Annual Utilization Report of Specialty Clinics
Facility Name:UCSD DIALYSIS CLINIC
OSHPD ID:306374242Report Status:Submitted
License Category:DialysisReport Year:2015
Table of Contents
Click on any of the links listed below to view the corresponding section.
Section 1 - General Information
Section 2 - Clinic 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:UCSD DIALYSIS CLINIC
2.OSHPD ID Number:306374242
3.Street Address:200 W ARBOR DR
4.City:SAN DIEGO
5.Zip:92103
6.Facility Phone No.:( 619) 643 - 5503 ext.
7.Administrator Name:Maryellen McLaughlin
8.Administrator E-mail Address:mmclaughlin@ucsd.edu
9.Was this clinic in operation at any time during the year?Yes
10.Operation Open From:1/1/2015
11.Operation Open To:12/31/2015
12.Name of Parent Corporation:UC SAN DIEGO HEALTH SYSTEM
13.Corporate Business Address:200 WEST ARBOR DRIVE
14.City:SAN DIEGO
15.State:CA
16.Zip:92103 - 8781
17.Person Completing Report:Judith Filangeri
18.Report Preparer's Phone No.:702-473-1153
19.Fax No.:866-583-8437
20.E-mail Address:jfilangeri@cbe-usa.net
30.Submitted by:ucsddialysis
31.Submitted Date and Time:2/3/2016 11:14:22 AM
Section 2 - Clinic Description
LICENSE CATEGORY (TYPE) (Completed by OSHPD.)
Line
No.		(1)
1.License CategoryDialysis
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:University of California
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.)15719,566
SURGICAL CLINICS ONLY
Line
No.		(1)
Number
5.Number of surgical operating rooms on December 310
6.Total number of surgical operations performed during the calendar year0
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
DIALYSIS CLINICS ONLY
Line
No.		(1)
Number
21.No. of Dialysis Stations18
22.Approved for In-Home Training(CAPD, CCPD)No
Section 4 - Income Statement
INCOME STATEMENT
Line
No.		(1)
Total
1.Gross Patient Revenue$26,463,055
WRITE-OFFS AND ADJUSTMENTS:
2.Charity$0
3.Contractual Adjustments$21,317,387
4.Bad Debts$677
8.Other Adjustments-$1,923
9.Total Write-Offs and Adjustments (lines 2-8)$21,316,141
10.Net Patient Revenue (line 1 minus line 9)$5,146,914
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)$5,146,914
Operating Expenses:
30.Salaries, Wages and Employee Benefits$3,707,595
31.Contract Services - Professional$180,000
32.Supplies$1,224,789
33.Rent / Depreciation / Mortgage Interest$68,528
34.Utilities$7,957
35.Professional Liability Insurance$0
36.Other Insurances$0
44.All Other Expenses$286,652
45.Total Operating Expenses (sum lines 30 - 44)$5,475,521
50.Net From Operations (line 25 minus line 45)-$328,607

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
Line
No.		(1)
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)."
Line
No.		(1)
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