Annual Utilization Report of Specialty Clinics
Facility Name:FOUR SEASONS SURGERY CENTERS OF ANAHEIM
OSHPD ID:306304287Report Status:Submitted
License Category:SurgicalReport Year:2006
Table of Contents
Click on any of the links listed below to view the corresponding section.
Section 1 - General Information
Section 2 - Facility Description
Section 3 - Patients and Encounters
Section 4 - Income Statement
Section 5 - Major Capital Expenditures
Errors and Warnings
Section 1 - General Information

1.Facility Name:FOUR SEASONS SURGERY CENTERS OF ANAHEIM
2.OSHPD ID Number:306304287
3.Street Address:1324 S. EUCLID STREET
4.City:ANAHEIM
5.Zip:92802
6.Facility Phone No.:( 714) 262 - 0047 ext.
7.Administrator Name:Emma Canales
8.Administrator E-mail Address:ecanales@fs-sc.net
9.Was this clinic in operation at any time during the year?Yes
10.Operation Open From:1/1/2006
11.Operation Open To:12/31/2006
12.Name of Parent Corporation:Claims Services of America
13.Corporate Business Address:5370 S. Durango Drive
14.City:Las Vegas
15.State:NV
16.Zip:89113 -
17.Person Completing Report:Emma Canales
18.Report Preparer's Phone No.:714-262-0047
19.Fax No.:714-262-0058
20.E-mail Address:ecanales@fs-sc.net
30.Submitted by:fourseasons
31.Submitted Date and Time:2/16/2007 12:14:47 PM


Section 2 - Facility Description
LICENSE CATEGORY (TYPE)
Line
No.		(1)
1.License CategorySurgical
LICENSEE TYPE OF CONTROL
Line
No.		(1)
5.Select the category that best describes the licensee type of ownership of your clinic from drop down list:Investor - Corporation


Section 3 - Patients and Encounters
PATIENTS AND ENCOUNTERS IN THE CALENDAR YEAR (ALL CLINICS)
Please report the total number of individual, unduplicated patients served and the total number of encounters for these patients. Please refer to the instructions for further details.
Line
No.		(1)
Unduplicated Patients		(2)
Encounters
1.Total, all locations under this license (Main, Mobile, Satellite, etc.)343472
SURGICAL CLINICS ONLY
Line
No.		(1)
Number
5.Number of surgical operating rooms on December 313
6.Total number of surgical operations performed during the calendar year472
PSYCHOLOGY CLINICS ONLY
Line
No.		Service Type(1)
Encounters
11.General Medical0
12.Substance Abuse (alcohol and drug)0
13.Mental Health Counseling0
14.All Other0
15.Total0


Section 4 - Income Statement
INCOME STATEMENT
Line
No.		(1)
Total
1.Gross Patient Revenue$786,120
WRITE-OFFS AND ADJUSTMENTS:
2.Charity$0
3.Contractual Adjustments$0
4.Bad Debts$0
8.Other Adjustments$0
9.Total Write-Offs and Adjustments (line 2-8)$0
10.Net Patient Revenue (line 1 minus 9)$786,120
Other Operating Revenue:
11.Grants - Public$0
12.Grants - Private$0
13.Donations / Contributions$0
19.Other$0
20.Total Other Operating Revenue (sum lines 11 - 19)$0
25.Total Operating Revenue (line 10 + Line 20)$786,120
Operating Expenses:
30.Salaries, Wages and Employee Benefits$972,345
31.Contract Services - Professional$120,221
32.Supplies$337,263
33.Rent / Depreciation / Mortgage Interest$385,554
34.Utilities$34,431
35.Professional Liability Insurance$66,061
36.Other Insurances$27,377
44.All Other Expenses$1,010,325
45.Total Operating Expenses (sum lines 30 - 44)$2,953,577
50.Net From Operations (line 25 minus Line 45)-$2,167,457

Section 5 - Major Capital Expenditures

Section 127285(3) of the Health and Safety Code requires each clinic to report "acquisitions of diagnostic or therapeutic equipment during the reporting period with a value in excess of five hundred thousand dollars ($500,000)."

Diagnostic and Therapeutic Equipment Acquired During The Report Period
1.Did your clinic acquire any diagnostic or therapeutic equipment that had a value in excess of $500,000? (If 'Yes', fill out lines 2 through 11, as necessary, below.)No

Diagnostic and Therapeutic Equipment Detail
Line
No.		(1)
Description of Equipment		(2)
Value		(3)
Date of Aquisition
MM/DD/YYYY		(4)
Means of Acquisition
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Building Projects Commenced During Report Period Costing Over $1,000,000

Section 127285(4) of the Health and Safety Code requires each clinic to report the "commencement of projects during the reporting period that require a capital expenditure for the facility or clinic in excess of one million dollars ($1,000,000)."
25.Did your clinic commence any building projects during the report period which will require an aggregate capital expenditure exceeding $1,000,000? (If 'Yes', fill out lines 26 through 30, as necessary, below.)No

Detail of Capital Expenditures
Line
No.		(1)
Description of Project		(2)
Projected Total Capital Expenditure		(3)
OSHPD Project No.
(if applicable)
26.
27.
28.
29.
30.

General Comments:
Errors and Warnings