboratory Services 4520 265

270 Blood Bank 4540 270


280 Cardiac Catheterization Services 4570 280

285 Cardiology Services 4590 285


295 Electroencephalography 4620 295

300 Radiology - Diagnostic 4630 300

305 Radiology - Therapeutic 4640 305

310 Nuclear Medicine 4650 310

315 Magnetic Resonance Imaging 4660 315

320 Ultrasonography 4670 320

325 Computed Tomographic Scanner 4680 325

330 Drugs Sold to Patients 4710 330

335 Respiratory Therapy 4720 335


345 Renal Dialysis 4740 345



360 Physical Therapy 4770 360








400 Other Ancillary Services 4870 400


415 TOTAL PATIENT REVENUE 415




OTHER THIRD PARTIES Traditional

OTHER THIRD PARTIES


420 Provision for Bad Debts $64,954 $82,751 $4,544,169 420

425 Contractual Adjustments (exclude capitation revenue) $3,876,076 $4,938,123 $239,413,303 425


430 Charity 430


435




455 TOTAL DEDUCTIONS FROM REVENUE $3,941,030 $5,020,874 $243,957,472 455


460 NET PATIENT REVENUE (Line 415 - 455 + 457) $1,065,500 $1,357,447 $106,300,611 460

OTHER THIRD PARTIES


Line No


Account No





Line No

Revenue Subclassifications .02, .03, .06 .42, .43, .46 .12,.13,.16 .52, .53, .56

230ANCILLARY SERVICES:Labor and Delivery Services 4400 $3,827 $13,009,969 $1,305,682 230

235 Surgery and Recovery Services 4420 $1,017,731 $835,449 $20,096,432 $21,542,926 235

240 Ambulatory Surgery Services 4430 $106,370 $3,360 $1,686,848 240

245 Anesthesiology 4450 $100,700 $140,717 $2,397,204 $2,944,830 245

250 Medical Supplies sold to Patients 4470 $651,203 $504,822 $18,409,104 $13,399,712 250


260 Clinical Laboratory Services 4500 $346,211 $247,769 $16,401,063 $14,109,788 260


270 Blood Bank 4540 $549 $184,881 $98,336 270


280 Cardiac Catheterization Services 4570 $227,986 $8,678,468 $7,424,391 280

285 Cardiology Services 4590 $87,411 $2,523,873 $4,069,361 285


295 Electroencephalography 4620 $7,899 $315,622 295

300 Radiology - Diagnostic 4630 $43,019 $405,923 $1,064,147 $5,209,492 300

305 Radiology - Therapeutic 4640 $216,869 $6,200,826 305

310 Nuclear Medicine 4650 $47,785 $625,703 $3,328,573 310

315 Magnetic Resonance Imaging 4660 $42,814 $123,277 $1,417,802 $1,895,905 315

320 Ultrasonography 4670 $10,102 $23,532 $979,808 $2,698,612 320

325 Computed Tomographic Scanner 4680 $130,004 $414,651 $4,532,248 $11,124,778 325

330 Drugs Sold to Patients 4710 $347,681 $164,439 $11,819,967 $11,497,111 330

335 Respiratory Therapy 4720 $203,831 $11,141 $4,795,711 $561,002 335


345 Renal Dialysis 4740 $614,371 $97,205 345



360 Physical Therapy 4770 $178,937 $486,471 $1,003,523 $2,220,626 360








400 Other Ancillary Services 4870 $498 $14,718 $48,235 $4,761,161 400







DEDUCTIONS FROM REVENUE OTHER INDIGENT OTHER PAYORS

Inpatient Outpatient Inpatient Outpatient

420 Provision for Bad Debts $211,035 $383,728 420

425 Contractual Adjustments (exclude capitation revenue) 425


430 Charity $6,146,665 $11,176,554 430


435



450 Other Deductions $13,095,457 $23,811,624 450

455 TOTAL DEDUCTIONS FROM REVENUE $19,453,157 $35,371,906 455


460 NET PATIENT REVENUE (Line 415 - 455 + 457) ($3,186,857) ($5,794,698) 460

OTHER INDIGENT OTHER PAYORS

Line No


Account No





Line No

Revenue Subclassifications .08 .48 .00, .09 .40, .49

230ANCILLARY SERVICES:Labor and Delivery Services 4400 $729,107 $270,070 230

235 Surgery and Recovery Services 4420 $916,824 $487,871 235

240 Ambulatory Surgery Services 4430 $10,219 240

245 Anesthesiology 4450 $130,764 $50,562 245

250 Medical Supplies sold to Patients 4470 $1,036,618 $1,104,970 250


260 Clinical Laboratory Services 4500 $1,995,994 $5,767,178 260

265 Pathological Laboratory Services 4520 $24,822 $16,843 265

270 Blood Bank 4540 $21,445 $4,547 270


280 Cardiac Catheterization Services 4570 $768,507 $146,738 280

285 Cardiology Services 4590 $114,594 $924,214 285





310 Nuclear Medicine 4650 $26,266 $51,920 310

315 Magnetic Resonance Imaging 4660 $168,231 $82,646 315

320 Ultrasonography 4670 $147,955 $484,103 320

325 Computed Tomographic Scanner 4680 $624,062 $2,779,618 325

330 Drugs Sold to Patients 4710 $1,133,133 $557,145 330

335 Respiratory Therapy 4720 $440,494 $92,795 335





360 Physical Therapy 4770 $141,502 $89,549 360








400 Other Ancillary Services 4870 $64,869 $40,364 400

405 TOTAL ANCILLARY SERVICES $8,672,455 $14,110,894 405

415 TOTAL PATIENT REVENUE $16,266,300 $29,577,208 415





DEDUCTIONS FROM REVENUETotal Inpatient Total Outpatient Total

420 Provision for Bad Debts $11,612,383 420

425 Contractual Adjustments (exclude capitation revenue) $1,109,389,265 425


430 Charity $19,248,021 430


435



450 Other Deductions $36,907,081 450

455 TOTAL DEDUCTIONS FROM REVENUE $1,177,156,750 455


460 NET PATIENT REVENUE (Line 415 - 455 + 457) $249,209,593 460

TOTAL

Line No


Account No



(23) Gross patient Revenue Line

No

230ANCILLARY SERVICES:Labor and Delivery Services 4400 $36,661,304 $6,251,805 $42,913,109 230

235 Surgery and Recovery Services 4420 $74,641,426 $57,245,940 $131,887,366 235

240 Ambulatory Surgery Services 4430 $19,753 $5,263,089 $5,282,842 240

245 Anesthesiology 4450 $8,237,724 $7,365,235 $15,602,959 245

250 Medical Supplies sold to Patients 4470 $70,812,886 $43,600,909 $114,413,795 250


260 Clinical Laboratory Services 4500 $88,088,365 $54,952,448 $143,040,813 260

265 Pathological Laboratory Services 4520 $2,137,812 $2,197,519 $4,335,331 265

270 Blood Bank 4540 $1,195,433 $399,121 $1,594,554 270


280 Cardiac Catheterization Services 4570 $39,392,571 $35,594,851 $74,987,422 280

285 Cardiology Services 4590 $15,005,936 $14,655,957 $29,661,893 285



300 Radiology - Diagnostic 4630 $8,191,818 $19,945,281 $28,137,099 300

305 Radiology - Therapeutic 4640 $216,869 $13,352,777 $13,569,646 305

310 Nuclear Medicine 4650 $1,211,717 $9,684,570 $10,896,287 310

315 Magnetic Resonance Imaging 4660 $2,958,705 $5,616,379 $8,575,084 315

320 Ultrasonography 4670 $4,589,969 $7,730,143 $12,320,112 320

325 Computed Tomographic Scanner 4680 $23,522,436 $36,764,742 $60,287,178 325

330 Drugs Sold to Patients 4710 $58,439,368 $36,121,945 $94,561,313 330

335 Respiratory Therapy 4720 $36,982,475 $2,245,535 $39,228,010 335


345 Renal Dialysis 4740 $1,998,741 $590,219 $2,588,960 345



360 Physical Therapy 4770 $6,442,922 $6,897,704 $13,340,626 360








400 Other Ancillary Services 4870 $4,039,051 $16,325,423 $20,364,474 400

405 TOTAL ANCILLARY SERVICES $485,073,579 $383,321,829 $868,395,408 405

415 TOTAL PATIENT REVENUE $870,695,041 $555,671,302 $1,426,366,343 415





Line No

SUPPLEMENTAL OTHER OPERATING REVENUE INFORMATION Account No.

(1) Other Operating Revenue

Line No

5PART I: COST REDUCTIONS DISTRIBUTED TO SEVERAL COST CENTERSDonated Commodities 5650 5

10 Cash Discounts of Purchases 5660 10

15 Sale of Scrap and Waste 5670 15

20 Rebates and Refunds 5680 20

25 Other Commissions 5710 25

30 Non-Patient Room Rentals 5730 30

35 Other (Specify) 35

40 NURSING SERVICE REVENUE $68,893 40

45 45

50 50

65PART II: MINOR RECOVERIES DISTRIBUTED TO ONE COST CENTERTelephone and Telegraph Revenue 5470 65

70 Donated Blood 5750 70

75 Vending Machine Commissions 5690 $33,063 75

80 Television/Radio Rentals 5720 80

85 Finance Charges on Patient Accounts Receivable 5520 85

90 Child Care Services Revenue - Employees 5760 90

95 Other (Specify) NUTRITIONAL EDUCATION 95

100 SPORTS MEDICINE 100

105 105

110 FAMILY PLANNING REVENUES $42,972 110

115 115

120 TOTAL PARTS I AND II $144,928 120

130PART III: OTHER OPERATING REVENUE ALLOCATEDNon-Patient Food Sales 5320 $1,233,510 130

135 Laundry and Linen Revenue 5340 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 170

175 Medical Records Abstracts Sales 5700 $12,054 175

180 Management Services Revenue 5740 180

185 Transfers from Restricted Funds for Operations (Non-Revenue Centers) 5790 185

190 Worker's Compensation Refunds 5782 190

195 Community Health Education Revenue 5770 195

196 Reinsurance Recoveries 5781 196

200 Other (Specify) MISC REVENUES $3,290,186 200

205 205

210 210

215 215

220 TOTAL PART III $4,535,750 220

225PART IV: RESEARCH & EDUCATION REVENUES AND TRANSFERSTransfers from Restricted Funds for Research Expense 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 275

280 TOTAL OTHER OPERATING REVENUE (Sum of Lines 120,220 and 275) $4,680,678 280

14 SUPPLEMENTAL OTHER OPERATING REVENUE INFORMATION




COMPENSATION

Line No


(1) Salaries

and Wages

(2) Employee

Benefits

(3) Professional Fees

(4) Total

Compensation Line No

Natural Classification Code No .07 .10-.19 .20

DAILY HOSPITAL SERVICES

5 Medical/Surgical Intensive Care 6010 $72,000 $72,000 5



20 Neonatal Intensive Care 6070 $127,365 $127,365 20





45 Medical/Surgical Acute 6170 $14,300 $14,300 45



60 Psychiatric Acute - Adolescent & Child 6360 60





85 Hospice - Inpatient Care 6470 85



100 Sub-Acute Care 6560 $4,820 $4,820 100



110 Psychiatric Long-Term Care 6610 110





150 TOTAL DAILY HOSPITAL SERVICES $218,485 $218,485 150

AMBULATORY SERVICES

160 Emergency Services 7010 $3,479,620 $3,479,620 160



175 Clinics 7070 $39,600 $39,600 175



190 Outpatient Chemical Dependency Svcs. 7220 190







225 TOTAL AMBULATORY SERVICES $3,519,220 $3,519,220 225

15 RECLASSIFICATION WORKSHEET- PHYSICIAN AND STUDENT COMPENSATION -PATIENT REVENUE PRODUCING CENTERS




PERCENT OF TIME SPENT BY FUNCTION

Line No


No

(5) Research

Supported by Hospital

(6) Medical

Education Supported by Hospital (Non-

Inservice)

(7) General

Administration and Hospital Committees

(8) Nursing and

Paramedical Care of Hospital

Patients

Line No


5 Medical/Surgical Intensive Care 6010 $72,000 5



20 Neonatal Intensive Care 6070 $127,365 20





45 Medical/Surgical Acute 6170 $14,300 45











100 Sub-Acute Care 6560 $4,820 100








150 TOTAL DAILY HOSPITAL SERVICES $218,485 150

AMBULATORY SERVICES

160 Emergency Services 7010 $3,479,620 160



175 Clinics 7070 $39,600 175










225 TOTAL AMBULATORY SERVICES $3,519,220 225






Line No


No

(9) Physician and Intern/Resident Care of Hospital

Patients

(10) Supervision and Other Functions

of the Cost Center

(13) Allocation of

Page 16, Column(9), to Revenue Centers (See Instructions)

Line No


5 Medical/Surgical Intensive Care 6010 5




























AMBULATORY SERVICES

160 Emergency Services 7010 160



175 Clinics 7070 175















COMPENSATION

Line No


(1) Salaries

and Wages

(2) Employee

Benefits

(3) Professional

Fees

(4) Total


Natural Classification Code No .07 .10-.19 .20

ANCILLARY SERVICES

230 Labor and Delivery Services 7400 $1,782,795 $1,782,795 230




250 Medical Supplies Sold to Patients 7470 250


260 Clinical Laboratory Services 7500 $243,813 $243,813 260


270 Blood Bank 7540 270


280 Cardiac Catheterization Services 7570 $158,508 $158,508 280



295 Electroencephalography 7620 $950 $950 295

300 Radiology - Diagnostic 7630 $532,929 $532,929 300







335 Respiratory Therapy 7720 $364,842 $364,842 335


345 Renal Dialysis 7740 $7,475 $7,475 345




365 Speech-Language Pathology 7780 365








405 TOTAL ANCILLARY SERVICES $3,312,462 $3,312,462 405






Line No


No

(5) Research


(6) Medical


Inservice)

(7) General


(8) Nursing and


Patients

Line No

ANCILLARY SERVICES

230 Labor and Delivery Services 7400 $1,782,795 230

235 Surgery and Recovery Services 7420 $135,000 235





260 Clinical Laboratory Services 7500 $243,813 260


270 Blood Bank 7540 270


280 Cardiac Catheterization Services 7570 $158,508 280

285 Cardiology Services 7590 $7,200 285


295 Electroencephalography 7620 $950 295

300 Radiology - Diagnostic 7630 $532,929 300

305 Radiology - Therapeutic 7640 $18,950 305


315 Magnetic Resonance Imaging 7660 $60,000 315




335 Respiratory Therapy 7720 $364,842 335


345 Renal Dialysis 7740 $7,475 345












405 TOTAL ANCILLARY SERVICES $3,312,462 405






Line No


No


Patients


of the Cost Center

(13) Allocation of

Page 16, Column(9), to Revenue Centers (See Instructions)

Line No

ANCILLARY SERVICES

230 Labor and Delivery Services 7400 230








270 Blood Bank 7540 270
































COMPENSATION

Line No

NON-REVENUE PRODUCING CENTERS Account No

(1) Salaries

and Wages

(2) Employee

Benefits


(4) Total


Natural Classification Code .07,.09 .10-.19 .20

RESEARCH COSTS

5 Research Projects and Administration 8010 5

10 TOTAL RESEARCH 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 $1,376,836 $1,376,836 30

35 Paramedical Education 8250 35

40 Student Housing 8260 40

45 Other Health Profession Education 8290 45

50 TOTAL EDUCATION $1,376,836 $1,376,836 50

ADMINISTRATIVE SERVICES

205 Hospital Administration 8610 205

210 Governing Board Expense 8620 210

215 Public Relations 8630 215

220 Management Engineering 8640 220

225 Personnel 8650 225

230 Employee Health Services 8660 230

235 Auxiliary Groups 8670 235

240 Chaplaincy Services 8680 240

245 Medical Library 8690 245

250 Medical Records 8700 250

255 Medical Staff Administration 8710 $107,000 $107,000 255

260 Nursing Administration 8720 260

265 Nursing Float Personnel 8730 265

270 Inservice Education - Nursing 8740 270

275 Utilization Management 8750 $275,713 $275,713 275

280 Community Health Education 8760 280

295 Other Administrative Services 8790 $32,149 $32,149 295

300 TOTAL ADMINISTRATIVE SERVICES $414,862 $414,862 300

TOTAL

305 TOTAL PAGES 15 AND 16 $8,841,865 $8,841,865 305

DO NOT INCLUDE ANY COMPENSATION LISTED ABOVE ON PAGE 17 OR 18, COLUMNS (1), (2) OR (4).

16 RECLASSIFICATION WORKSHEET - PHYSICIAN AND STUDENT COMPENSATION - NON-REVENUE PRODUCING CENTERS






Line No


Account No

(5) Research


(6) Medical


Inservice)

(7) General


(8) Nursing and


Patients

Line No

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education 8240 $1,376,836 30




50 TOTAL EDUCATION $1,376,836 50












255 Medical Staff Administration 8710 $107,000 255




275 Utilization Management 8750 $275,713 275


295 Other Administrative Services 8790 $32,149 295

300 TOTAL ADMINISTRATIVE SERVICES $414,862 300

TOTAL

305 TOTAL PAGES 15 AND 16 $8,841,865 305

TOTAL LINE 305 TO PAGE 18,

COLUMN(3), LINE 5

LINES 15-50 PAGE 16,TO

SAME LINES ON PAGE 18, COL.(3);

OTHERS TO PAGE 18,

COLUMN(3), LINE 15

TOTAL LINE 305 TO PAGE 18,

COLUMN(3) LINE 295

LINE ITEMS TO PAGE 17,

COLUMN(3) LINES AS

APPROPRIATE (SEE

INSTRUCTIONS)





Line No


No


Patients


of the Cost CenterLine No

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education 8240 30




50 TOTAL EDUCATION 50












255 Medical Staff Administration 8710 255




275 Utilization Management 8750 275


295 Other Administrative Services 8790 295

300 TOTAL ADMINISTRATIVE SERVICES 300

TOTAL

305 TOTAL PAGES 15 AND 16 305

LINE 50 TO PAGE 15, COLUMN(13)

(SEE INSTRUCTIONS)

LINE ITEMS TO PAGES 17 & 18,

COLUMN(3), LINES AS

APPROPRIATE (SEE

INSTRUCTIONS)





Line No

PATIENTREVENUE PRODUCING CENTERS Account

No

(1) Salaries

and Wages

(2) Employee

Benefits

(3) Reclassified

Physician and Student

Compensation Pages 15 &16, Cols. (8) & (10)


Line No

Natural Classification Code .00-.06,.08, .09,.91,.95

.10-.19,.92-.96 .07,.10-.19,.20 .21-.29


5 Medical/Surgical Intensive Care 6010 $8,908,465 $3,129,563 $34,483 5



20 Neonatal Intensive Care 6070 $3,402,943 $1,195,461 $35,932 20





45 Medical/Surgical Acute 6170 $22,742,915 $7,989,637 $361,506 45

50 Pediatric Acute 6290 $2,180,605 $766,051 $4,815 50



65 Obstetrics Acute 6380 $4,245,458 $1,491,438 $3,092 65






95 Nursery Acute 6530 $3,357,361 $1,179,448 $2,446 95

100 Sub-Acute Care 6560 $2,883,769 $1,013,074 $36,968 100








150 TOTAL DAILY HOSPITAL SERVICES $47,721,516 $16,764,672 $479,242 150

AMBULATORY SERVICES

160 Emergency Services 7010 $9,121,043 $3,204,242 $279,840 160



175 Clinics 7070 $1,956,447 $687,304 175




195 Observation Care 7230 $3,530,815 $1,240,383 $24,893 195






225 TOTAL AMBULATORY SERVICES $14,608,305 $5,131,929 $304,733 225

17 TRIAL BALANCE WORKSHEET AND SUPPLEMENTAL EXPENSE INFORMATION -PATIENT REVENUE PRODUCING CENTERS




Line No


No

(5) Supplies

(6) Purchased

Services

(7) Depreciation

(8) Leases

and Rentals Line No

Natural Classification Code .31-.50,.93,.97 .61-.69 .71-.74 .75-.76


5 Medical/Surgical Intensive Care 6010 $518,922 $11,088 $16,950 5



20 Neonatal Intensive Care 6070 $99,316 $4,715 20





45 Medical/Surgical Acute 6170 $1,004,696 $7,776 $968 45

50 Pediatric Acute 6290 $33,624 $1,058 50



65 Obstetrics Acute 6380 $129,459 $37,521 $5,963 65






95 Nursery Acute 6530 $102,378 $29,672 $4,715 95

100 Sub-Acute Care 6560 $294,539 $1,555,923 100








150 TOTAL DAILY HOSPITAL SERVICES $2,182,934 $1,647,753 $28,596 150

AMBULATORY SERVICES

160 Emergency Services 7010 $360,466 $84,859 $2,066 160



175 Clinics 7070 $159,093 $102,708 $811,732 175




195 Observation Care 7230 $109,618 195






225 TOTAL AMBULATORY SERVICES $629,177 $187,567 $813,798 225





Line No

PATIENTREVENUE PRODUCING CENTERS

Account No

(9) Other Direct

Expenses

(10) Total Direct Expenses

Columns (1) thru (9)

(11) Adjustments of Direct Expenses

from Page 14, Parts I & II

(12) (Optional) Adjusted Direct Expenses [Cols.

(10) minus (11)] to Page 20, Column

(1)

Line No

Natural Classification Code .77-.90,.94-.98


5 Medical/Surgical Intensive Care 6010 $4,883 $12,624,354 5



20 Neonatal Intensive Care 6070 $16,846 $4,755,213 20





45 Medical/Surgical Acute 6170 $12,034 $32,119,532 45

50 Pediatric Acute 6290 $617 $2,986,770 50



65 Obstetrics Acute 6380 $21,517 $5,934,448 65






95 Nursery Acute 6530 $17,016 $4,693,036 95

100 Sub-Acute Care 6560 $785 $5,785,058 100








150 TOTAL DAILY HOSPITAL SERVICES $73,698 $68,898,411 150

AMBULATORY SERVICES

160 Emergency Services 7010 $41,894 $13,094,410 160



175 Clinics 7070 $9,338 $3,726,622 $42,972 175




195 Observation Care 7230 $967 $4,906,676 195






225 TOTAL AMBULATORY SERVICES $52,199 $21,727,708 $42,972 225





Report Period End: O'CONNOR HOSPITALFacility D.B.A. Name :


Line No


No

(13) (Optional) Units of Service

from Page 4, Columns (4) + (5)

or Col(1)

(14)(Optional) Adjusted Direct Expenses Per

Unit Column (12) ÷ (13)

Line No


5 Medical/Surgical Intensive Care 6010 5




























AMBULATORY SERVICES

160 Emergency Services 7010 160



175 Clinics 7070 175











06/30/2014



Line No


No

(1) Salaries

and Wages

(2) Employee

Benefits

(3) Reclassified


Compensation Pages 15 &16, Cols. (8) & (10)

(4) Professional

Fees

Line No


.10-.19,.92-.96 .07,.10-.19,.20 .21-.29

ANCILLARY SERVICES

230 Labor and Delivery Services 7400 $7,105,441 $2,496,157 230

235 Surgery and Recovery Services 7420 $7,681,322 $2,698,465 $12,659 235

240 Ambulatory Surgery Services 7430 $1,898,668 $667,006 240




260 Clinical Laboratory Services 7500 $6,219,814 $2,185,034 $33,940 260


270 Blood Bank 7540 270


280 Cardiac Catheterization Services 7570 $2,518,479 $884,747 $9,111 280




300 Radiology - Diagnostic 7630 $1,357,628 $476,938 $15,716 300




320 Ultrasonography 7670 $436,458 $153,329 320

325 Computed Tomographic Scanner 7680 $2,129,137 $747,970 325


335 Respiratory Therapy 7720 $2,948,526 $1,035,823 $186,354 335


345 Renal Dialysis 7740 $726,554 $255,240 $39,085 345



360 Physical Therapy 7770 $3,457,239 $1,214,535 360








400 Other Ancillary Services 7870 $1,668,690 $586,214 400

405 TOTAL ANCILLARY SERVICES $40,877,817 $14,360,463 $301,955 405

PATIENT CARE SERVICES

410 Purchased Inpatient Services 7900 410

411 Purchased Outpatient Services 7950 411

415 TOTAL PATIENT CARE SERVICES $103,207,638 $36,257,064 $1,085,930 415





Line No


No

(5) Supplies

(6) Purchased Services

(7) Depreciation

(8) Leases

and Rentals Line No


ANCILLARY SERVICES

230 Labor and Delivery Services 7400 $804,595 $44,423 230


240 Ambulatory Surgery Services 7430 $50,429 $1,020 240

245 Anesthesiology 7450 $33,970 245

250 Medical Supplies Sold to Patients 7470 $22,032,411 250


260 Clinical Laboratory Services 7500 $2,466,270 $1,437,185 $23,777 260


270 Blood Bank 7540 $1,266,287 270


280 Cardiac Catheterization Services 7570 $313,323 $32,573 $388,708 280




300 Radiology - Diagnostic 7630 $70,860 $144,146 300




320 Ultrasonography 7670 $31,675 $208 320

325 Computed Tomographic Scanner 7680 $465,840 $3,384 325

330 Drugs Sold to Patients 7710 $4,985,135 330

335 Respiratory Therapy 7720 $42,713 $9,340 $56,221 335


345 Renal Dialysis 7740 $107,503 $999 345



360 Physical Therapy 7770 $38,345 $3,147 $178,219 360








400 Other Ancillary Services 7870 $64,710 $16,232 $175 400

405 TOTAL ANCILLARY SERVICES $34,611,701 $3,001,905 $647,100 405




415 TOTAL PATIENT CARE SERVICES $37,423,812 $4,837,225 $1,489,494 415





Line No

PATIENTREVENUE PRODUCING CENTERS

Account No

(9) Other Direct

Expenses







(1)

Line No


ANCILLARY SERVICES

230 Labor and Delivery Services 7400 $7,231 $10,457,847 230

235 Surgery and Recovery Services 7420 $33,134 $11,771,545 235

240 Ambulatory Surgery Services 7430 $6,447 $2,623,570 240

245 Anesthesiology 7450 $33,970 245

250 Medical Supplies Sold to Patients 7470 $22,032,411 250


260 Clinical Laboratory Services 7500 $102,106 $12,468,126 260

265 Pathological Laboratory Services 7520 $76 $894,112 265

270 Blood Bank 7540 $721 $1,267,008 270


280 Cardiac Catheterization Services 7570 $26,884 $4,173,825 280





305 Radiology - Therapeutic 7640 $80 $850,398 305

310 Nuclear Medicine 7650 $9,817 $2,339,342 310


320 Ultrasonography 7670 $604 $622,274 320

325 Computed Tomographic Scanner 7680 $3,346,331 325

330 Drugs Sold to Patients 7710 $4,985,135 330

335 Respiratory Therapy 7720 $7,091 $4,286,068 335


345 Renal Dialysis 7740 $1,129,381 345



360 Physical Therapy 7770 $15,007 $4,906,492 360








400 Other Ancillary Services 7870 $103 $2,336,124 400

405 TOTAL ANCILLARY SERVICES $308,347 $94,109,288 405




415 TOTAL PATIENT CARE SERVICES $434,244 $184,735,407 $42,972 415







Line No


No

(13) (Optional) Units of Service

from Page 4, Columns (4) + (5)

or Col(1)



Line No

ANCILLARY SERVICES

230 Labor and Delivery Services 7400 230








270 Blood Bank 7540 270































415 TOTAL PATIENT CARE SERVICES 415

06/30/2014



Line No

NON-REVENUEPRODUCING CENTERS Account

No

(1) Salaries

and Wages

(2) Employee

Benefits

(3) Reclassified


Compensation Pages 15 &16, Cols. (5),(6),(7),

(8)& (10)

(4) Professional

Fees

Line No


.10-.19,.92-.96 .07,.10-.19,.20 .21-.29

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education 8240 $1,492,027 $524,152 30




50 TOTAL EDUCATION $1,492,027 $524,152 50

GENERAL SERVICES

55 Printing and Duplicating 8310 $40,135 $14,100 55

60 Kitchen 8320 60

65 Non-Patient Food Services 8330 $1,704,977 $598,962 65

70 Dietary 8340 $1,161,803 $408,144 70

75 Laundry and Linen 8350 75

80 Social Work Services 8360 $432,062 $151,784 80

85 Central Transportation 8370 85

90 Central Services and Supplies 8380 $607,099 $213,275 90

95 Pharmacy 8390 $3,530,299 $1,240,202 95

100 Purchasing and Stores 8400 $883,509 $310,379 100

105 Grounds 8410 105

110 Security 8420 $103 $36 $713,989 110

115 Parking 8430 115

120 Housekeeping 8440 $2,844,553 $999,298 120

125 Plant Operations 8450 125

130 Plant Maintenance 8460 $2,359,451 $828,880 $12,933 130

135 Communications 8470 $380,403 $133,636 135

140 Data Processing 8480 $516,744 $181,533 140

145 Other General Services 8490 145

150 TOTAL GENERAL SERVICES $14,461,138 $5,080,229 $726,922 150

FISCAL SERVICES

155 General Accounting 8510 $454,865 $159,795 155

160 Patient Accounting 8530 160

165 Credit and Collection 8550 165

170 Admitting 8560 $2,081,282 $731,159 170

175 Outpatient Registration 8570 175

195 Other Fiscal Services 8590 195

200 TOTAL FISCAL SERVICES $2,536,147 $890,954 200


18 TRIAL BALANCE WORKSHEET AND SUPPLEMENTAL EXPENSE INFORMATION NON-REVENUE PRODUCING CENTERS



Line No

NON-REVENUEPRODUCING CENTERS Account

No

(5) Supplies


(7) Depreciation

(8) Leases and

Rentals Line No


RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education 8240 $8,515 $20,396 $54,103 30




50 TOTAL EDUCATION $8,515 $20,396 $54,103 50

GENERAL SERVICES


60 Kitchen 8320 60

65 Non-Patient Food Services 8330 $747,278 $46,774 65

70 Dietary 8340 $509,204 $31,872 70

75 Laundry and Linen 8350 $44,331 $839,656 75



90 Central Services and Supplies 8380 $109,635 $304,892 $845,216 90

95 Pharmacy 8390 $2,626,690 $15,958 $454,780 95

100 Purchasing and Stores 8400 $6,338 $313,993 100

105 Grounds 8410 105

110 Security 8420 $76,285 $27,179 110

115 Parking 8430 115

120 Housekeeping 8440 $450,305 $884,784 120


130 Plant Maintenance 8460 $362,338 $4,035,246 130

135 Communications 8470 $9,049 $48,684 $247 135

140 Data Processing 8480 $41,896 $9,688,111 140


150 TOTAL GENERAL SERVICES $4,984,556 $16,062,210 $1,614,236 150

FISCAL SERVICES

155 General Accounting 8510 $89,524 155

160 Patient Accounting 8530 $1,077,273 160


170 Admitting 8560 $49,378 $18,724 170



200 TOTAL FISCAL SERVICES $49,378 $1,185,521 200





Line No

NON REVENUEPRODUCING CENTERS

Account No

(9) Other Direct

Expenses







(1)

Line No


RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education 8240 $361,623 $2,460,816 30




50 TOTAL EDUCATION $361,623 $2,460,816 50

GENERAL SERVICES


60 Kitchen 8320 60

65 Non-Patient Food Services 8330 $2,811 $3,100,802 65

70 Dietary 8340 $1,915 $2,112,938 70

75 Laundry and Linen 8350 $883,987 75



90 Central Services and Supplies 8380 $2,516 $2,082,633 90

95 Pharmacy 8390 $60,516 $7,928,445 95

100 Purchasing and Stores 8400 $9,109 $1,523,328 100

105 Grounds 8410 105

110 Security 8420 $9,106 $826,698 110

115 Parking 8430 115

120 Housekeeping 8440 $15,085 $5,194,025 120


130 Plant Maintenance 8460 $2,686,539 $10,285,387 130

135 Communications 8470 $147,682 $719,701 135

140 Data Processing 8480 $393,027 $10,821,311 140


150 TOTAL GENERAL SERVICES $3,389,996 $46,319,287 150

FISCAL SERVICES

155 General Accounting 8510 $39,912 $744,096 155

160 Patient Accounting 8530 $45,874 $1,123,147 160


170 Admitting 8560 $1,019 $2,881,562 170



200 TOTAL FISCAL SERVICES $86,805 $4,748,805 200







Line No

NON REVENUEPRODUCING CENTERS Account

No

(13) Units of Service



Line No

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education 8240 24 30





GENERAL SERVICES

55 Printing and Duplicating 8310 16,585 55

60 Kitchen 8320 60

65 Non-Patient Food Services 8330 146,113 65

70 Dietary 8340 141,267 70

75 Laundry and Linen 8350 1,194,651 75

80 Social Work Services 8360 18,170 80


90 Central Services and Supplies 8380 80,242 90

95 Pharmacy 8390 80,360 95

100 Purchasing and Stores 8400 40,283 100

105 Grounds 8410 105

110 Security 8420 1,232 110

115 Parking 8430 115

120 Housekeeping 8440 365,159 120


130 Plant Maintenance 8460 397,248 130

135 Communications 8470 1,232 135

140 Data Processing 8480 1,426,366 140


150 TOTAL GENERAL SERVICES 150

FISCAL SERVICES

155 General Accounting 8510 1,232 155

160 Patient Accounting 8530 1,426,366 160


170 Admitting 8560 10,991 170



200 TOTAL FISCAL SERVICES 200

06/30/2014




Line No


No

(1) Salaries

and Wages

(2) Employee

Benefits

(3) Reclassified


Compensation Pages 15 & 16,

Cols. (5),(6),(7),(8) & (10)

(4) Professional

Fees

Line No


.10-.19,.92-.96 .07,.10-.19,.20 .21-.29


205 Hospital Administration 8610 $5,959,598 $2,093,618 $228,265 205


215 Public Relations 8630 $202,141 $71,013 215


225 Personnel 8650 $506,077 $177,786 $12,897 225

230 Employee Health Services 8660 $665,696 $233,860 230

235 Auxiliary Groups 8670 $408,407 $143,474 235

240 Chaplaincy Services 8680 $347,488 $122,073 240

245 Medical Library 8690 $64,710 $22,733 245

250 Medical Records 8700 $1,768,400 $621,243 250

255 Medical Staff Administration 8710 $289,505 $101,704 $108,304 255

260 Nursing Administration 8720 $1,735,613 $609,725 $16,157 260


270 Inservice Education - Nursing 8740 $422,994 $148,599 270

275 Utilization Management 8750 $4,410,150 $1,549,295 $3,162 275

280 Community Health Education 8770 $415 $146 280

295 Other Administrative Services 8790 $1,203,315 $422,727 $8,841,865 295

300 TOTAL ADMINISTRATIVE SERVICES $17,984,509 $6,317,996 $8,841,865 $368,785 300

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) $139,681,459 $49,070,395 $8,841,865 $2,181,637 365

370 Non-Operating Cost Centers 370

375 TOTAL COSTS $139,681,459 $49,070,395 $8,841,865 $2,181,637 375




06/30/2014Facility D.B.A. Name : Report Period End: O'CONNOR HOSPITAL

Line No


No

(5) Supplies


(7) Depreciation

(8) Leases and

Rentals Line No



205 Hospital Administration 8610 $107,785 $10,668,974 $53,280 $20,744 205




225 Personnel 8650 $11,458 $102,514 225




245 Medical Library 8690 $30,365 245

250 Medical Records 8700 $59,436 $528,838 250


260 Nursing Administration 8720 $8,007 $46,524 260



275 Utilization Management 8750 $38,243 $315,759 275


295 Other Administrative Services 8790 $23,724 $118,001 295

300 TOTAL ADMINISTRATIVE SERVICES $327,048 $12,163,953 $53,280 $20,744 300

UNASSIGNED COSTS

305 Depreciation and Amortization 8810 $12,472,055 305


315 Insurance - Hosp and Prof. Malpractice 8830 315


325 Lic. & Other Taxes (Other than income) 8850 325





360 TOTAL UNASSIGNED COSTS $12,472,055 360

TOTAL

365 TOTAL OPERATING COSTS (17 & 18) $42,793,309 $34,269,305 $12,525,335 $3,178,577 365

370 Non-Operating Cost Centers $129,592 $448,450 $17,874 $882,702 370

375 TOTAL COSTS $42,922,901 $34,717,755 $12,543,209 $4,061,279 375

18 TRIAL BALANCE WORKSHEET AND SUPPLEMENTAL EXPENSE INFORMATION -NON-REVENUE PRODUCING CENTERS




Line No

NON REVENUE PRODUCING CENTERS

Account No

(9) Other Direct

Expenses







(1)

Line No



205 Hospital Administration 8610 $6,885,885 $26,018,149 $33,063 205




225 Personnel 8650 $729,455 $1,540,187 225




245 Medical Library 8690 $20,435 $138,243 245

250 Medical Records 8700 $15,864 $2,993,781 250


260 Nursing Administration 8720 $60,979 $2,477,005 $68,893 260



275 Utilization Management 8750 $184,066 $6,500,675 275

280 Community Health Education 8770 $561 280

295 Other Administrative Services 8790 $78,577 $10,688,209 295

300 TOTAL ADMINISTRATIVE SERVICES $8,757,148 $54,835,328 $101,956 300

UNASSIGNED COSTS

305 Depreciation and Amortization 8810 $12,472,055 305


315 Insurance - Hosp and Prof. Malpractice 8830 $1,041,629 $1,041,629 315

320 Insurance - Other 8840 $560,690 $560,690 320

325 Lic. & Other Taxes (Other than income) 8850 $265,524 $265,524 325


345 Interest - Other 8870 $3,163,811 $3,163,811 345



360 TOTAL UNASSIGNED COSTS $5,031,654 $17,503,709 360

TOTAL

365 TOTAL OPERATING COSTS (17 & 18) $18,061,470 $310,603,352 $144,928 365

370 Non-Operating Cost Centers $1,951,590 $3,430,208 370

375 TOTAL COSTS $20,013,060 $314,033,560 $144,928 375






Line No


No

(13) Units of Service



Line No


205 Hospital Administration 8610 1,232 205


215 Public Relations 8630 1,431,047 215


225 Personnel 8650 1,232 225

230 Employee Health Services 8660 1,232 230

235 Auxiliary Groups 8670 26,363 235

240 Chaplaincy Services 8680 49,663 240

245 Medical Library 8690 641 245

250 Medical Records 8700 81,358 250

255 Medical Staff Administration 8710 641 255

260 Nursing Administration 8720 440 260


270 Inservice Education - Nursing 8740 7,153 270

275 Utilization Management 8750 10,991 275

280 Community Health Education 8770 4 280


300 TOTAL ADMINISTRATIVE SERVICES 300

UNASSIGNED COSTS

305 Depreciation and Amortization 8810 397,243 305


315 Insurance - Hosp and Prof. Malpractice 8830 1,426,366 315

320 Insurance - Other 8840 397,248 320

325 Lic. & Other Taxes (Other than income) 8850 397,248 325


345 Interest - Other 8870 397,248 345



360 TOTAL UNASSIGNED COSTS 360

TOTAL

365 TOTAL OPERATING COSTS (17 & 18) 365


375 TOTAL COSTS 375

06/30/2014



Line No

NON-REVENUE PRODUCING CENTERSBASIS OF ALLOCATION

(2) Square Feet (4) Accumulated Costs

(5) Hospital FTE's

(6) Supplies from Pages 17 & 18

column (5)

(7) Square Feet Serviced

Line No

LINES BEING ALLOCATED 5-25 30-80 85-100 105 110

5 Interest - Other 5

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 30

35 Hospital Administration 7,005 35

40 Governing Board Expense 40


50 Management Engineering 50

55 Community Health Education 55

60 Other Administrative Services 60

65 General Accounting 65

70 Communications 1,902 70

75 Other Fiscal Services 75

80 Printing and Duplicating 80

85 Personnel 4,299 85

90 Employee Health Services 90

95 Employee Benefits (Non-Payroll Related) 95

100 Non-Patient Food Services 8,444 100

105 Purchasing and Stores 1,599 105

110 Housekeeping 1,170 110

115 Grounds 115

120 Security 1,134 1,134 120

125 Parking 125

130 Plant Operations 27,480 27,480 130

135 Plant Maintenance 4,956 4,956 135

140 Other General Services 140

145 Dietary 7,735 7,735 145

150 Laundry and Linen 969 969 150

155 Patient Accounting 155

160 Data Processing 4,476 4,476 160

165 Credit and Collection 165

170 Auxiliary Groups 1,391 1,391 170

175 Chaplaincy Services 3,230 3,230 175

180 Medical Library 1,315 1,315 180

185 Medical Records 4,134 4,134 185

190 Medical Staff Administration 894 894 190

195 Social Work Services 299 299 195

200 Utilization Management 1,825 1,825 200

205 Insurance - Hospital and Professional Malpractice 205

210 Admitting 4,454 4,121 210

215 Other Unassigned Costs 215

220 Outpatient Registration 220

225 Nursing Administration 987 987 225

230 Inservice Education-Nursing 759 759 230

235 Central Services and Supplies 9,933 9,933 235

240 Pharmacy 6,884 6,884 240

245 Research Projects and Administration 245

250 Education Administration Office 250

255 Student Housing 255

260 Licensed Vocational Nurse Program 260

265 School of Nursing 265

270 Paramedical Education 270

275 Other Health Profession Education 275

280 Medical Postgraduate Education 2,413 2,413 280

19 COST ALLOCATION - STATISTICAL BASIS

O'CONNOR HOSPITALFacility D.B.A. Name : Report Period End: 06/30/2014



Line No


(8) Square Feet from Column

(2)

(9)Meals Served (10)Dry Pounds Processed

(11)Gross Patient Revenue from

Page 12,Column (23)

(12)Gross Outpatient

Revenue from Pg 12,Col(22)

Line No

LINES BEING ALLOCATED 115-140 145 150 155-215 220







35 Hospital Administration 35


45 Public Relations 45





70 Communications 70



85 Personnel 85



100 Non-Patient Food Services 100

105 Purchasing and Stores 105

110 Housekeeping 110

115 Grounds 115

120 Security 120

125 Parking 125

130 Plant Operations 130

135 Plant Maintenance 135


145 Dietary 145

150 Laundry and Linen 150


160 Data Processing 160


170 Auxiliary Groups 170

175 Chaplaincy Services 175

180 Medical Library 180

185 Medical Records 185

190 Medical Staff Administration 190

195 Social Work Services 195

200 Utilization Management 200


210 Admitting 210



225 Nursing Administration 225

230 Inservice Education-Nursing 230

235 Central Services and Supplies 235

240 Pharmacy 240








280 Medical Postgraduate Education 280





Line No


(13)Nursing FTE's

(14) Central Service and

Supply Costed Requisitions

(15) Pharmacy Costed

Requisitions


Column (11)

(18) Students in All Approved

Programs Line No

LINES BEING ALLOCATED 225-230 235 240 245 250-255

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240













Line No


(19) Nursing Student

Departmental Assignment

(20) Paramedic Student Departmental Assignment

(21) Medical PostGraduate Departmental Assignment

Line No

LINES BEING ALLOCATED 260-265 270-275 280

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240













Line No



(5) Hospital FTE's


column (5)


Line No


505DAILY HOSPITAL SERVICES Medical/Surgical Intensive Care 10,269 10,269 505

510 Coronary Care 510


520 Neonatal Intensive Care 1,296 1,296 520


530 Burn Care 530



545 Medical/Surgical Acute 71,452 71,452 545

550 Pediatric Acute 8,756 8,756 550



565 Obstetrics Acute 5,347 5,347 565






595 Nursery Acute 8,311 8,311 595

600 Sub-Acute Care 10,164 10,164 600








660AMBULATORY SERVICES Emergency Services 15,478 15,478 660



675 Clinics 21,736 21,736 675



690 Outpatient Chemical Dependency Services 690

695 Observation Care 6,912 6,912 695






730ANCILLARY SERVICES Labor and Delivery Services 17,286 17,286 730

735 Surgery and Recovery Services 28,596 28,596 735


745 Anesthesiology 530 530 745



760 Clinical Laboratory Services 8,342 8,342 760

765 Pathological Laboratory Services 1,387 1,387 765

770 Blood Bank 446 446 770


780 Cardiac Catheterization Services 3,191 142 780





Line No



(2)



Page 12,Column (23)

(12)Gross Outpatient


Line No


505DAILY HOSPITAL SERVICES Medical/Surgical Intensive Care 6,859 87,715 505





530 Burn Care 530



545 Medical/Surgical Acute 77,958 525,178 545

550 Pediatric Acute 4,619 23,317 550



565 Obstetrics Acute 23,576 24,427 565






595 Nursery Acute 8,883 595

600 Sub-Acute Care 28,255 119,914 600








660AMBULATORY SERVICES Emergency Services 69,950 660



675 Clinics 45,167 675










730ANCILLARY SERVICES Labor and Delivery Services 146,561 730

735 Surgery and Recovery Services 76,612 735







770 Blood Bank 770


780 Cardiac Catheterization Services 5,552 780





Line No


(13)Nursing FTE's




Requisitions


Column (11)


Programs Line No


505DAILY HOSPITAL SERVICES Medical/Surgical Intensive Care $556,841 505



520 Neonatal Intensive Care $127,113 520


530 Burn Care 530



545 Medical/Surgical Acute $885,524 545

550 Pediatric Acute $38,057 550



565 Obstetrics Acute $138,439 565






595 Nursery Acute $111,247 595

600 Sub-Acute Care $190,361 600








660AMBULATORY SERVICES Emergency Services $258,947 660



675 Clinics $211,640 675




695 Observation Care $28,680 695






730ANCILLARY SERVICES Labor and Delivery Services $178,881 730

735 Surgery and Recovery Services $1,643,065 735


745 Anesthesiology $35,968 745

750 Medical Supplies Sold to Patients $22,032,411 750


760 Clinical Laboratory Services $1,890,612 760

765 Pathological Laboratory Services $109,277 765

770 Blood Bank $1,443,224 770


780 Cardiac Catheterization Services $129,872 780





Line No




(20) Paramedic Student

Department Assignment


Line No


505DAILY HOSPITAL SERVICES Medical/Surgical Intensive Care 24.00 505





530 Burn Care 530













595 Nursery Acute 595









660AMBULATORY SERVICES Emergency Services 660



675 Clinics 675










730ANCILLARY SERVICES Labor and Delivery Services 730








770 Blood Bank 770







Line No



(5) Hospital FTE's


column (5)


Line No


ANCILLARY SERVICES (Continued)

785 Cardiology Services 2,487 2,487 785



800 Radiology - Diagnostic 9,211 9,211 800

805 Radiology - Therapeutic 6,317 6,317 805

810 Nuclear Medicine 3,510 3,510 810

815 Magnetic Resonance Imaging 3,295 815

820 Ultrasonography 994 994 820

825 Computed Tomographic Scanner 1,744 1,744 825


835 Respiratory Therapy 2,697 2,697 835



850 Lithotripsy 850


860 Physical Therapy 10,511 10,511 860

865 Speech - Language Pathology 865







900 Other Ancillary Services 19,920 19,920 900



915 Non-Operating Cost Centers 6,383 6,383 915

920 Total Statistical Units (Lines 5-915) 397,248 365,159 920



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



Line No



(2)



Page 12,Column (23)

(12)Gross OutPatient


Line No






800 Radiology - Diagnostic 3,331 800

805 Radiology - Therapeutic 3,331 805




825 Computed Tomographic Scanner 4,441 825





850 Lithotripsy 850


860 Physical Therapy 1,110 860








900 Other Ancillary Services 3,331 900




920 Total Statistical Units (Lines 5-915) 141,267 1,148,820 920









Line No


(13)Nursing FTE's




Requisitions


Column (11)


Programs Line No



785 Cardiology Services $1,548 785



800 Radiology - Diagnostic $41,171 800

805 Radiology - Therapeutic $5,581 805

810 Nuclear Medicine $13,060 810

815 Magnetic Resonance Imaging $3,885 815

820 Ultrasonography $4,680 820

825 Computed Tomographic Scanner $11,453 825

830 Drugs Sold to Patients $4,985,135 830

835 Respiratory Therapy $16,969 835


845 Renal Dialysis $6,368 845

850 Lithotripsy 850


860 Physical Therapy $50,545 860








900 Other Ancillary Services $64,417 900




920 Total Statistical Units (Lines 5-915) $30,229,836 $4,985,135 920









Line No




(20) Paramedic Student Departmental Assignment


Line No
















850 Lithotripsy 850














920 Total Statistical Units (Lines 5-915) 24.00 920









Line No


Account No (1)Adjusted Direct Costs from Page 17 & 18,Column (12)

(2)Square Feet (3)Subtotal Line No

LINES BEING ALLOCATED 5-25



15 Licenses and Taxes (Other than on income) 8850 15

20 Depreciation and Amortization 8810 20









65 General Accounting 8510 65

70 Communications 8470 70


80 Printing and Duplicating 8310 80




100 Non-Patient Food Services 8330 100

105 Purchasing and Stores 8400 105

110 Housekeeping 8440 110

115 Grounds 8410 115

120 Security 8420 120

125 Parking 8430 125


135 Plant Maintenance 8460 135


145 Dietary 8340 145

150 Laundry and Linen 8350 150

155 Patient Accounting 8530 155

160 Data Processing 8480 160






190 Medical Staff Administration 8710 190

195 Social Work Services 8360 195

200 Utilization Management 8750 200

205 Insurance - Hospital and Professional Malpractice 8830 205

210 Admitting 8560 210

215 Other Unassigned Costs 8890 215



230 Inservice Education-Nursing 8740 230

235 Central Services and Supplies 8380 235

240 Pharmacy 8390 240








280 Medical Postgraduate Education 8260 280

285 TOTAL NON-REVENUE PRODUCING CENTERS 285

20 COST ALLOCATION




20 COST ALLOCATION

Line No


(4)Accumulated Costs

(5)Hospital FTE's (6) Supplies from Pages 17 & 18,

Column (5)

(7)Square Feet Serviced

Line No

LINES BEING ALLOCATED 30-80 85-100 105 110

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240












20 COST ALLOCATION

Line No


(8)Square Feet from Column (2)


(11)Gross Patient Revenue from Page

12, Column 23

Line No

LINES BEING ALLOCATED 115-140 145 150 155-215

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240












20 COST ALLOCATION

Line No


(12)Gross Outpatient Revenue

from Page 12,Column 22

(13)Nursing FTE's

(14)Central Service and Supply Costed

Requisitions


Requisitions

Line No

LINES BEING ALLOCATED 220 225-230 235 240 No

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240












Line No


(16)Subtotal (17)Gross Patient Revenue from

Column (11)


Programs

(19)Nursing Student Departmental Assignment

Line No

LINES BEING ALLOCATED 245 250-255 260-265

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240









285 TOTAL NON-REVENUE PRODUCING CENTERS 285

20 COST ALLOCATION

O'CONNOR HOSPITAL 06/30/2014Report Period End: Facility D.B.A. Name :



Line No


(20)Paramedic Student Departmental Assignment

(21)Medical Postgraduate Departmental Assignment

(22)Transfers for Operating

Costs

(23)Total

Line

LINES BEING ALLOCATED 270-275 280 No

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240









20 COST ALLOCATION




Line No

REVENUE PRODUCING CENTERSBASIS OF ALLOCATION




350COST RECOVERIES (Page 14, Part III) 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 (Non-Revenue Centers)

5790 415

420 Other (Specify) 5780 420




440 TOTAL COST RECOVERIES 440

445 Research & Education Revenue and Transfers 445

505DAILY HOSPITAL SERVICES Medical/Surgical Intensive Care 6010 505





530 Burn Care 6110 530















601 Sub-Acute Care Pediatric 6570 601








660AMBULATORY SERVICES Emergency Services 7010 660



20 COST ALLOCATION




20 COST ALLOCATION

Line No




Column (5)


Line No


350COST RECOVERIES (Page 14, Part III) Non-Patient Food Sales 350

355 Laundry and Linen Revenue 355

360 Social Work Services Revenue 360

365 Supplies Sold to Non-Patients Revenue 365

370 Drugs Sold to Non-Patients Revenue 370

375 Purchasing Services Revenue 375

380 Parking Revenue 380

385 Housekeeping and Maintenance Services Revenue 385

390 Data Processing Services Revenue 390

395 Medical Records Abstracts Sales 395

400 Management Services Revenue 400

405 Worker's Compensation Refunds 405

410 Community Health Education Revenue 410

411 Reinsurance Recoveries 411


415







505DAILY HOSPITAL SERVICES Medical/Surgical Intensive Care 505





530 Burn Care 530















601 Sub-Acute Care Pediatric 601














20 COST ALLOCATION

Line No





12, Column 23

Line No

















415












530 Burn Care 530





























20 COST ALLOCATION

Line No


(12)Gross Outpatient Revenue

from Page 12,Column 22

(13)Nursing FTE's


Requisitions


Requisitions

Line No

















415












530 Burn Care 530





























Line No



Column (11)


Programs


Line No

















415












530 Burn Care 530


























20 COST ALLOCATION




Line No





Costs

(23)Total

Line

















415












530 Burn Care 530


























20 COST ALLOCATION




Line No





675 Clinics 7070 675











730ANCILLARY SERVICES Labor and Delivery Services

7400730








770 Blood Bank 7540 770



















865 Speech - Language Pathology 7780 865












920 TOTAL -0- 920

20 COST ALLOCATION




20 COST ALLOCATION

Line No




Column (5)


Line No


675 Clinics 675



















770 Blood Bank 770
















850 Lithotripsy 850















920 TOTAL -0- -0- -0- -0- 920




20 COST ALLOCATION

Line No





12, Column 23

Line No


675 Clinics 675



















770 Blood Bank 770
















850 Lithotripsy 850















920 TOTAL -0- -0- -0- -0- 920




20 COST ALLOCATION

Line No



12,Column 22

(13)Nursing FTE's


Requisitions


Requisitions

Line No


675 Clinics 675



















770 Blood Bank 770
















850 Lithotripsy 850















920 TOTAL -0- -0- -0- -0- 920




Line No



Column (11)


Programs


Line No


675 Clinics 675



















770 Blood Bank 770
















850 Lithotripsy 850















920 TOTAL -0- -0- -0- 920

20 COST ALLOCATION




Line No





Costs

(23)Total

Line


675 Clinics 675



















770 Blood Bank 770
















850 Lithotripsy 850















920 TOTAL -0- -0- -0- 920

20 COST ALLOCATION




Line No

COST RECOVERY INFORMATION(1) Transfers for Operations Non-

Revenue Centers Page 14, Col(1), Line 185

(2)Other Operating Revenue Page

14,Col(1), Line 200

(3) Other Operating Revenue Page 14, Col (1), Line 205

(4)Other Operating Revenue Page 14, Col

(1),Line 210Line No

1 Cost Recovery ($3,290,186) 1







35 Hospital Administration $3,290,186 35










85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240



20a. COST ALLOCATION SHORT FORM


( Page 20a (1 of 6) Submitted Data )


Line No

COST RECOVERY INFORMATION(1) Transfers for Operations Non-

Revenue Centers Page 14, Col(1), Line 185

(2)Other Operating Revenue Page

14,Col(1), Line 200

(3) Other Operating Revenue Page 14, Col (1), Line 205

(4)Other Operating Revenue Page 14, Col

(1),Line 210Line No







285 TOTAL NON-REVENUE PRODUCING CENTERS -0- -0- -0- -0- 285





Line No

COST RECOVERY INFORMATION(5)Other Operating Revenue

Page 14, Column (1), Line 215

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

260Line No

1 Cost Recovery 1

















85 Personnel 85






115 Grounds 115

120 Security 120

125 Parking 125




145 Dietary 145













210 Admitting 210






240 Pharmacy 240







Line No

COST RECOVERY INFORMATION(5)Other Operating Revenue

Page 14, Column (1), Line 215

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

260Line No







285 TOTAL NON-REVENUE PRODUCING CENTERS -0- -0- 285





Line No

COST RECOVERY INFORMATION Account No(7)Transfers for

Operations (Revenue Centers) Page

14,Column (1), Line 270

Line No

500 Transfers for Operations(Revenue Centers) [Page 14, Column(1), Line 270]

500

505DAILY HOSPITAL SERVICES Medical/Surgical Intensive Care 6010 505





530 Burn Care 6110 530















601 Sub-Acute Care Pediatric 6570 601








660AMBULATORY SERVICES Emergency Services 7010 660



675 Clinics 7070 675















Line No

COST RECOVERY INFORMATION Account No(7)Transfers for

Operations (Revenue

Centers) Page 14,Column (1),

Line 270

Line No

730ANCILLARY SERVICES Labor and Delivery Services 7400 730








770 Blood Bank 7540 770



















865 Speech - Language Pathology 7780 865









920 TOTAL -0- 920





(1) (2) (3) (4) (5) (6)

CLASSIFICATION DESCRIPTION Management and

Supervision Technical and

Specialist Registered

Nurses

Line Natural Classification Code .00 .01 .02 Line

No REVENUE PRODUCING CENTERS Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No


5 Medical/Surgical Intensive Care $71.12 1,851 $65.49 59 $84.37 83,641 5

10 Coronary Care 10


20 Neonatal Intensive Care $77.89 1,700 $65.85 492 $82.96 31,493 20


30 Burn Care 30



45 Medical/Surgical Acute $74.74 10,753 $65.84 2,208 $73.37 207,680 45

50 Pediatric Acute $83.50 21,115 50



65 Obstetrics Acute $72.89 1,035 $65.32 2,160 $79.38 39,148 65






95 Nursery Acute $72.94 818 $78.64 32,668 95

100 Sub-Acute Care $35.99 3,818 $73.44 15,653 100








150 TOTAL DAILY HOSPITAL SERVICES 16,157 41,405 398,730 150

AMBULATORY SERVICES

160 Emergency Services $73.46 3,146 $29.83 23,538 $77.55 81,634 160



175 Clinics $77.10 1,684 $41.65 2,171 $69.18 15,213 175



190 Outpatient Chemical Dependency Svcs. 190

195 Observation Care $71.53 1,230 $66.28 18 $81.47 34,264 195






225 TOTAL AMBULATORY SERVICES 6,060 25,727 131,111 225

21 DETAIL OF DIRECT PAYROLL COSTS PATIENT REVENUE PRODUCING CENTERS




(7) (8) (9) (10) (11) (12)

CLASSIFICATION DESCRIPTION Licensed

Vocational Nurses Aides and Orderlies

Clerical and Other Administrative



Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No


5 Medical/Surgical Intensive Care $36.63 24 $32.24 225 $29.21 5,048 5

10 Coronary Care 10




30 Burn Care 30



45 Medical/Surgical Acute $43.35 3,375 $29.57 48,404 $29.46 24,664 45

50 Pediatric Acute $39.26 46 50



65 Obstetrics Acute $44.86 3,680 $27.20 2,461 65






95 Nursery Acute $44.87 2,910 $27.19 1,947 95

100 Sub-Acute Care $39.46 17,527 $27.97 19,084 100









AMBULATORY SERVICES

160 Emergency Services $28.96 853 $31.44 14,303 160



175 Clinics $40.54 1,879 $25.11 4,351 $28.27 4,509 175




195 Observation Care $41.13 24 $31.28 239 $27.85 2,618 195











(13) (14) (15) (16) (17) (18)

CLASSIFICATION DESCRIPTION Environmental and

Food Service Physicians (Salaried)

Non-Physicians Medical Practitioners


No "REVENUE PRODUCING CENTERS Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No


5 Medical/Surgical Intensive Care 5

10 Coronary Care 10




30 Burn Care 30













95 Nursery Acute 95










AMBULATORY SERVICES

160 Emergency Services 160



175 Clinics 175















(19) (20) (21)

CLASSIFICATION DESCRIPTION Other Salaries

and Wages Cost Center

Average Hourly Rate

Line Natural Classification Code .09 Line


Productive Hours

No


5 Medical/Surgical Intensive Care $78.69 5

10 Coronary Care 10


20 Neonatal Intensive Care $78.74 20


30 Burn Care 30



45 Medical/Surgical Acute $61.95 45

50 Pediatric Acute $81.47 50



65 Obstetrics Acute $73.21 65






95 Nursery Acute $73.21 95

100 Sub-Acute Care $45.12 100









AMBULATORY SERVICES

160 Emergency Services $61.96 160



175 Clinics $53.70 175




195 Observation Care $75.64 195











(22) (23) (24) (25)

Line No

HOURS SUMMARY (Optional) Full Time

Equivalent Employees

Line No

REVENUE PRODUCING CENTERS Productive Hours

Non-Productive

Hours

Total Paid Hours

Column (22) ÷ 2080


5 Medical/Surgical Intensive Care 90,848 22,368 113,216 5

10 Coronary Care 10


20 Neonatal Intensive Care 33,685 9,531 43,216 20


30 Burn Care 30



45 Medical/Surgical Acute 297,084 70,061 367,145 45

50 Pediatric Acute 21,161 5,604 26,765 50



65 Obstetrics Acute 48,484 9,503 57,987 65






95 Nursery Acute 38,343 7,515 45,858 95

100 Sub-Acute Care 56,082 7,835 63,917 100









AMBULATORY SERVICES

160 Emergency Services 123,474 23,742 147,216 160



175 Clinics 29,807 6,627 36,434 175




195 Observation Care 38,393 8,286 46,679 195









( Page 21 (5 of 10) Submitted Data )Date Prepared: 6/24/2015 HOSPITAL DISCLOSURE REPORT FACSIMILE

(1) (2) (3) (4) (5) (6)




Nurses



Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No

ANCILLARY SERVICES

230 Labor and Delivery Services $71.16 1,833 $59.76 4,284 $76.49 60,839 230

235 Surgery and Recovery Services $71.85 3,286 $42.25 20,553 $99.10 47,822 235

240 Ambulatory Surgery Services $27.65 355 $75.40 17,345 240




260 Clinical Laboratory Services $71.93 3,669 $54.68 57,005 260

265 Pathological Laboratory Services $48.43 3,062 265

270 Blood Bank 270


280 Cardiac Catheterization Services $86.30 1,800 $106.77 6,330 $120.83 11,804 280

285 Cardiology Services $62.66 1,768 $45.95 6,036 285


295 Electroencephalography $49.88 2,147 295

300 Radiology - Diagnostic $72.52 558 $58.29 16,083 $105.15 559 300

305 Radiology - Therapeutic $79.15 1,334 $58.45 3,598 $68.32 621 305

310 Nuclear Medicine $93.75 5,861 $69.40 727 310

315 Magnetic Resonance Imaging $69.36 5,376 315

320 Ultrasonography $72.34 179 $58.29 5,146 $116.51 179 320

325 Computed Tomographic Scanner $72.53 875 $58.29 25,222 $105.23 876 325


335 Respiratory Therapy $57.52 1,618 $47.18 48,882 $129.00 4 335


345 Renal Dialysis $95.26 7,302 345

350 Lithotripsy 350


360 Physical Therapy $70.18 3,528 $50.04 45,251 360








400 Other Ancillary Services $28.68 1,783 $97.73 14,080 400

405 TOTAL ANCILLARY SERVICES 20,448 256,974 162,158 405





(7) (8) (9) (10) (11) (12)






Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No

ANCILLARY SERVICES

230 Labor and Delivery Services $30.53 13,305 $34.09 7,442 230

235 Surgery and Recovery Services $28.14 8,023 $30.26 5,564 235

240 Ambulatory Surgery Services $28.36 4,037 $28.26 3,414 240




260 Clinical Laboratory Services $28.71 69,838 260

265 Pathological Laboratory Services $33.13 5,173 $34.50 2,124 265

270 Blood Bank 270


280 Cardiac Catheterization Services $27.60 1,854 280




300 Radiology - Diagnostic $36.52 1,793 300

305 Radiology - Therapeutic $27.20 1,965 305

310 Nuclear Medicine $27.44 2,768 310


320 Ultrasonography $36.51 574 320

325 Computed Tomographic Scanner $36.51 2,813 325





350 Lithotripsy 350


360 Physical Therapy $25.37 6,960 $28.34 5,983 360









405 TOTAL ANCILLARY SERVICES 107,336 36,294 405


06/30/2014Facility D.B.A. Name : Report Period End: O'CONNOR HOSPITAL




(13) (14) (15) (16) (17) (18)



Non-Physicians Medical Practitioners



Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No

ANCILLARY SERVICES

230 Labor and Delivery Services 230








270 Blood Bank 270
















350 Lithotripsy 350












Facility D.B.A. Name : Report Period End: 06/30/2014O'CONNOR HOSPITAL




(19) (20) (21)

CLASSIFICATION DESCRIPTION Other Salaries

and Wages Cost Center

Average Hourly Rate



Productive Hours

No

ANCILLARY SERVICES

230 Labor and Delivery Services $63.83 230

235 Surgery and Recovery Services $136.41 1,091 $70.39 235

240 Ambulatory Surgery Services $58.35 240




260 Clinical Laboratory Services $41.58 260

265 Pathological Laboratory Services $39.55 265

270 Blood Bank 270


280 Cardiac Catheterization Services $100.63 280

285 Cardiology Services $49.70 285


295 Electroencephalography $47.08 295

300 Radiology - Diagnostic $56.23 300

305 Radiology - Therapeutic $54.76 305

310 Nuclear Medicine $69.24 310

315 Magnetic Resonance Imaging $68.44 315

320 Ultrasonography $56.49 320

325 Computed Tomographic Scanner $56.23 325


335 Respiratory Therapy $46.37 335


345 Renal Dialysis $93.86 345

350 Lithotripsy 350


360 Physical Therapy $46.64 360








400 Other Ancillary Services $83.41 400

405 TOTAL ANCILLARY SERVICES 1,091 405




(22) (23) (24) (25)

Line No



Line No


Non-Productive

Hours

Total Paid Hours

Column (22) ÷ 2080

ANCILLARY SERVICES

230 Labor and Delivery Services 87,703 23,607 111,310 230

235 Surgery and Recovery Services 86,339 22,791 109,130 235

240 Ambulatory Surgery Services 25,151 7,391 32,542 240




260 Clinical Laboratory Services 130,512 19,066 149,578 260

265 Pathological Laboratory Services 10,359 940 11,299 265

270 Blood Bank 270


280 Cardiac Catheterization Services 21,788 3,239 25,027 280

285 Cardiology Services 7,804 1,456 9,260 285


295 Electroencephalography 2,147 621 2,768 295

300 Radiology - Diagnostic 18,993 5,152 24,145 300

305 Radiology - Therapeutic 7,518 1,745 9,263 305

310 Nuclear Medicine 9,356 1,461 10,817 310

315 Magnetic Resonance Imaging 5,376 1,000 6,376 315

320 Ultrasonography 6,078 1,648 7,726 320

325 Computed Tomographic Scanner 29,786 8,079 37,865 325


335 Respiratory Therapy 50,504 13,082 63,586 335


345 Renal Dialysis 7,302 439 7,741 345

350 Lithotripsy 350


360 Physical Therapy 61,722 12,404 74,126 360








400 Other Ancillary Services 15,863 4,142 20,005 400



Report Period End: O'CONNOR HOSPITAL 06/30/2014Facility D.B.A. Name :



(1) (2) (3) (4) (5)

CLASSIFICATION DESCRIPTION Registry Nursing

Personnel Other Contracted

Services Total Contracted

Hours

LineNatural Classification Code .25 .21, .26

Line


Productive Hours Average Hourly Rate

Productive Hours No


5 Medical/Surgical Intensive Care $55.62 620 620 5

10 Coronary Care 10


20 Neonatal Intensive Care $72.01 499 499 20


30 Burn Care 30



45 Medical/Surgical Acute $66.47 5,439 5,439 45

50 Pediatric Acute $65.96 73 73 50



65 Obstetrics Acute $71.92 77 77 65






95 Nursery Acute 95

100 Sub-Acute Care $49.03 754 754 100








150 TOTAL DAILY HOSPITAL SERVICES 7,462 7,462 150

AMBULATORY SERVICES

160 Emergency Services $68.67 4,075 4,075 160



175 Clinics 175




195 Observation Care $81.35 306 306 195






225 TOTAL AMBULATORY SERVICES 4,381 4,381 225

21.1 DETAIL OF DIRECT CONTRACTED COSTS PATIENT REVENUE PRODUCING CENTERS




21.1 DETAIL OF DIRECT CONTRACTED COSTS PATIENT REVENUE PRODUCING CENTERS

(1) (2) (3) (4) (5)

CLASSIFICATION DESCRIPTION Registry Nursing

Personnel Other Contracted

Services Total Contracted

Hours

LineNatural Classification Code .25 .21, .26

Line


Productive Hours Average Hourly Rate

Productive Hours No

ANCILLARY SERVICES

230 Labor and Delivery Services 230

235 Surgery and Recovery Services $57.80 219 219 235





260 Clinical Laboratory Services $78.43 320 $80.00 120 440 260


270 Blood Bank 270





295 Electroencephalography $363.57 14 14 295

300 Radiology - Diagnostic $80.48 168 168 300







335 Respiratory Therapy $60.70 3,070 3,070 335


345 Renal Dialysis $50.43 775 775 345

350 Lithotripsy 350















(1) (2) (3) (4) (5) (6)




Nurses



Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education $61.99 943 $44.38 889 30




50 TOTAL EDUCATION 943 889 50

GENERAL SERVICES

55 Printing and Duplicating $24.80 1,399 55

60 Kitchen 60

65 Non-Patient Food Services $46.55 3,283 $40.79 7,638 65

70 Dietary $46.53 2,238 $40.74 5,222 70


80 Social Work Services $50.77 7,657 80

85 Central Transportation 85

90 Central Services and Supplies $38.27 1,792 $29.34 15,585 90

95 Pharmacy $84.04 3,348 $52.38 50,879 95

100 Purchasing and Stores $65.42 3,412 $27.18 18,910 100

105 Grounds 105

110 Security $51.50 2 110

115 Parking 115

120 Housekeeping $37.97 1,330 $24.91 43 120


130 Plant Maintenance $68.95 3,638 $82.30 3,416 130

135 Communications $33.80 1,797 $53.00 2 135

140 Data Processing $67.86 6,461 140


150 TOTAL GENERAL SERVICES 20,838 117,214 150

FISCAL SERVICES

155 General Accounting $85.22 3,573 $45.94 1,825 155



170 Admitting $49.08 4,398 $45.67 3 170



200 TOTAL FISCAL SERVICES 7,971 1,828 200

22 DETAIL OF DIRECT PAYROLL COSTS NON-REVENUE PRODUCING CENTERS




(1) (2) (3) (4) (5) (6)




Nurses



Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No


205 Hospital Administration $81.03 24,162 $40.70 27,268 205


215 Public Relations $61.88 2,496 $35.52 475 215


225 Personnel $84.40 2,549 $43.50 2,822 225

230 Employee Health Services $74.54 1,675 $62.29 6,690 230

235 Auxiliary Groups $54.64 3,267 $37.02 3,447 235

240 Chaplaincy Services $50.74 1,804 $37.31 5,390 240

245 Medical Library $36.69 1,538 245

250 Medical Records $63.83 3,494 $31.65 19,918 250

255 Medical Staff Administration $58.15 1,906 $37.65 3,500 255

260 Nursing Administration $78.15 14,984 $89.65 147 260

265 Nursing Float Personnel 265

270 Inservice Education - Nursing $54.50 2 $65.37 4,972 270

275 Utilization Management $79.39 9,371 $61.45 45,188 275


295 Other Administrative Services $45.47 4,129 $26.57 23,685 295

300 TOTAL ADMINISTRATIVE SERVICES 69,839 145,040 300







(7) (8) (9) (10) (11) (12)






Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education $31.18 1,710 30




50 TOTAL EDUCATION 1,710 50

GENERAL SERVICES

55 Printing and Duplicating $23.80 193 55

60 Kitchen 60

65 Non-Patient Food Services $28.13 24 65

70 Dietary $28.09 4,211 70





95 Pharmacy $31.29 1,587 95


105 Grounds 105

110 Security 110

115 Parking 115



130 Plant Maintenance $33.69 1,749 130

135 Communications $23.75 11,212 135

140 Data Processing $24.80 5 140


150 TOTAL GENERAL SERVICES 18,981 150

FISCAL SERVICES




170 Admitting $29.10 53,010 170



200 TOTAL FISCAL SERVICES 53,010 200





(7) (8) (9) (10) (11) (12)






Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No


205 Hospital Administration $28.80 56,174 205




225 Personnel $30.37 2,104 225

230 Employee Health Services $31.59 248 230

235 Auxiliary Groups $33.52 1,835 235



250 Medical Records $33.43 20,195 250

255 Medical Staff Administration $42.56 99 255

260 Nursing Administration $28.96 5,755 260


270 Inservice Education - Nursing $31.03 887 270

275 Utilization Management $27.86 5,839 275


295 Other Administrative Services $17.88 11,929 295

300 TOTAL ADMINISTRATIVE SERVICES 105,065 300







(13) (14) (15) (16) (17) (18)



Non-Physician Medical Practitioners



Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No

RESEARCH COSTS



EDUCATION COSTS









GENERAL SERVICES


60 Kitchen 60

65 Non-Patient Food Services $26.11 38,081 65

70 Dietary $25.72 21,742 70





95 Pharmacy 95


105 Grounds 105

110 Security 110

115 Parking 115

120 Housekeeping $25.69 93,492 120


130 Plant Maintenance $49.15 28,845 130





FISCAL SERVICES




170 Admitting 170








(13) (14) (15) (16) (17) (18)



Non-Physician Medical Practitioners



Productive Hours

Average Hourly Rate

Productive Hours

Average Hourly Rate

Productive Hours

No






225 Personnel 225

230 Employee Health Services $25.82 1,666 230








270 Inservice Education - Nursing 270











(19) (20) (21)

CLASSIFICATION DESCRIPTION Other Salaries and Wages

Cost Center Average Hourly

Rate



Productive Hours

No

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education $26.04 48,538 $25.87 30




50 TOTAL EDUCATION 48,538 50

GENERAL SERVICES

55 Printing and Duplicating $24.62 55

60 Kitchen 60

65 Non-Patient Food Services $30.78 65

70 Dietary $30.77 70


80 Social Work Services $51.23 80


90 Central Services and Supplies $30.34 90

95 Pharmacy $53.02 95

100 Purchasing and Stores $33.81 100

105 Grounds 105

110 Security $34.33 110

115 Parking 115

120 Housekeeping $26.01 120


130 Plant Maintenance $53.43 130

135 Communications $25.69 135

140 Data Processing $69.03 140


150 TOTAL GENERAL SERVICES 150

FISCAL SERVICES

155 General Accounting $73.73 155



170 Admitting $31.14 170








(19) (20) (21)

CLASSIFICATION DESCRIPTION Other Salaries and Wages

Cost Center Average Hourly

Rate



Productive Hours

No


205 Hospital Administration $188.40 1,905 $46.62 205


215 Public Relations $60.34 215


225 Personnel $58.12 225

230 Employee Health Services $26.28 963 $55.89 230

235 Auxiliary Groups $42.17 235

240 Chaplaincy Services $41.66 240

245 Medical Library $38.61 245

250 Medical Records $35.17 250

255 Medical Staff Administration $47.50 255

260 Nursing Administration $55.28 135 $65.98 260


270 Inservice Education - Nursing $27.91 11 $59.14 270

275 Utilization Management $62.33 275

280 Community Health Education $83.00 5 $69.17 280

295 Other Administrative Services $26.00 295








(22) (23) (24) (25)

Line No



Line No


Non-Productive

Hours

Total Paid Hours

Column (22) ÷ 2080

RESEARCH COSTS



EDUCATION COSTS




30 Medical Postgraduate Education 52,080 5,593 57,673 30




50 TOTAL EDUCATION 52,080 5,593 57,673 50

GENERAL SERVICES

55 Printing and Duplicating 1,592 38 1,630 55

60 Kitchen 60

65 Non-Patient Food Services 49,026 6,366 55,392 65

70 Dietary 33,413 4,339 37,752 70


80 Social Work Services 7,657 777 8,434 80


90 Central Services and Supplies 17,377 2,634 20,011 90

95 Pharmacy 55,814 10,774 66,588 95

100 Purchasing and Stores 22,322 3,812 26,134 100

105 Grounds 105

110 Security 2 1 3 110

115 Parking 115

120 Housekeeping 94,865 14,516 109,381 120


130 Plant Maintenance 37,648 6,508 44,156 130

135 Communications 13,011 1,794 14,805 135

140 Data Processing 6,466 1,020 7,486 140


150 TOTAL GENERAL SERVICES 339,193 52,579 391,772 150

FISCAL SERVICES

155 General Accounting 5,398 771 6,169 155



170 Admitting 57,411 9,419 66,830 170



200 TOTAL FISCAL SERVICES 62,809 10,190 72,999 200





(22) (23) (24) (25)

Line No



Line No


Non-Productive

Hours

Total Paid Hours

Column (22) ÷ 2080


205 Hospital Administration 109,509 18,314 127,823 205


215 Public Relations 2,971 379 3,350 215


225 Personnel 7,475 1,233 8,708 225

230 Employee Health Services 11,242 668 11,910 230

235 Auxiliary Groups 8,549 1,135 9,684 235

240 Chaplaincy Services 7,194 1,148 8,342 240

245 Medical Library 1,538 138 1,676 245

250 Medical Records 43,607 6,680 50,287 250

255 Medical Staff Administration 5,505 590 6,095 255

260 Nursing Administration 21,021 5,285 26,306 260


270 Inservice Education - Nursing 5,872 1,281 7,153 270

275 Utilization Management 60,398 10,360 70,758 275

280 Community Health Education 5 1 6 280

295 Other Administrative Services 39,743 6,532 46,275 295

300 TOTAL ADMINISTRATIVE SERVICES 324,629 53,744 378,373 300







22.1 DETAIL OF DIRECT CONTRACTED COSTS NON-REVENUE PRODUCING CENTERS


(3) (4)

CLASSIFICATION DESCRIPTION Other Contracted

Services


No NON-REVENUE PRODUCING CENTERS Average Hourly Rate

Productive Hours

No

RESEARCH COSTS



EDUCATION COSTS









GENERAL SERVICES


60 Kitchen 60


70 Dietary 70





95 Pharmacy 95


105 Grounds 105

110 Security $26.24 27,205 110

115 Parking 115



130 Plant Maintenance $30.43 425 130





FISCAL SERVICES




170 Admitting 170






(3) (4)

CLASSIFICATION DESCRIPTION Other Contracted

Services


No NON-REVENUE PRODUCING CENTERS Average Hourly Rate

Productive Hours

No


205 Hospital Administration $40.47 6,206 205




225 Personnel $83.21 155 225






255 Medical Staff Administration $64.93 1,668 255

260 Nursing Administration $45.70 337 260


270 Inservice Education - Nursing 270







22.1 DETAIL OF DIRECT CONTRACTED COSTS NON-REVENUE PRODUCING CENTERS




oshpd reports (1)

Documents

net outpatient revenue

net inpatient revenue

gross outpatient revenue

gross inpatient revenue

outpatient visits

inpatient daysfinancial

t care

er visits