Priority One Medical Transport, Inc.

Size: px

Start display at page:

Download "Priority One Medical Transport, Inc."

Pauline Marsh
6 years ago
Views:

1 Bidder Priority One Medical Transport, Inc. Zone(s) A LODI B C TRACY Option A B XXX C Directions Complete this Identification page and the following Expense budgets (Years 1, 2, and 3) Revenue budgets (Years 1, 2, and 3) Proposed charges (Years 1 and 2) On each spreadsheet, enter information into the colored boxes. Other numbers will be calculated. PRIORITY ONE MEDICAL TRANSPORT INC. LODI AND TRACY COMBINED OPTION -B Note 1: Year 2 of Budget add an addional 168 Unit hours to the system to be equally used Note 2: Year 3 of Budget add an addional 76 Unit hours to the system to be equally used LODI AREA Uses 6 Ambulances in Peak Deployment -(1) additional SMT unit (Total 7 Units) 3X24X365 2X10X365 1X08X5X365 1X08X5X52 SMT- Unit SMT- Station Management Team unit to be fielded to handle unusually high Call Volume TRACY AREA Uses 5 Ambulances in Peak Deployment - (1) additional SMT unit (Total 6 Units) 3X24X365 2X10X365 1X08X5X52 SMT- Unit SMT- Station Management Team unit to be fielded to handle unusually high Call Volume

2 Personnel Paramedics Wages $858, Benefits $396, EMT-Is Wages $538, Benefits $253, Dispatchers Wages $329, Benefits $64, Other Personnel Wages $243, Benefits $49, Subtotal $2,732, Vehicles Fuel $237, Repair and maintenance $77, Equipment lease/depreciation $345, Subtotal $660, Medical Equipment/Supplies Supplies $184, Equipment lease/depreciation $82, Maintenance and repair $13, Subtotal $281, Other Rents and leases $160, Insurance $130, Utilities and telephone $88, Office supplies and postage $17, Professional services $60, Taxes $223, Interest - Loan $60, County Fees/ City Fees $45, System, PSAP,CAD, $150, Haz Mat Waste $3, City of Lodi - Fire Dept Pass Thru $106, City of Tracy - Fire Dept Pass Thru $106, Training Budget $90, Subtotal $1,239, Total Expenses $4,913, EXPENSES YEAR 1

3 Patient Charges Private payments $3,588, Medi-Cal $168, Medicare $1,477, Other third party payments $13, Subtotal $5,248, Other sources of revenue (specify) $0.00 $0.00 $0.00 Total Revenue $5,248, Net income (total revenue minus $334, total expenses) Basis for Revenue Projections/ Annual Number of Transports % Average Payment/ Annual Revenue Source of Payment Transport Private $1, $3,588, Medi-Cal Only $ $168, Medicare/Medi-cal $ $314, Medicare Only $ $1,231, Medicare Co-Pay Write Downs 0 -$69, No Payment $20.00 $13, Total $5,248, REVENUE YEAR 1

4 Personnel Paramedics Wages $1,026, Benefits $455, EMT-Is Wages $647, Benefits $292, Dispatchers Wages $345, Benefits $67, Other Personnel Wages $256, Benefits $51, Subtotal $3,141, Vehicles Fuel $369, Repair and maintenance $129, Equipment lease/depreciation $375, Subtotal $874, Medical Equipment/Supplies Supplies $192, Equipment lease/depreciation $87, Maintenance and repair $18, Subtotal $298, Other Rents and leases $184, Insurance $165, Utilities and telephone $124, Office supplies and postage $31, Professional services $145, Taxes $315, Interest - Loans $86, County Fees/City Fees $65, System, PSAP, CAD $135, Haz Mat Waste $3, City of Lodi - Fire Dept Pass Thru $120, City of Tracy- Fire Dept Pass Thru $120, Training Budget/PSA $125, Subtotal $1,622, Total Expenses $5,936, EXPENSES YEAR 2

5 Patient Charges Private payments $4,077, Medi-Cal $210, Medicare $2,106, Other third party payments $16, Subtotal $6,410, Other sources of revenue (specify) $0.00 $0.00 $0.00 Total Revenue $6,410, Net income (total revenue minus $473, total expenses) Basis for Revenue Projections/ Annual Number of Transports % Average Payment/ Annual Revenue Source of Payment Transport Private $1, $4,077, Medi-Cal Only $ $210, Medicare/Medi-cal $ $445, Medicare Only $ $1,743, Medicare Co-Pay Write Downs 0 0 -$82, No Payment $20.00 $16, Total $6,410, REVENUE YEAR 2

6 Personnel Paramedics Wages $1,077, Benefits $478, EMT-Is Wages $679, Benefits $306, Dispatchers Wages $362, Benefits $70, Other Personnel Wages $268, Benefits $54, Subtotal $3,299, Vehicles Fuel $442, Repair and maintenance $135, Equipment lease/depreciation $393, Subtotal $972, Medical Equipment/Supplies Supplies $202, Equipment lease/depreciation $95, Maintenance and repair $22, Subtotal $320, Other Rents and leases $210, Insurance $185, Utilities and telephone $145, Office supplies and postage $37, Professional services $165, Taxes $592, Interest - Loans $97, County Fees/ City Fees $60, System, PSAP,CAD $100, Haz Mat Waste $4, City of Lodi- Fire Dept Pass Thru $124, City of Tracy- Fire Dept Pass Thru $124, Training Budget $100, Total Expenses $1,944, Total Expenses $6,536, EXPENSES YEAR 3

7 Patient Charges Private payments $4,771, Medi-Cal $239, Medicare $2,394, Other third party payments $19, Subtotal $7,424, Other sources of revenue (specify) $0.00 $0.00 $0.00 Total Revenue $7,424, Net income (total revenue minus $888, total expenses) Basis for Revenue Projections/ Annual Number of Transports % Average Payment/ Annual Revenue Source of Payment Transport Private $1, $4,771, Medi-Cal Only $ $239, Medicare/Medi-cal $ $505, Medicare Only $ $1,974, Medicare Co-Pay Write Downs 0 0 $0.00 -$85, No Payment $20.00 $19, Total $7,424, Three Year Net (after taxes) 8.9% REVENUE YEAR 3

ACTUAL FINANCIAL DATA

LONG REPORT - completed annually by: For-Profit Companies and Larger Ambulance Organizations - completed by all applicants for a General Rate Increase ACTUAL FINANCIAL DATA AMBULANCE REVENUE and COST REPORT