DOCKET NO: BOARD MEETING: PROJECT NO: PROJECT COST: A - 6 FACILITY NAME: March 27-28, 2007 06-071 CITY: Original: $0 Regional Surgicenter, Ltd. Moline TYPE OF PROJECT: Substantive HSA: X PROJECT DESCRIPTION: The applicant proposes to add one surgical specialty to its current limited specialty ambulatory surgical treatment center ( ASTC ). Currently, the facility provides Gastroenterology procedures. The proposed project would add the General /Other surgical specialty. The facility will continue to use its existing eight gastro-intestinal endoscopy procedure rooms and support space with no modifications to the facility and; therefore, will incur no project cost.
STATE AGENCY REPORT Regional Surgicenter, Ltd. Moline, Illinois I. The Proposed Project The applicant proposes to add the General /Other surgical specialty to its limited specialty ASTC. The facility currently provides the Gastroenterology surgical service. The facility will continue to use its existing eight gastro-intestinal endoscopy procedure rooms and support space with no modifications to the facility. There is no cost associated with this project. II. Summary of Findings A. The State Agency finds the proposed project does not appear to be in conformance with the provisions of Part 1110. B. The State Agency finds the proposed project does not appear to be in conformance with the provisions of Part 1120. III. General Information The applicant is Regional Surgicenter, Ltd. The ASTC is located at 545 Valley View Drive in Moline (HSA X). There are five other facilities providing outpatient surgical services within 30 minutes travel time of the applicant s proposed facility. This is a substantive project which is subject to both a Part 1110 and Part 1120 review. An opportunity for public hearing was offered, but one was not requested. In addition, no written comments were received by the State Agency regarding the proposed project. Since the project has no cost, obligation will occur at permit issuance (per 77 IAC 1130.720(b)). The project s completion date is April 2, 2008. IV. The Proposed Project Details The applicant proposes to add the General /Other surgical specialty to its current limited specialty ASTC. The ASTC currently provides the
Page 2 of 15 Gastroenterology surgical service. The facility will continue to use its existing eight gastro-intestinal endoscopy procedure rooms and support space with no modifications to the facility. There is not cost associated with this project. V. Project Costs and Sources of Funds The total project cost is $0. VI. Review Criteria Non-Hospital Based Ambulatory Surgery A. Criterion 1110.1540(a) Scope of Services Provided The AGENCY NOTE under the criterion states: A permit is required for the addition of a surgical specialty by a limited specialty ASTC. The State Agency notes the applicant is applying for the addition of a surgical specialty to an existing limited specialty ASTC. B. Criterion 1110.1540(b) Target Population Criterion 1110.1540(c) Projected Patient Volume Criterion 1110.1540(d) Treatment Room Need Assessment The State Agency notes these criteria are not applicable to this project. THE STATE AGENCY NOTES THE TARGET POPULATION (77 IAC 1110.1540(b), PROJECTED PATIENT VOLUME (77 IAC 1110.1540(c) AND TREATMENT NEED ASSESSMENT CRITERIA (77 IAC 1110.1540(d) ARE NOT APPLICABLE TO THIS PROJECT. C. Criterion 1110.1540(e) Impact on Other Facilities The criterion states: An applicant proposing to change the specialties offered at an existing ASTC or proposing to establish an ASTC must document the impact the proposal will have on the out-patient surgical capacity of all other existing ASTCs and hospitals within the intended geographic service area and that the proposed project will not result in an unnecessary duplication of
Page 3 of 15 services or facilities. Documentation shall include any correspondence from such existing facilities regarding the impact of the proposed project, and correspondence from physicians intending to refer patients to the proposed facility. Outpatient surgical capacity will be determined by the Agency, utilizing the latest available data from the Agency s annual questionnaires, and will be the number of surgery rooms for ASTCs and the number of equivalent outpatient surgery rooms for hospitals. Equivalent outpatient surgery rooms for hospitals are determined by dividing the total hours of a hospital s outpatient surgery by 1,500 hours. In addition to documentation submitted by the applicant, the State Agency shall review utilization data from annual questionnaires submitted by such health care facilities and data received directly from health facilities located within the intended geographic service area, including public testimony. The applicant states that five health care facilities that provide outpatient surgical service are located within its GSA. These facilities include: Trinity Medical Center West (Rock Island), Trinity Medical Center 7 th Street Campus (Moline), quad City Endoscopy (Rock Island), Genesis Illini Campus (Silvis) and Quad City Ambulatory Surgery Center (Moline). These five facilities were contacted about the potential impact the proposed project would have on their facility (application pages 39 45). The applicant received responses from two providers (Trinity Medical Center and Quad City Ambulatory Surgery Center. Both facilities do not oppose the project and stated that no adverse impact was anticipated. The State Agency notes the response from Trinity Medical Center covers both the Rock Island and Moline campuses. As noted in Table One, the applicant s facility has capacity to perform additional surgical procedures. The other ASTCs within the GSA (Quad City Ambulatory Surgery Center and Quad City Endoscopy) do not have excess surgical capacity. Quad City Ambulatory Surgery Center is designated as a limited-specialty ASTC providing orthopedic and pain management. The facility would need to obtain a CON to provide the General / Other surgical specialty. Quad City Endoscopy is also designated as a limited-specialty ASTC providing Gastroenterology. This facility would need a CON to add other surgical specialties. The three identified hospitals within the GSA, however, have excess surgical capacity and these facilities provide the service requested by the
Page 4 of 15 applicant. As noted, the applicant notified the three hospitals of its proposal. Two of the hospitals (Trinity Medical Centers) stated that the project would not have an adverse impact on their facilities. The other hospital, Genesis Medical Center, did not respond to the applicant s request. The applicant states the purpose of the proposed project is to allow Dr. Kishore Alapati, a Colorectal general surgeon who is part of Gastroenterology Consultants, S.C., to be allowed to perform general surgery procedures at the ASTC. Dr. Alapati currently has privileges at the ASTC to perform endoscopy procedures and he would like to simultaneously perform minor colorectal procedures. Many colonoscopy patients need other minor colorectal procedures during the performance of a colonoscopy. According to the applicant, should the CON be approved, Dr. Alapati s patients will benefit by being able to have one anesthetic for the associated minor procedures. Based on the information submitted by the applicants and the information furnished by existing providers in the GSA, it appears that no adverse impact would occur with the approval of the project. The applicant s facility is authorized to provide the Gastroenterology surgical service. The addition of the General / Other surgical service is being requested to allow for additional minor colorectal procedures to be performed during the course of a colonoscopy. Two of the three identified hospitals in the GSA have stated there will be no adverse impact at their facilities with the approval of this project. The two ASTCs within the GSA do not provide the proposed service. The remaining provider, Genesis Medical Center, did not respond to the applicant s inquiry and did not provide written comments to the State Agency. THE STATE AGENCY FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE IMPACT ON OTHER FACILITIES CRITERION (77 IAC 1110.1540(e)). D. Criterion 1110.1540(f) Establishment of New Facilities Criterion 1110.1540(g) Charge Commitment The State Agency notes these criteria are not applicable to this project.
Page 5 of 15 THE STATE AGENCY FINDS THE ESTABLISHMENT OF NEW FACILITIES (77 IAC 1110.1540(f) AND CHARGE COMMITMENT CRITERIA ARE NOT APPLICABLE TO THIS PROJECT. E. Criterion 1110.1540(h) - Non-Hospital Based Ambulatory Surgery - Change in Scope of Service This application is for the addition of one surgical specialty to an existing limited specialty ASTC. As such, the State Board s rules provide review criteria for this particular Change in Scope of Service. The criterion reads as follows: Any applicant proposing to change the surgical specialties currently being provided by adding one or more of the surgical specialties listed under subsection (a) of this Section must document one of the following: 1) that there are no other facilities (existing ASTCs or hospitals with outpatient surgical capacity) within the intended geographic service area which provide the proposed new specialty; or 2) that the existing facilities (existing ASTCs or hospitals with outpatient surgical capacity) within the intended geographic service area of the applicant facility are operating at or above the 80% occupancy target; or 3) that the existing programs are not accessible to the general population of the geographic service area in which the applicant facility is located. The applicant states that there are no existing multi-specialty ASTCs in the planning area. Only the inpatient hospitals, Trinity Medical Center, West Campus and 7 th Street Campus, and Genesis Illini Campus offer outpatient General Surgery. Therefore, all general outpatient surgery is offered at hospital based rates, which is a more costly way to provide these services. Furthermore: The closest non-hospital based provider that is currently providing this service is Mississippi Medical Plaza (located in Davenport, Iowa), which is on the other side of the Mississippi River.
Page 6 of 15 Facility The State Agency notes the review criteria is applicable to both ASTCs and hospitals providing outpatient surgery. To ascertain existing providers surgical utilization, the State Agency summarized these facilities data from the 2005 IDPH hospital and ASTC questionnaires. Table One displays this information. Table One Surgical Utilization of Area Providers City / HSA Hospitals Hours of Surgery Hours of Outpt. Surgery Number of ORs Equiv. Outpt. ORs ORs Justified Excess OR Capacity Genesis Medical Center Silvis 10 5,480 3,746 5 3 4 Yes Trinity Medical Center 7 th Street Moline 10 9,728 8,585 9 6 7 Yes Trinity Medical Center West Rock Island 10 7,695 2,192 7 2 6 Yes Ambulatory Surgical Treatment Centers Facility City / HSA ASTC Type Number of Hours of ORs ORs Surgery Justified Excess OR Regional Surgicenter Moline Limited 8 10,158 7 Yes Quad City Ambulatory Surgery Ctr Moline 10 Limited 2 4,458 3 No Quad City Endoscopy Rock Island Limited 2 1,863 2 No Utilization based on the HFPBs 2005 Inventory of Health Care Facilities and Services, Hospital/ASTC Profiles. Drive times and distance determined based on MapQuest calculated by the State Agency. These facilities distance and travel times from the applicant s facility are displayed in Table Two. Travel time and distance determinations are based on MapQuest calculations by the State Agency. The information in Table Two is listed by distance (miles). TABLE TWO Distance and Travel Time Information Facility City Distance Travel Time (miles) (minutes) Quad City Ambulatory Surgery Ctr Moline.04 1 Quad City Endoscopy Rock Island 3.30 7 Trinity Medical Center 7 th Street Moline 2.10 4 Trinity Medical Center - West Rock Island 3.30 6 Genesis Medical Center Silvis 10.20 15 As noted in Table One, the three hospitals within the area had excess surgical capacity in 2005. These hospitals provide the General / Other surgical specialty requested by the applicant. The State Agency notes Trinity Medical Center (representing both the Moline and Rock Island campuses) submitted a letter indicating it does not oppose this project and anticipates minimal impact as a result of this facility adding General
Page 7 of 15 Surgery to its Scope of Services. The other hospital, Genesis Medical Center in Silvis, did not provide written comments regarding the project. The applicant demonstrated it will perform 150 general surgery procedures per year due to the activity of one general surgeon. The applicant estimates this will generate approximately 225 hours of surgery annually. As noted in Table One, the applicant has excess capacity at its facility to assume this workload. Also, an impact letter was sent to all area providers of outpatient surgical service. Three providers (Trinity Medical Centers and Quad City Ambulatory Surgery) indicated they do not oppose the project and anticipate minimal impact on their facilities. The State Agency notes there are hospitals with excess surgical capacity in the GSA which provide the proposed surgical specialty. Thus, the applicant cannot meet the requirements of subsection h)1) of the criterion. There are existing facilities within the GSA that did not operate at the State board s target utilization rate for 2005 (the most recent data available). Thus, the applicant cannot meet the requirements of subsection h)2) of this criterion. Finally, the applicant did not demonstrate that the existing providers are not accessible to the general population of the GSA. Thus, it cannot meet the requirements of subsection h)3) of the criterion. Since the applicant cannot meet any of the requirements of the criterion, a positive finding cannot be made. THE STATE AGENCY FINDS THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE CHANGE IN SCOPE OF SERVICE CRITERION (77 IAC 1110.1540(h)). VII. General Review Criteria A. Criterion 1110.230(a) Location The criterion states: An applicant who proposes to establish a new health care facility or a new category of service or who proposes to acquire major medical equipment that is not located in a health care facility and that is not being
Page 8 of 15 acquired by or on behalf of a health care facility must document the following: 1) that the primary purpose of the proposed project will be to provide care to the residents of the planning area in which the proposed project will be physically located. Documentation for existing facilities shall include patient origin information for all admissions for the last 12 months. Patient origin information must be presented by zip code and be based upon the patient's legal residence other than a health care facility for the last six months immediately prior to admission. For all other projects for which referrals are required to support the project, patient origin information for the referrals is required. Each referral letter must contain a certification by the health care worker physician that the representations contained therein are true and correct. A complete set of the referral letters with original notarized signatures must accompany the application for permit. The applicants provided zip code data for the anticipated patient referrals and it appears a significant majority of the zip codes are within the GSA. Thus, it appears the new facility will provide care to residents of the proposed GSA. However as referenced in Table One, there are underutilized providers in the GSA. Thus, it appears the addition of the proposed surgical specialty may result in a maldistribution of service. THE STATE AGENCY FINDS THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE LOCATION CRITERION (77 IAC 1110.230(a)). B. Criterion 1110.230(b) - Background of Applicants The criterion states: 1) The applicant shall demonstrate that it is fit, willing and able, and has the qualifications, background and character to adequately provide a proper standard of health care service for the community. [20 ILCS 3960/6] In evaluating the fitness of the applicant, the State Board shall consider whether adverse action has been taken against the applicant, or against any health care
Page 9 of 15 facility owned or operated by the applicant, directly or indirectly, within three years preceding the filing of the application. The applicant provided licensure and certification information as required. The applicant certified it has not had any adverse actions taken by Medicare or Medicaid, or any State or Federal regulatory authority within the past three years. It appears the applicant is fit, willing and able and has the qualifications, background and character to adequately provide a proper standard of healthcare service for the community. THE STATE AGENCY FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE BACKGROUND OF APPLICANTS CRITERION (77 IAC 1110.230(b)). C. Criterion 1110.230(c) Alternatives The criterion states: The applicant must document that the proposed project is the most effective or least costly alternative. Documentation shall consist of a comparison of the proposed project to alternative options. Such a comparison must address issues of cost, patient access, quality, and financial benefits in both the short and long term. If the alternative selected is based solely or in part on improved quality of care, the applicant shall provide empirical evidence including quantifiable outcome data that verifies improved quality of care. Alternatives must include, but are not limited to: purchase of equipment, leasing or utilization (by contract or agreement) of other facilities, development of freestanding settings for service and alternate settings within the facility. The following alternatives were considered by the applicants: 1. Expand scope of service by adding general surgery 2. Do Nothing: Continued use of Existing Facilities According to the applicant, the first alternative of adding General Surgery has no costs, improves access, improves quality, reduces costs and improves financial benefits of the facility and the providers.
Page 10 of 15 The applicant states the second alternative is the continued exclusive use of the hospital-based facilities to provide outpatient General Surgery. This option was rejected because, according to the applicants, this puts healthcare contracts at risk, making over the border Iowa physicians poised more effectively to obtain payor contracts. As referenced in Table One, there are existing providers within the GSA that have excess surgical capacity. Thus, it appears the more appropriate alternative would be to these providers. Also, the applicant did not provide a cost analysis for the second alternative as required by the criterion. THE STATE AGENCY FINDS THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE ALTERNATIVES CRITERION (77 IAC 1130.230(c)). D. Criterion 1110.230(d) - Need for the Project The criterion states: 1) If the State Board has determined need pursuant to Part 1100, the proposed project shall not exceed additional need determined unless the applicant meets the criterion for a variance. 2) If the State Board has not determined need pursuant to Part 1100, the applicant must document that it will serve a population group in need of the services proposed and that insufficient service exists to meet the need. Documentation shall include but not be limited to: A) area studies (which evaluate population trends and service use factors); B) calculation of need based upon models of estimating need for the service (all assumptions of the model and mathematical calculations must be included); C) historical high utilization of other area providers; and D) identification of individuals likely to use the project. 3) If the project is for the acquisition of major medical equipment that does not result in the establishment of a category of service, the applicant must document that the equipment will achieve or
Page 11 of 15 exceed any applicable target utilization levels specified in Appendix B within 12 months after acquisition. As referenced in Table One, there are existing providers within the GSA that have excess surgical capacity. Further, the applicant has not documented that there are individuals in need of the service in the GSA and that there are insufficient services to meet this need. Thus, it does not appear that need has been demonstrated for the proposal. THE STATE AGENCY FINDS THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE NEED FOR THE PROJECT CRITERION (77 IAC 1110.230(d)). E. Criterion 1110.230(e) - Size of the Project As referenced, the applicant s facility is not adding space or incurring cost for this project. Therefore, this criterion is not applicable. THE STATE AGENCY NOTES THE SIZE OF PROJECT CRITERION (77 IAC 1110.230(e)) IS NOT APPLICABLE TO THIS PROJECT. VIII. Review Criteria - Financial Feasibility A. Criterion 1120.210(a) Financial Viability The criterion states: a) If an applicant has not documented a bond rating of "A" or better (pursuant to Section 1120.120), then the applicant must address the review criteria in this Section. 1) Viability Ratios Applicants (including co-applicants) must document compliance with viability ratio standards detailed in Appendix A of this Part or address a variance. Applicants must document compliance for the most recent three years for which audited financial statements are available. For Category B applications, the applicant also must document compliance through the first full fiscal year after project completion or for the first full fiscal year when the project achieves or exceeds target utilization pursuant to 77 Ill. Adm. Code 1100, whichever is later, or address a variance.
Page 12 of 15 2) Variance for Applications Not Meeting Ratios Applicants not in compliance with any of the viability ratios must document that another organization, public or private, shall assume the legal responsibility to meet the debt obligations should the applicant default Table Three displays the applicant s financial ratio information. TABLE THREE Regional Surgicenter, Ltd. Financial Ratio Data Historic Data Ratio Standard 2003 2004 2005 Current Ratio >=1.5 10.8 4.0 2.8 Net Margin Percentage >=3.5% 53.02% 45.47% 47.15% Percent Debt to Total Capitalization <=80% NA NA NA Projected Debt Service Coverage >=1.75 NA NA NA Days Cash on Hand >=45 93 27 34 Cushion Ratio >=5 NA NA NA The State Agency notes the ratios indicated as NA are not applicable since the applicant does not have any debt. Further, the applicant did not provide audited financial statements. The proposed project has no cost and is therefore a Category A project (per 77 IAC 1120.20(b)(1)(A)). Per 77 IAC 1120.210(a)(1), the applicant is not required to provide projected ratio information. The State Agency notes the Days Cash on Hand for 2004 and 2005 is the only ratio that does not meet the State standard of greater than or equal to 45 days. The Days of Cash on Hand ratio is an indication of the number days the facility could operate if no future revenue is provided. As referenced, this project has no cost and the applicant has no debt. The State Agency noted that the applicant s historic Day Cash on Hand ratio did not meet the State Board s standard. The applicant did not document the variance (77 IAC 1120.210(a)(2)) to the ratio. As a result, the applicant is not in compliance with this criterion. THE STATE AGENCY FINDS THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE FINANCIAL FEASIBILITY CRITERION (77 IAC 1120.210).
Page 13 of 15 B. Criterion 1120.210(b) - Availability of Funds This project has no cost; therefore, this criterion is not applicable. THE STATE AGENCY NOTES THE AVAILABILITY OF FUNDS CRITERION (77 IAC 1120.210(b) IS NOT APPLICABLE TO THIS PROJECT. C. Criterion 1120.210(c) - Start-Up Costs This project has no cost; therefore, this criterion is not applicable. THE STATE AGENCY NOTES THE START-UP COSTS CRITERION (77 IAC 1120.210(C) IS NOT APPLICABLE TO THIS PROJECT. IX. Review Criteria - Economic Feasibility A. Criterion 1120.310(a) - Reasonableness of Financing Arrangements B. Criterion 1120.310(b) - Conditions of Debt Financing C. Criterion 1120.310(c) - Reasonableness of Project Cost This project has no cost; therefore, these criteria are not applicable. THE STATE AGENCY NOTES THE ABOVE CRITERIA ARE NOT APPLICABLE TO THIS PROJECT. D. Criterion 1120.310(d) - Projected Operating Costs The Criterion states: The applicant must provide the projected direct annual operating costs (in current dollars per equivalent patient day or unit of service) for the first full fiscal year after project completion or the first full fiscal year when the project achieves or exceeds target utilization pursuant to 77 Ill. Adm. Code 1100, whichever is later. Direct cost means the fully allocated costs of salaries, benefits, and supplies for the service. Currently, the cost per procedure at the applicant s facility is $185.00. The applicant anticipates the 2007 costs per procedure will be $191.00. The State Board does not have a standard for these costs.
Page 14 of 15 THE STATE AGENCY NOTES THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE PROJECTED OPERATING COSTS CRITERION (77 IAC 1120.310(d)). E. Criterion 1120.310(e) - Total Effect of the Project on Capital Costs The criterion states: The applicant must provide the total projected annual capital costs (in current dollars per equivalent patient day) for the first full fiscal year after project completion or the first full fiscal year when the project achieves or exceeds target utilization pursuant to 77 Ill. Adm. Code 1100, whichever is later. This project has no cost; therefore, this criterion is not applicable. THE STATE AGENCY NOTES THE PROJECT APPEARS TO BE IN CONFORMANCE WITH THE TOTAL EFFECT OF THE PROJECT ON CAPITAL COSTS CRITERION (77 IAC 1120.310(e)). F. Criterion 1120.310(f) - Non-Patient Related Services This project is for patient related services and; therefore, this criterion is not applicable. THE STATE AGENCY NOTES THE NON-PATIENT RELATED SERVICES CRITERION (77 IAC 1120.310(f)) IS NOT APPLICABLE TO THIS PROJECT. G:\FAC\SAR\2006-SAR\06-071 Regional Surgicenter Ltd.doc
30 MINUTE DRIVE TIME Name Address City QUAD CITY ENDOSCOPY - MOLINE 4340 7th Street MOLINE QUAD CITY AMB. SURGERY CENTER, LLC 520 VALLEY VIEW DRIVE MOLINE REGIONAL SURGICENTER, LTD. 545 VALLEY VIEW DRIVE MOLINE Trinity Medical Center - West 2701 17th Street Rock Island Trinity Medical Center 500 John Deer Road Moline Hammond Henry Hospital 600 N. College Avenue Geneseo Illini Hospital 801 Hospital Road Silvis HAS 10 ASTC LISTING Name Address City QUAD CITY ENDOSCOPY - MOLINE 4340 7th Street MOLINE QUAD CITY AMB. SURGERY CENTER, LLC 520 VALLEY VIEW DRIVE MOLINE REGIONAL SURGICENTER, LTD. 545 VALLEY VIEW DRIVE MOLINE HOSPITAL LISTING Mercer County Hospital 409 N.W 9th Avenue Aledo Trinity Medical Center - West 2701 17th Street Rock Island Trinity Medical Center 500 John Deer Road Moline Hammond Henry Hospital 600 N. College Avenue Geneseo Illini Hospital 801 Hospital Road Silvis Kewanee Hospital 719 Elliott Street Kewanee
AMBULATORY SURGICAL TREATMENT CENTER PROFILES FOR YEAR 2005 Health Service Area 010 REGIONAL SURGICENTER, LTD. MOLINE 2006 NUMBER OF PATIENTS BY AGE GROUP AGE MALE FEMALE TOTAL 0-14 62 48 110 15-24 77 152 229 25-44 411 626 1,037 45-59 1,314 1,793 3,107 60-64 446 507 953 65-69 390 452 842 70-74 284 374 658 75-84 404 546 950 85-99 85 155 240 100 over 0 0 0 TOTAL 3,473 4,653 8,126 NUMBER OF PATIENTS BY PRIMARY PAYMENT SOURCE PAYMENT SOURCE MALE FEMALE TOTAL Medicaid 122 248 370 Medicare 815 1,205 2,020 Other Public 50 50 100 Insurance 2,266 2,858 5,124 Private Pay 195 267 462 Charity Care 25 25 50 TOTAL 3,473 4,653 8,126 SURGICAL UTILIZATION FOR THE REPORTING YEAR SURGERY PREP and TOTAL SURGERY TIME CLEAN-UP TIME TOTAL SURGERY AVERAGE CASE TIME SURGERY AREA SURGERIES (HOURS) (HOURS) (HOURS) (HOURS) Cardiovascular 0 0.00 0.00 0.00 0.00 Dermatology 0 0.00 0.00 0.00 0.00 Gastroenterology 8126 4,063.00 6,094.50 10157.50 1.25 General 0 0.00 0.00 0.00 0.00 Laser Eye Surgery 0 0.00 0.00 0.00 0.00 Neurology 0 0.00 0.00 0.00 0.00 OB/Gynecology 0 0.00 0.00 0.00 0.00 Ophthalmology 0 0.00 0.00 0.00 0.00 Oral/Maxillofacial 0 0.00 0.00 0.00 0.00 Orthopedic 0 0.00 0.00 0.00 0.00 Otolaryngology 0 0.00 0.00 0.00 0.00 Pain Management 0 0.00 0.00 0.00 0.00 Plastic Surgery 0 0.00 0.00 0.00 0.00 Podiatry 0 0.00 0.00 0.00 0.00 Thoracic 0 0.00 0.00 0.00 0.00 Urology 0 0.00 0.00 0.00 0.00 TOTAL 8126 4,063.00 6,094.50 10157.50 1.25 EXPENDITURES EXPENDITURE TYPE AMOUNT PERCENT Adminiistration 125,000.00 3.2% Medical Staff 500,000.00 12.7% Other Medical Staff 147,746.00 3.7% Non-Medical Staff 100,000.00 2.5% Building/Maintenance 13,542.00 0.3% Medical Supplies 1,171,365.00 29.7% Medical Equipment 426,973.00 10.8% Malpractice Insurance 25,553.00 0.6% Mortgage 0.00 0.0% Rent 562,674.00 14.3% Advertising 40,995.00 1.0% Other Insurance 4,978.00 0.1% Office Expenditures 53,687.00 1.4% Other 771,643.00 19.6% TOTAL 3,944,156.00 REVENUES REVENUE SOURCE AMOUNT PERCENT Medicaid 148,662.62 1.7% Medicare 1,297,919.79 14.7% Other Public 29,484.18 0.3% Insurance 6,857,511.02 77.6% Private Pay 492,618.29 5.6% Other 11,599.93 0.1% TOTAL 8,837,795.83 DEDUCTIONS FROM GROSS BILLING DEDUCTIONS AMOUNT PERCENT Bad Debts 168,249.58 4.6% Charity Care 15,504.94 0.4% Medicaid Allowances 511,849.57 14.1% Medicare Allowances 967,394.27 26.6% Prearranged Discounts 1,080,986.60 29.7% Other Allowances 898,197.96 24.7% TOTAL 3,642,182.92 10/6/2006 Page 213 of 232
AMBULATORY SURGICAL TREATMENT CENTER PROFILES FOR YEAR 2005 Health Service Area 010 REGIONAL SURGICENTER, LTD. MOLINE 2006 Reference Numbers 010 7001878 161 REGIONAL SURGICENTER, LTD. 545 VALLEY VIEW DRIVE MOLINE, IL 61265-6138 Administrator Date Kay Wynn, R.N. Completed 309-762-0529 5/19/2006 Registered Agent Dr Rao & Vedavathi Movva Property Owner Dr & Vedavathi Movva Legal Owner Vedavathi Movva Rao V Movva MD President Vedavathi Movva 10 Windy Point Rock Island, IL 61201 Vice President Rao V. Movva, M.D. 10 Windy Point Rock Island, IL 61201 Secretary Angela Kachevas 2914 44th Street Rock Island, IL 61201 Treasurer Malinda Chapman 9207 Fenton Road Fenton, IL 61251 Number of Operating Rooms 0 Number of Laser Rooms 0 Number of Gastro-intestinal Endoscopy Rooms 8 Number of Recovery Stations Stage 1 21 Number of Recovery Stations Stage 2 3 Exam Rooms 0 One Additional Procedure Room 0 Two Additional Procedure Rooms 0 Related Organizations or Entities Name Relationship Type of Interest Valley View Management Business Management Contract STAFFING PATTERNS PERSONNEL FULL-TIME EQUIVALENTS Administrator 1.00 Physicians 0.00 Dir. of Nurses 1.00 Reg. Nurses 17.00 Certified Aides 12.00 Other Hlth. Profs. 0.00 Other Non-Hlth. Profs 0.00 TOTAL 31.00 HOSPITAL TRANSFER RELATIONSHIPS HOSPITAL NAME NUMBER OF PATIENTS Trinity Medical Center 4 Genesis Illini Campus 0 0 0 0 Type of Ownership Church Related Not For Profit DAYS AND HOURS OF OPERATION Monday 10 Tuesday 10 Wednesday 10 Thursday 10 Friday 10 Saturday 0 Sunday 0 Note: Percentages when added may not total 100% because of rounding Note: Suammary data are base on figures supplied by individual ASTC's Source: Health Systems Development Illinois Department of Public Health 525 West Jefferson Springfield, illinois Phone: 217/782-3516 10/6/2006 Page 214 of 232