Annual Utilization Report of Specialty Clinics
Facility Name:INLAND SURGERY CENTER
OSHPD ID:306334076Report Status:Revised
License Category:SurgicalReport Year:2002
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:INLAND SURGERY CENTER
2.OSHPD ID Number:306334076
3.Street Address:361 NORTH SAN JACINTO
4.City:HEMET
5.Zip:92543
6.Facility Phone No.:(909) 652 - 4343 ext. 227
7.Administrator Name:Maughan Parkinson
8.Administrator E-mail Address:Maughanp@inlandeyeclinic.com
9.Was this clinic in operation at any time during the year?Yes
10.Operation Open From:01/01/2002
11.Operation Open To:12/31/2002
12.Name of Parent Corporation:N/A
13.Corporate Business Address:N/A
N/A
14.City:N/A
15.State:
16.Zip:-
17.Person Completing Report:Jeri Hynes
18.Report Preparer's Phone No.:909-652-4343
19.Fax No.:909-765-6036
20.E-mail Address:Jerih@inlandeyeclinic.com
30.Submitted by:306334076
31.Submitted Date and Time:11/3/2003 2:36:43 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 control of your clinic from drop down list:Investor - Partnership


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.)625981
SURGICAL CLINICS ONLY
Line
No.		(1)
Number
5.Number of surgical operating rooms on December 311
6.Total number of surgical operations performed during the calendar year981
7.If you provided abortion services directly at your clinic, provide the total number of abortions performed0
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$1,823,213
WRITE-OFFS AND ADJUSTMENTS:
2.Charity$0
3.Contractual Adjustments$783,977
4.Bad Debts$0
8.Other Adjustments$0
9.Total Write-Offs and Adjustments (line 2-8)$783,977
10.Net Patient Revenue (line 1 minus 9)$1,039,236
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)$1,039,236
Operating Expenses:
30.Salaries, Wages and Employee Benefits$470,067
31.Contract Services - Professional$0
32.Supplies$247,219
33.Rent / Depreciation / Mortgage Interest$133,221
34.Utilities$35,683
35.Professional Liability Insurance$20,748
36.Other Insurances$22,529
44.All Other Expenses$87,407
45.Total Operating Expenses (sum lines 30 - 44)$1,016,874
50.Net From Operations (line 25 minus Line 45)$22,362

The Clinic's License Fee Will Be Based Upon The Completion Of This Income Statement And Will Be Calculated Accordingly.

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 of $500,000 or more? (If 'Yes', fill out lines 2 through 11 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
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
11.0

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 below.)No

Detail of Capital Expenditures
Line
No.		(1)
Description of Project		(2)
Projected Total Capital Expenditure		(3)
OSHPD Project No.
(if applicable)
26.0
27.0
28.0
390
30.0

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