SAN JUAN ISLAND EMS BUDGET PRESENTATION RESCUE. RESOURCE. RESPONSE. FISCAL YEAR 1 JANUARY DECEMBER In Association with:

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1 SAN JUAN ISLAND EMS RESCUE. RESOURCE. RESPONSE. In Association with: BUDGET PRESENTATION FISCAL YEAR 1 JANUARY DECEMBER 2016 YEAR TO DATE FIGURES THROUGH NOVEMBER 2015

2 San Juan County Public Hospital District #1 Commissioners The Commissioners of San Juan County Public Hospital District #1 oversee San Juan Island EMS, to provide District citizens and visitors with high quality, efficient, and cost effective pre-hospital care. BOARD OF COMMISSIONERS J. Michael Edwards, DDS, MD, FACS, Board Chair Lenore Bayuk, MN, ACNS, Board Commissioner Rosanna O Donnell, BA, Board Commissioner Mark Schwinge, PhD, Board Commissioner Barbara Sharp, Board Commissioner Pamela Hutchins, BA, San Juan County Public Hospital District #1 Superintendent 2

3 San Juan Island Emergency Medical Services Friday Harbor, WA Management and Staff SJIEMS Supervising Physician: Dr. Sean Stone Interim EMS Administrators: Cady Davies and Pamela Hutchins EMS Director of Critical Care Transport: Larry Wall, BSN, RN, CEN, CFRN, NREMT, CMTE EMS Director of Emergency Response Services: Weyshawn Koons, NRP, SEI EMS Director of Operations: Ben Waldron, AAS, NREMT EMS Director of Outreach: Lainey Volk, EMT EMS Logistics Coordinator: Kaitlyn Johnson, BA, EMT 3

4 TABLE OF CONTENTS LETTER TO COMMISSIONERS... 6 INTRODUCTION TO SAN JUAN ISLAND EMS... 8 OVERVIEW... 8 MISSION... 8 VISION... 8 VALUES... 8 AGENCY ORGANIZATIONAL CHART SERVICE AREA SERVICE AREA POPULATION DEMOGRAPHICS PROPERTY TAX REVENUES OPERATING BUDGET OVERVIEW REVENUE BUDGET AND PRESENTATION PERFORMANCE MEASUREMENT BUDGET SUMMARY ADMINISTRATION, OPERATIONS, & FACILITIES BUDGET KEY ASSUMPTIONS MAJOR HIGHLIGHTS REVISED BUDGET PROPOSAL ADMINISTRATION, OPERATIONS, & FACILITIES EXHIBIT PROPOSED BUDGET REVISION: ADMINISTRATION, OPERATIONS, AND FACILITIES (SUMMARY VERSION) EXHIBIT PROPOSED BUDGET REVISION: ADMINISTRATION, OPERATIONS, AND FACILITIES (EXPANDED VERSION) EMS GROUND AMBULANCE SERVICES BUDGET KEY ASSUMPTIONS

5 MAJOR HIGHLIGHTS REVISED BUDGET PROPOSAL EMS GROUND AMBULANCE SERVICES EXHIBIT PROPOSED BUDGET REVISION: EMS GROUND AMBULANCE SERVICE (SUMMARY VERSION) EXHIBIT PROPOSED BUDGET REVISION: EMS GROUND AMBULANCE SERVICE (EXPANDED VERSION).26 EMS AIR/MEDEVAC AMBULANCE SERVICES BUDGET KEY ASSUMPTIONS MAJOR HIGHLIGHTS REVISED BUDGET PROPOSAL EMS AIR/MEDEVAC AMBULANCE SERVICES EXHIBIT PROPOSED BUDGET REVISION: EMS AIR/MEDEVAC AMBULANCE SERVICES (SUMMARY VERSION) EXHIBIT PROPOSED BUDGET REVISION: EMS AIR/MEDEVAC AMBULANCE SERVICES (EXPANDED VERSION) EMS CONSOLIDATED FINANCIAL STATEMENTS BUDGET EXHIBIT PROPOSED BUDGET REVISION: SAN JUAN ISLAND EMS CONSOLIDATED FINANCIAL STATEMENT (SUMMARY VERSION) EXHIBIT PROPOSED BUDGET REVISION: SAN JUAN ISLAND EMS CONSOLIDATED FINANCIAL STATEMENT (EXPANDED VERSION) GLOSSARY

6 LETTER TO COMMISSIONERS San Juan Island Emergency Medical Services 1079 Spring St., Friday Harbor, WA Phone: Commissioner J. Michael Edwards, Chair Commissioner Lenore Bayuk Commissioner Rosanna O Donnell Commissioner Mark Schwinge Commissioner Barbara Sharp Dear San Juan County Public Hospital #1 District Commissioners: We are pleased to submit the budget request for San Juan Island EMS and MedEvac (SJIEMS) for the fiscal year ending December 31, Prior to preparing the budget, staff performed an organizational analysis including a review of our financials, system processes, deployment, consolidation, and infrastructure. The presented budget fairly and accurately represents both anticipated revenues and expenditures necessary to operate SJIEMS for the Total revenues derived from service revenues are projected at $1,994,500. The tax revenue subsidy from the EMS Levy, governed by the San Juan County Public Hospital District #1 (District), is projected to be $1,072,278, which was estimated by the San Juan County Assessor. An additional $47,500 in other miscellaneous revenue (i.e., interest, donations, reimbursements, and grant funds) is expected. The combined total revenue budget is $3,086,478. This budget represents funding necessary to serve District residents and visitors. Below is a summary of each key area of focus provided in this 2015 budget revision packet. Departmental Budget Breakdowns In an effort to better identify resource utilization we have prepared a departmental breakdown of the budget to include a three year historical perspective, and the 2016 proposed budget revision. The EMS agency has four departments: 6

7 Administration/Operations, Facilities, EMS Ground Ambulance Services, and EMS Air/MedEvac Ambulance Services. We conducted a review of our accounting processes to determine how expenses previously were divided among these departments. When possible, expense items were allocated directly to specific line items. Other allocations relied on personnel feedback and office space utilization. Capital Budget Requests This section provides a historical review of approved capital budget expenditures and the current 2016 requests. Current Cash Flows and Future Operations This section presents historical and current cash positions associated with the SJIEMS General Fund account Additionally, the contracted financial consultant offers several suggestions for the agency and commissioners. Operational Analysis in Preparation for 2016 This section identifies areas needing additional review prior to drafting future budgets. Summary The proposed SJIEMS budget for FY 2016 provides funding to operate SJIEMS, while maintaining the current level of service. In this time of continued transition, SJIEMS is effectively utilizing an improved operational plan supported by a very fiscally conservative budget. We are committed to doing more with less and will monitor all expenditures and continue to explore opportunities for increased efficiencies in the EMS system. We are confident that this budget will meet the needs and demands in all areas of our service responsibility. Sincerely, Pamela Hutchins, SJCPHD #1 Superintendent and Interim Administrator Cady Davies, Executive Assistant and Interim Administrator 7

8 INTRODUCTION TO SAN JUAN ISLAND EMS OVERVIEW San Juan Island EMS and MedEvac (SJIEMS), governed by San Juan County Public Hospital District #1, provides emergency advanced life support emergency medical care and transport to the residents of, and visitors to, the Town of Friday Harbor, San Juan Island, and the outer islands of Brown, Henry, Pearl, Speiden, Johns, and Stuart. Our MedEvac service, Island Air Ambulance, partners with Island Air, Inc. to provide air ambulance services throughout San Juan County when requested. The medical crews consist of at least one Flight Nurse and an advanced trained EMT or another Flight RN or Paramedic. Critical patients are flown with at least two advanced providers (two RNs or RN and Paramedic). Our agency operates 3 ground Mobile Intensive Care Units (MICU s) and three Paramedic firstresponder vehicles. Our career Paramedics, Registered Nurses and 32 EMTs are located throughout the island. We are associated with regional, national, and international organizations, and nationally accredited by CAMTS. MISSION To provide exceptional, compassionate patient care through education, response, and transport. VISION We desire to continuously provide excellent patient services and education while adapting to challenges of our unique island communities. VALUES Adopting innovative, island appropriate systems using best practices Advocating our patients needs Building leadership and professionalism Improving patient care and clinical quality Delivering patient care in an environment of safety, confidentiality, and compassion 8

9 Developing a strong sense of camaraderie Educating to decrease accidents and illnesses and increase community preparedness Providing clinically relevant training Fostering communication and cooperation with the community and other agencies Meeting challenges with flexibility and creativity Promoting an environment of trust, respect, and safety Ensuring appropriate management of resources We are committed to keeping pace with call volume demands, advances in emergency medical services technology, and changes to the clinical care guidelines for pre-hospital care. Our core services will continue to include the following: 24/7 Advanced Life Support response, rescue, emergency care, and patient transport with no out- of-pocket expenses for district residents after insurance is billed Four paramedics, three flight nurses and 32 professionally trained Emergency Medical Technicians (EMTs), seven of which are dual trained as flight EMTs, using state-of-theart medical equipment and 3 intensive care ambulances There are currently seven students attending the EMT class, which will be completed this spring Our 32 EMT neighbors have automatic defibrillators, oxygen and first responder kits to immediately stabilize patients. Paramedics, flight nurses and EMTs receive recurrent training and use evidence based, best patient care practices A nationally awarded emergency aeromedical program using state of the art equipment, partnering with Island Air Ambulance who provides multiple safety awarded aviation services Outer island residents receive training, and loan of emergency equipment Marine response to outer islands and waterways in conjunction with the San Juan County Sheriff SJIEMS Community Education/Prevention Programs, including CPR, AED and First Aid training, Senior Fall Prevention Program, Child Poison Prevention programs, Wilderness Medicine courses, and blood pressure screening clinics for reduced or no cost Other benefits to District residents include a FREE Kid s Don t Float lifejacket lending program at the Port and Roche Harbor; FREE Bike and skate safety/helmets; and FREE Infant/Child Car seats to those in need. EMS staff organizing and presenting the Every 15 Minutes anti-drinking and driving program for our communities teens. SJIEMS offers event standby services during community activities 9

10 AGENCY ORGANIZATIONAL CHART San Juan Count Plic Hospital District #1 Elected Commissioners Superintendent of District Recording Secretary Pam Hutchins San Juan Island EMS and EMS Interim Administrators Pam Hutchins Cady Davies Aero Medical Partner Island Air Inc. SJC Medical Program Director Dr. Michael Sullivan Executive Assistant Cady Davies Director of Education & Prevention Lainey Volk Director of Operations Ben Waldron Dr. Director of 911 SEI Training Weyshawn Koons Supervising Ground Physician Dr. Sean Stone Director of CCT Flight Program Larry Wall Supervising Flight Physician TBD AHA CTC SERVICE AREA AHA Instructors Logistics Kaitlyn Johnson Ground Volunteer Flight Volunteer Flight Wilderness SOLO Support DaveDunaway Debbie Grimes Staff Medic Ryan Nelson Medic/Safety Flight RN/Train Trish Outreach Outreach Operation Officers EMT Kyle Davies Medic/Wilderness 10 Noah Waldron Flight RN/ QA Arna Robins

11 SERVICE AREA San Juan County comprises approximately 200 islands, 172 with names. The U.S. Census Bureau reports that the County has a total area of 621 square miles. Of these, 175 square miles are land and 446 square miles are water. Among Washington State counties, San Juan is the smallest by land area, with the second highest ratio of water-to-land area. Island County is the only other county in the state to have more water area than land area. San Juan Island is accessible by air, private boat or the Washington State Ferry system. Islands within our official Hospital District: Brown, Henry, Johns, Pearl, and San Juan, Spieden, and Stuart. When requested, we provide air ambulance services to other islands. 11

12 POPULATION DEMOGRAPHICS The permanent population of San Juan Island is almost 7, % of residents are over the age of 65--almost double the State average of 13.7%. San Juan County has nearly 16,000 residents. County age distribution resembles that of San Juan Island: 26.2% are age 65 or older. Within the next five years, San Juan Island s average age is projected to decline more rapidly than that of the County at large (-1.5% versus -0.8%). During summer months, the island population more than doubles. Demographics inform EMS needs and priorities. For example, older adults have a substantially higher risk of developing chronic illnesses, requiring more healthcare services than does a younger population. Community service providers share a concern for the growing undocumented Hispanic population s access to care. As shown below, the County s population increase has begun to slow. Additional demographic data support for analysis of historical trends relates to median home prices and property values within San Juan County. Another chart below shows changes in median home prices. San Juan County Population Year Year Population % Change , , % , % , % , % , % , % , % , % , % , % Sources: Washington State OFM Forcast 2005 & Washington State OFM 2014 Population Trends San Juan County Median Home Price Median Home Year Price % Change 2000 $ 250, $ 272, % 2004 $ 337, % 2006 $ 539, % 2008 $ 510, % 2009 $ 443, % 2010 $ 422, % 2011 $ 405, % 2012 $ 362, % 2013 $ 387, % 1ST QTR 2014 $ 391, % Sources: Washington Center for Real Estate Research at Runstad Center / University of Washington 12

13 PROPERTY TAX REVENUES Currently San Juan Island EMS and MedEvac (SJIEMS) is supported by tax revenues of $.35 per thousand dollars of assessed property value. State law allows for up to a $.50 tax for EMS. SJIEMS has worked diligently to maintain operations within the recent $.35 mil rate, unchanged for the past two levy renewals. The $.35 mil rate has yielded fewer operational dollars due to declining property valuations and resulting tax revenues. Also affecting revenues are the District s growing and aging population, and new healthcare laws that impact our reimbursement models. The charts below show the recent trends in population growth, assessed property tax revenue and EMS service call volumes. 13

14 OPERATING BUDGET OVERVIEW REVENUE Patient service revenues, program fees, and property tax revenues from San Juan County Public Hospital District #1fund all activities of San Juan Island Emergency Medical, Services and MedEvac (SJIEMS). BUDGET AND PRESENTATION The budget as presented in the subsequent sections was prepared in keeping with the policy directives of SJIEMS and District Commissioners. SJIEMS contracted with Wier Management Solutions, Inc. (WMS) to provide a budget review by a healthcare accountant. As part of that engagement WMS was requested to provide a new presentation format for the revised 2015 and future budgets. The integrity of the original consolidated reporting of revenue and expenses has been preserved and shall be utilized for final reporting and approval. Additional financial statement breakdowns have been provided. This new presentation also includes statistical reviews for key areas, including percentage ratios, volume statistics, and revenue and expenses by call volumes. As noted in the Letter to District Commissioners, there has been an effort to better identify resource utilization. As a result a departmental breakdown of the budget was created, along with a comparison of the three previous years. There are four departments within the EMS agency, Administration/Operations, Facilities, EMS Ground Ambulance Services, and EMS Air/MedEvac Ambulance Services. Each department has its own summary. Also, there is a Consolidated Summary of all departments. Revenue Projections: The 2016 budget shows an increase in levy tax dollars of $129,278, reflecting the San Juan County Assessor s office s projection. Service revenues also are projected to increase. Operating Expenses: Expenses are adjusted for several recently identified operating expense increases. Specifically, noted are increases in air transport service contract fees, per diem flight nurse costs, legal fees and expected radio/pager upgrade expenses. All variable expenses directly associated with service volumes and total charge volumes are increased respectively for the proposed revenue changes. Several expenses categories were identified to be either overstated or understated and were appropriately reduced. 14

15 Capital Outlay: Capital outlay projections were reduced since no vehicles are expected to be purchased in Discussion continues concerning reviewing the financial picture quarterly to make decisions about potentially moving funds from the facilities reserves to make more substantial payments on the Bond. PERFORMANCE MEASUREMENT Throughout the year, budget performance is monitored monthly through reports generated by the San Juan County Auditor and Treasurer, including revenue and expenditure reports. These document revenues and expenditure amounts, including budgeted amounts, monthly and year-to-date actual receipts and expenditures, and the percent received or spent. The EMS Chief, District Superintendent, and EMS Executive Assistant review these reports and follow up where unfavorable variances are indicated. The Executive Assistant will then subsequently utilize the proposed format provided in this budget revision to draft reports for presentation to the District Commissioners at regular meetings BUDGET SUMMARY Budget Year Reconciliation 2016 Reserves Expenses Revenue Beginning Cash 835,215 Total Revenue 3,091,978 Excess Bond Principal Payment Potential Operating Expenses (3,355,685) Capital Expenditures (5,000) Bond Principal Payments (57,000) Cash Held in Reserves Budgeted Operating Reserve 164,508 Builidng Loan Payment Reserves 275,000 Vehicle Reserves 45,000 Excess Bond Principal Payment Potential 25,000 Reserve Total 509,508 (509,508) Net Budget Year Activities ,927,193 15

16 ADMINISTRATION, OPERATIONS, & FACILITIES BUDGET KEY ASSUMPTIONS The following are key assumptions relating to the expenses categories included within the Administration, Operations, and Facilities cost centers of San Juan Island EMS and MedEvac (SJIEMS). A description of items included in the Administration, Operations, and Facilities subsection of the financial statement breakdown is provided below. The budgeted financial statement trails the Major Highlights section of this report. At the bottom of this financial statement breakdown, the expenses are netted out to zero, reflecting the allocation of these items to the revenue generating service lines within SJIEMS. ADMINISTRATION/OPERATIONS The expenses included in Salaries and Benefits are personnel expenses and their directly related benefit expenses that impact all functions and operations of the entire agency. This includes the Chief/EMS Administrator, Director of Operations, Executive Assistant, Superintendent San Juan Public Hospital District #1 (includes offsetting reimbursements), Director of Outreach, and Logistics Coordinator. All expenses that do not generate revenue, including fixed overhead operations costs, are accounted for in this cost center. These include accounting fees, advertising expenses, elections/warrants expenses, general umbrella insurance, legal fees, office expenses, and state auditors expenses. The pass through expense, funded by the District, for the District Superintendent can also be found in this department. The Administration Operations cost center is subsequently allocated between the two revenue generating service line departments. The ratios used to allocate these expense items are based on one of three measures: Personnel Costs are split at an 80/20 ratio respectively between EMS Ground Ambulance and EMS Air/MedEvac Ambulance services, with the exception of the EMS Administrator at 40/60. Supervising Physicians are at a ratio of 50/50. Legal fees have been allocated 20/80 due to the Medicaid audit. This allocation was based on a review of two factors; the volume of calls generated between service lines and the time estimated to be spent supporting specific service lines. Additionally, several other expenses were identified as 80/20 cost share, including Administration Fees, General Umbrella Liability Insurance, Office supplies and Equipment, and Telephone. 16

17 Required overhead costs benefiting the agency at large are allocated evenly between the two revenue service lines. This include Accounting Services, State Auditor Services, Elections and Warrants Costs, Postage, Advertising/Promotion, and Software support fees. All costs associated with the Superintendent of the District are 100% allocated to the EMS Ground Ambulance service line along with the associated pass through revenue. FACILITIES This Includes physical property management related expenses, including Building Insurance, and Building Repairs and Maintenance which includes Building Fixtures, Station Building Supplies, and Structures. Other facility expense categories include Minor Building Equipment, Utilities expenses (electricity and water), and Bond Interest Expense. Facilities costs are subsequently allocated between the two revenue generating departments. These expense items are split 90/10 between EMS Ground Ambulance and EMS Air/MedEvac Ambulance services respectively, based on use of the Administrative Building staff space, the EMT/Paramedic workroom used by all EMS personnel, use of the general meeting room and training room space for the respective departments, and storage space for supplies and equipment. MAJOR HIGHLIGHTS The items noted below have been recommended for a revision within the 2016 budget. The revision amount and subsequent explanation is provided. ADMINISTRATION/OPERATIONS All administrative and operations salaries reduced by 8.25% in 2014 were continued, except the EMS Administrator Salary was increased to a level sufficient to attract an EMS administrator with the appropriate level of experience. Logistics Coordinator hours have been reduced to 32 hours per week. Payroll taxes were slightly increased to account for the impact of a new Administrator. There was an increase in staffing benefits related to the potential costs associated with the recruitment of a new Chief/EMS Administrator. The Moving Allowance cost was estimated at $5000, which is considered a reasonable and customary amount. Legal Services was reduced to $40,000 and the Air/MedEvac ratio allocation was increased due to anticipated costs associated with an ongoing legal matter associated with that agency aspect. 17

18 Accounting Services were decreased to reflect the projected oversight by an experienced Administrator, and the reduced need for ongoing financial advisement. Software services fee were adjusted to reflect costs that were understated at the time of the originally approved budget. These additional costs are anticipated to be increased by $9,000 to $15,000. State Auditor fees are anticipated to be higher than originally budgeted by $2,000. FACILITIES Building Insurance was kept the same as Bond interest payments are not anticipated to change in Interest expense associated with the GO Bonds has been reduced by $2000 to more closely align with anticipated payment rates. Building Structure Costs and Station Equipment were both decreased by $1,000, while Station Supplies was increased by $500. Electricity expenses were kept the same, while water was reduced by $ REVISED BUDGET PROPOSAL ADMINISTRATION, OPERATIONS, & FACILITIES The 2016 Revised Budget associated with the Administration, Operations, and Facilities cost centers is provided in the subsequent Exhibit 1in the summary format. The full line item detail financial statement for these cost centers can be found in Exhibit 2. 18

19 EXHIBIT PROPOSED BUDGET REVISION: ADMINISTRATION, OPERATIONS, AND FACILITIES (SUMMARY VERSION) San Juan Island EMS Administration, Operations, & Facilities Administration/Operations Period Approved Proposed Actuals Actuals Actuals Annualized Budget Budget Salaries and Benefits 762, , , , , ,105 Superintendent Salary SJCPHD 47,500 47,500 59,280 59,280 59,280 59,280 Salary & Benefits Pass-through Revenue (75,000) (75,000) (93,750) (84,030) (83,000) (83,000) Office Expenses 19,594 24,518 26,033 22,833 22,500 21,500 Telephone 14,160 11,749 12,479 10,156 12,000 10,000 Advertising 23,100 8,975 6,836 7,544 5,000 8,000 Professional Services 12,578 27,938 20,590 69,450 71,000 65,000 General Insurance 2,056 2,158-5,315 4,093 4,093 Elections and Warrants 11,074 1,836 19,630 11,195 6,000 21,000 Administrative Fees Travel Costs 29,927 10,184 10,108 4,085 4,900 4,200 Subtotal Administration/Operations 847, , , , , ,178 Facilities Building Insurance 25,472 27,744 43,779 27,660 28,825 28,825 Bond Interest Expense - 64,006 61,080 59,237 62,000 60,000 Building Repairs & Maintenance 21,232 17,707 12,421 16,805 8,000 7,500 Utilities 9,662 18,958 14,626 15,849 16,500 16,000 Equipment - 4,826 2,180 1,285 2,500 1,500 Subtotal Facilities 56, , , , , ,825 Total Administration/Operations/Facilities to be Allocated 903, , , , , ,003 Allocated to EMS Ground Ambulance Services (707,822) (611,851) (627,115) (555,696) (619,905) (582,141) Allocated to EMS Air/MedEvac Ambulance Services (196,049) (162,893) (173,689) (169,376) (184,053) (223,862) Net Administration/Operations/Facilities Remaining

20 EXHIBIT PROPOSED BUDGET REVISION: ADMINISTRATION, OPERATIONS, AND FACILITIES (EXPANDED VERSION) San Juan Island EMS Administration, Operations, & Facilities Period Administration/Operations Approved Proposed Actuals Actuals Actuals Annualized Budget Budget EMS Administrator 125, , ,500 68, , ,000 Office Manager 67, Executive Assistant - 69,015 68,030 63,977 63,970 63,970 Facilities Manager Operations Director 57,996 59,155 58,311 56,602 55,630 55,675 Prevention Coordinator 51, Logistics Coordinator 59,819 48,480 47,701 40,510 45,500 41,000 Outreach Coordinator - 59,756 61,115 53,927 57,460 57,460 Vacation/Holiday (cashed) 31,749 10,981 4, FICA 90,127 30,499 32,193 27,291 30,500 30,500 L & I 6,695 5,392 10,051 12,755 10,000 13,000 Retirement 50,626 30,479 49,614 39,652 53,000 50,000 Uniforms 29, ,000 1,000 Medical 152, , , , , ,000 Deferred Comp. 8,700 5,400 6,057 10,320 6,300 12,000 Unemployment , ,675 1,500 2,500 Cell Phone Stipend - Admin - 1,600 1, HRA Account 15, Moving Allowance 15,319-5,000-14,500 5,000 Flight Memberships - 1, Salaries and Benefits 762, , , , , ,105 Superintendent Salary SJCPHD 47,500 47,500 59,280 59,280 59,280 59,280 Salary & Benefits Pass-through Revenue (75,000) (75,000) (93,750) (84,030) (83,000) (83,000) Office Supplies 14,973 9,461 3,954 4,843 2,500 3,500 Software 3,691 11,371 17,588 15,628 15,000 14,000 Office Equipment - 1,244 2,326 1,193 1,000 1,000 Postage 930 2,442 2,165 1,169 4,000 3,000 Office Expenses 19,594 24,518 26,033 22,833 22,500 21,500 Telephone 14,160 11,749 12,479 10,156 12,000 10,000 Advertising 23,100 8,975 6,836 7,544 5,000 8,000 Accounting Services 3,011 8, ,801 11,000 15,000 Legal Services 2,203 19,596 3,620 32,649 50,000 40,000 State Auditor 7,364-16,011-10,000 10,000 Professional Services 12,578 27,938 20,590 69,450 71,000 65,000 General Insurance 2,056 2,158-5,315 4,093 4,093 Election Costs 4,718-13,861 4,332-15,000 County Auditor-Warrants 6,355 1,836 5,770 6,863 6,000 6,000 Elections and Warrants 11,074 1,836 19,630 11,195 6,000 21,000 Administrative Fees Per Diem 6, , Mileage 12,031 6,357 5,912 2,451 2,500 2,500 Lodging 11,875 3,290 3,986 1,315 1,200 1,200 Travel Costs 29,927 10,184 10,108 4,085 4,900 4,200 Subtotal Administration/Operations 847, , , , , ,178 Facilities Building Insurance 25,472 27,744 43,779 27,660 28,825 28,825 Interest GO Bonds til ,006 61,080 59,237 62,000 60,000 Interest Expense Bond Interest Expense - 64,006 61,080 59,237 62,000 60,000 Building/Fixtures - 1, Structures 3,590 11,531 8,403 13,541 5,000 4,000 Station/Building Supplies 17,642 4,307 4,018 3,264 3,000 3,500 Building Repairs & Maintenance 21,232 17,707 12,421 16,805 8,000 7,500 Electricity 5,356 9,153 7,119 8,751 9,000 9,000 Water 4,306 9,805 7,507 7,098 7,500 7,000 Utilities 9,662 18,958 14,626 15,849 16,500 16,000 Equipment - 4,826 2,180 1,285 2,500 1,500 Subtotal Facilities 56, , , , , ,825 Total Administration/Operations/Facilities to be Allocated 903, , , , , ,003 Allocated to EMS Ground Ambulance Services (707,822) (611,851) (627,115) (555,696) (619,905) (582,141) Allocated to EMS Air/MedEvac Ambulance Services (196,049) (162,893) (173,689) (169,376) (184,053) (223,862) Net Administration/Operations/Facilities Remaining

21 EMS GROUND AMBULANCE SERVICES BUDGET KEY ASSUMPTIONS The following key assumptions relate to the expense categories included within the EMS Ground Ambulance Service of SJIEMS. Items included in the EMS Ground Ambulance Service subsection of the financial statement breakdown are described below. The budgeted financial statement follows the Major Highlights section. In addition to budgeted financial statements, several revenue and cost statistics are provided. EMS GROUND AMBULANCE SERVICES The major revenue sources for this service line include Tax Revenues, Grant Revenues, Program (CPR/1 st Aid/Wilderness Class) Fees, Service Fees (Ground/Aid Car/BLS) which are reduced by patient refunds issued, and Reimbursements/Refunds/Rebates. Minor revenue sources for the EMS Ground Ambulance Service include Donations/Contributions, Loan Repayments, Miscellaneous Revenues, Sale of Capital Assets, and Interest Income, The EMS Ground Ambulance receives allocation of Administration, Operations, and Facilities as noted in the prior section. Salaries and Benefits expenses impact all functions and operations of the EMS Ground Ambulance service line. If this expense is not considered 100% related to EMS Ground services then the shared allocations are shown below. Paramedics expenses are split 96/4 between EMS Ground and EMS Air/MedEvac services. EMTs split 74/26 between EMS Ground and EMS Air/MedEvac services. Volunteer Officers, unsplit. Ground and Flight Supervising Physicians are allocated at 50/50 between EMS Ground and EMS Air/MedEvac services. Volunteer Appreciation, split 80/20. EMS Uniform Costs are divded 20/80. All costs associated with the SJCPHD Superintendent are allocated to EMS Ground Ambulance service line, along with the associated pass through revenue. The following expense categories were identified as being shared expenses and allocated between the EMS Ground Ambulance Service and the EMS Air/MedEvac Ambulance Service based on the respective call volumes: Medical Supplies, Medications, Preparedness expenses, Medical Exams, Minor Medical Equipment, EMS Equipment Maintenance and Repairs, Contracted Services, Medical Claims Billing Services, and Contracted Services-Dispatch. The Laundry and District costs are considered to be shared equally between the two service lines. Portable Equipment and Vehicle Insurance costs are considered to be shared and are allocated at 90/10. 21

22 The following expenses categories are considered to be direct expenses associated with the EMS Ground Ambulance service and are allocated at 100%: all Community Outreach Program costs, all Vehicle and Maintenance costs, and Marine Boat fees. The following expense categories are considered to be shared expenses between EMS Ground and EMS Air/MedEvac service lines: Travel costs associated with staff training and education are allocated 20/80 between EMS Ground and EMS Air/MedEvac services. Tuition costs associated with staff training and education are allocated at 57/43, based on the specific individuals budgeted to receive continuing education and the respective service lines they work within. Training costs are allocated 80/20 between EMS Ground and EMS Air/MedEvac. Dues and Membership costs are allocated 20/80. Again, this is based on the specific individuals budgeted to receive association dues and membership benefits and the respective service lines they work within. MAJOR HIGHLIGHTS The items noted below have been recommended for a revision within the 2016 budget. The revision amount and subsequent explanation is provided. EMS GROUND AMBULANCE SERVICE Major Revenue Sources Property Tax Revenues are being increased from $949,700 to $1,072,278 reflecting projections for 2016 as stated by the San Juan County Tax Assessor. Program Fee revenues were increased by $3,127 to reflect the return from extended leave by the Outreach Program Director. EMS Ground Ambulance Service revenues are slightly increased over the previously budgeted rates. Ground revenue was adjusted accordingly to $380,000. Patient Refunds are adjusted to reflect the anticipated refunds for Minor Revenue Sources Other Grants was increased by $10,000 to reflect expected grant to pay for a Wilderness EMT Class and the Dept. of Health Grant was increased by $1500 to reflect promised funds, per Outreach Coordinator. Small Refunds from Vendors was decreased by $7,000 to align better with projected 2015 revenues. 22

23 Donations are adjusted to more accurately represent the level of donations expected at this time. This has been reduced by $2,000. Sale of Fixed Assets has been decreased by $4,000 to reflect the anticipated receipts from sale of one of the Ford Explorer, as expected by the Director of Operations. Investment Interest Income has been increased by $200 to reflect a more accurate earnings rate in 2015 based on current performance. Expenses Salaries and Benefit expenses were reduced by the following: o EMT salaries were reduced by $5,000 to reflect a more accurate rate based on negotiations completed subsequent to the original budget preparation. o Paramedic Salaries were increased by $3,000 to cover required salary increase steps. o Provider L&I expenses were increased by $10,943 to reflect the increased rates based on the recent years Labor & Industry claims experience. Radio Equipment expense was increased by $5,000 to reflect the additional cost associated with upgrading of radios and pagers. EMS Equipment Repairs and Maintenance was increased by $5,000 to reflect anticipated cost associated with antenna repairs. Contract Services were increased by $26,000 to reflect actual repair and maintenance fees due to ongoing medical equipment and repairs. This line item was understated in the last 2015 budget. EMS Billing Services was increased by $10,002 to reflect more accurately the end of 2015 projected numbers. Tuition expenses were reduced to reflect the currently anticipated costs in This resulted in a reduction of $510. District Costs were anticipated to be overstated for As a result this expense item has been increased by $2,000. Dues and Memberships costs were adjusted to reflect the currently anticipated costs in 2015, resulting in a decrease of $5,000. Dispatch fees were adjusted in the original budget to reflect the rate change based on achieving the next tier of billing rates, as a result of dispatch volumes experienced. Closer review of this expense item resulted in a reduction of anticipated expenses of 23

24 $12,000. Ground-to-flight percentages were changed to more reflect more accurately the costs associated with Sheriff s dispatch for ground of approximately $40,000. Community Outreach Supplies were decreased by $3,000 due to being originally understated. Current year costs reflect increased use of the community car seat program. Fuel and Oil decreased by $1,000 to better reflect projected totals for 2016 Medical supplies was decreased by $10,000 due to re-organization and work by staff to cuts costs and back up supplies where possible. Medications costs were decreased by $1,000 due to work by staff to re-organize back up supplies REVISED BUDGET PROPOSAL EMS GROUND AMBULANCE SERVICES The 2016 Revised Budget associated with the EMS Ground Ambulance Services is provided in the subsequent Exhibit 3 Summary format. Full line item details for these cost centers can be found in Exhibit 4. 24

25 EXHIBIT PROPOSED BUDGET REVISION: EMS GROUND AMBULANCE SERVICE (SUMMARY VERSION) San Juan Island EMS EMS Ground Ambulance Services Period Approved Proposed Actuals Actuals Actuals YTD AS OF Budget Budget EMS Ground Ambulance Services /31/ Income Totals by Category: Major Revenue Sources Tax Revenues 1,200,519 1,000, , , ,700 1,078,978 Grant Revenues 3,134 1,272 3,953 2,809 1,500 13,000 Service Revenues 478, , , , , ,000 Patient Refunds (1,902) (3,573) (745) - (1,519) (1,547) Reimbursements/Refunds/Rebates 10,135 2,575 4,052 1,563 3,000 1,600 Subtotal Major Revenue Sources 1,690,465 1,593,750 1,368,813 1,426,597 1,341,322 1,501,031 Minor Revenue Sources Donation/Contribution Revenues 3,568 1,000 1, ,000 1,000 Loan Repayments - - 2,470 1,886 2,250 - Miscellaneous Revenues - 1, Sale of Assets/Capital Asset Revenues - 8, ,980 7,200 8,000 4,000 Interest Income , Subtotal Minor Revenue Sources 3,641 10, ,320 10,293 12,550 5,500 Total Revenues 1,694,106 1,604,053 1,959,133 1,436,891 1,353,872 1,506,531 Operational Expense by Departments Allocated Administration/Operations 657, , , , , ,698 Allocated Facilities 50, , , , , ,443 Subtotal Administration/Operations/Facilities 707, , , , , ,141 EMS Ground Ambulance Expenses Salaries and Benefits 711, , , , , ,965 Medical Supplies 79,300 58,556 52,763 50,790 52,585 45,521 Medical Equipment - 26,022 8,106 12,817 3,924 9,418 Laundry Equipment (Expensed Items) 6,850 3, ,626 3,924 7,848 Equipment Repairs/Maintenance 12,555 18,390 13,927 26,798 14,127 22,761 Travel Costs - 1,633 1,192 2,019 1,200 1,200 Billing Services 80, ,404 70,805 84,604 74,951 82,801 Education/Training 19,030 15,945 6,156 6,695 7,716 7,425 Dues & Fees 9,711 5,316 3,110 2,447 8,300 4,200 Contracted Services - Dispatch 64,256 69,636 71,657 52,283 80,054 40,000 Community Outreach 6,400 26,930 13,789 14,783 21,000 19,500 Insurance Expenses 6,498 6,700-9,144 7,620 7,620 Vehicle Maintenance & Expenses 57,980 46,892 26,870 31,402 28,000 27,500 Subtotal EMS Ground Ambulance Services 1,055,903 1,150,387 1,038,993 1,086,028 1,112,291 1,069,310 Total Operating Expenses 1,763,725 1,762,238 1,666,108 1,641,724 1,732,196 1,651,451 Net Profitability (Revenues - Expenses) (69,619) (158,186) 293,025 (204,833) (378,324) (144,920) 25

26 EXHIBIT PROPOSED BUDGET REVISION: EMS GROUND AMBULANCE SERVICE (EXPANDED VERSION) San Juan Island EMS EMS Ground Ambulance Services Period Actuals Actuals Actuals YTD AS OF Approved Budget Proposed Budget EMS Ground Ambulance Services /31/ Income Totals by Category: Major Revenue Sources Property Tax Revenue 1,193, , , , ,000 1,072,278 Leasehold Tax 5,379 3,251 4,989 4,774 5,000 5,000 Timber Harvest Tax - Private Land 59 1, Payment In-Lieu of Property Tax (DNR) 1, ,500 1,500 Tax Revenues 1,200,519 1,000, , , ,700 1,078,978 Dept of Health Trauma Grant (Fire) 3,134 1,272 3,953 2,809 1,500 3,000 Other grants ,000 Grant Revenues 3,134 1,272 3,953 2,809 1,500 13,000 Program Fees 22,246 35,254 28,526 21,684 25,873 29,000 Ground Ambulance/Aid Car/Bls 456, , , , , ,000 Service Revenues 478, , , , , ,000 Patient Refunds (1,902) (3,573) (745) - (1,519) (1,547) Reimbursements/Refunds/Rebates 10,135 2,575 4,052 1,563 3,000 1,600 Subtotal Major Revenue Sources 1,690,465 1,593,750 1,368,813 1,426,597 1,341,322 1,501,031 Minor Revenue Sources Donations - - 1, ,000 - Contributions/Donations--Private Sources 3,568 1, ,000 Donation/Contribution Revenues 3,568 1,000 1, ,000 1,000 Loan Repayments - - 2,470 1,886 2,250 - Miscellaneous Revenues - 1, Sale of Fixed Assets ,980 7,200 8,000 4,000 Capital from Old EMS Building - 8, Sale of Assets/Capital Asset Revenues - 8, ,980 7,200 8,000 4,000 Interest Income , Subtotal Minor Revenue Sources 3,641 10, ,320 10,293 12,550 5,500 Total Revenues 1,694,106 1,604,053 1,959,133 1,436,891 1,353,872 1,506,531 Operational Expense by Departments EMS Administrator 100, ,000 98,800 55,123 87,200 72,000 Office Manager 53, Executive Assistant - 55,212 54,424 51,182 51,176 51,176 Facilities Manager Operations Director 46,397 47,324 46,648 45,281 44,504 44,540 Prevention Coordinator 41, Logistics Coordinator 47,855 38,784 38,161 32,408 36,400 32,800 Outreach Coordinator - 47,805 48,892 43,142 45,968 45,968 Vacation/Holiday (cashed) 25,399 8,785 3, FICA 72,101 24,399 25,755 21,833 24,400 24,400 L & I 5,356 4,314 8,041 10,204 8,000 10,400 Retirement 40,501 24,383 39,691 31,721 42,400 40,000 Uniforms 23, Medical 121,937 98, ,622 97, , ,000 Deferred Comp. 6,960 4,320 4,845 8,256 5,040 9,600 Unemployment 438 8, ,140 1,200 2,000 Cell Phone Stipend - Admin - 1, HRA Account 12, Moving Allowance 12,255-4,000-11,600 4,000 Flight Memberships - 1, Salaries and Benefits 610, , , , , ,684 Superintendent Salary SJCPHD 47,500 47,500 59,280 59,280 59,280 59,280 Salary & Benefits Pass-through Revenue (75,000) (75,000) (93,750) (84,030) (83,000) (83,000) Office Supplies 11,979 7,569 3,163 3,875 2,000 2,800 Software 1,845 5,686 8,794 7,814 7,500 7,000 Office Equipment , Postage 465 1,221 1, ,000 1,500 Office Expenses 14,289 15,471 14,901 13,227 12,300 12,100 Telephone 11,328 9,399 9,983 8,125 9,600 8,000 Advertising 11,550 4,488 3,418 3,772 2,500 4,000 Accounting Services 1,505 4, ,400 5,500 7,500 Legal Services 1,101 9,798 1,810 16,325 25,000 8,000 State Auditor 3,682-8,006-5,000 5,000 Professional Services 6,289 13,969 10,295 34,725 35,500 20,500 General Insurance 1,645 1,726-4,252 3,274 3,274 Election Costs 2,359-6,930 2,166-7,500 County Auditor-Warrants 3, ,885 3,431 3,000 3,000 Elections and Warrants 5, ,815 5,597 3,000 10,500 Administrative Fees Per Diem 4, Mileage 9,625 5,086 4,730 1,961 2,000 2,000 Lodging 9,500 2,632 3,189 1, Travel Costs 23,941 8,147 8,086 3,268 3,920 3,360 Allocated Administration/Operations 657, , , , , ,698 26

27 San Juan Island EMS EMS Ground Ambulance Services Period Actuals Actuals Actuals YTD AS OF Approved Budget Proposed Budget EMS Ground Ambulance Services /31/ Allocated Facilities Building Insurance 22,925 24,970 39,401 24,894 25,943 25,943 Interest GO Bonds til ,605 54,972 53,314 55,800 54,000 Interest Expense Bond Interest Expense - 57,605 54,972 53,314 55,800 54,000 Building/Fixtures - 1, Structures 3,231 10,378 7,563 12,187 4,500 3,600 Station/Building Supplies 15,878 3,876 3,617 2,938 2,700 3,150 Building Repairs & Maintenance 19,109 15,936 11,179 15,125 7,200 6,750 Electricity 4,820 8,238 6,407 7,876 8,100 8,100 Water 3,876 8,825 6,756 6,388 6,750 6,300 Utilities 8,696 17,062 13,163 14,264 14,850 14,400 Equipment - 4,343 1,962 1,156 2,250 1,350 Allocated Facilities 50, , , , , ,443 Subtotal Administration/Operations/Facilities 707, , , , , ,141 EMS Ground Ambulance Expenses Paramedics 469, , , , , ,400 EMTs 202, , , , , ,300 Volunteer Officers 1,450 3,030 5,740 10,968 11,000 11,000 Medical Program Director 21,750 30,452 30,002 30,002 30,000 25,000 Vacation / Holiday - cashed - 17,327 9, Provider FICA - 58,354 59,628 63,106 60,797 63,403 Provider L&I - 11,798 16,949 21,681 26,577 21,713 Provider Retirement - 46,403 52,546 59,561 54,718 59,060 Provider Medical - 61,090 59,814 54,776 74,694 65,140 Deferred Comp - 6,601 7,507 6,566 7,383 6,948 EMS Uniforms - Provider - 2,300 2,036 1,044 1,000 1,000 Cell Phone Stipend Provider 3,993 2, Volunteer Appreciation 12,571 15,611 10,888 6,576 9,600 8,000 Moving Allowance - - Salaries and Benefits 711, , , , , ,965 Medical Supplies 78,267 40,666 40,896 35,856 39,242 31,394 Medical Exams Medications - 17,868 11,611 14,615 12,558 13,342 Preparedness Medical Supplies 79,300 58,556 52,763 50,790 52,585 45,521 Medical Equipment - 26,022 8,106 12,817 3,924 9,418 Laundry Equipment (Expensed Items) 6,850 3, ,626 3,924 7,848 EMS Equipment Maint/Repair ,773 - Contract Services 12, , Contract Services/Maintenance - 18,390 13,927 18,824 2,355 22,761 Equipment Repairs/Maintenance 12,555 18,390 13,927 26,798 14,127 22,761 Per Diem - Provider Mileage - Provider , Lodging - Provider Travel Costs - 1,633 1,192 2,019 1,200 1,200 Billing Services 80, ,404 70,805 84,604 74,951 82,801 Tuition 2,894 4,448 1,285 1,256 1,716 1,425 Training 16,136 11,497 4,871 5,439 6,000 6,000 Education/Training 19,030 15,945 6,156 6,695 7,716 7,425 Dues & Memberships 931 1, , ,200 District Costs 2, ,500 - CAMTS Accreditation Marine Boat Fees 6,225 3,688 1,663 1,155 5,000 3,000 Certifications/ District/Licensing Fees 8,780 3,938 2,298 1,202 7,500 3,000 Dues & Fees 9,711 5,316 3,110 2,447 8,300 4,200 Contracted Services - Dispatch 64,256 69,636 71,657 52,283 80,054 40,000 Outreach Supplies - 16,574 5,878 10,590 15,000 12,000 Outreach Equipment , ,000 1,000 Wilderness Classes 6,400 10,032 6,470 3,842 5,000 6,500 Community Outreach 6,400 26,930 13,789 14,783 21,000 19,500 Portable Equipment Insurance Vehicle Insurance 5,664 5,853-8,365 6,971 6,971 Insurance Expenses 6,498 6,700-9,144 7,620 7,620 Motor Vehicle Parts 12, ,088 3,401 2,000 2,500 Vehicle Maint/Repair 29,584 33,823 12,253 18,799 15,000 15,000 Fuel and Oil 15,511 12,189 13,528 9,203 11,000 10,000 Vehicle Maintenance & Expenses 57,980 46,892 26,870 31,402 28,000 27,500 Subtotal EMS Ground Ambulance Services 1,055,903 1,150,387 1,038,993 1,086,028 1,112,291 1,069,310 Total Operating Expenses 1,763,725 1,762,238 1,666,108 1,641,724 1,732,196 1,651,451 Net Profitability (Revenues - Expenses) (69,619) (158,186) 293,025 (204,833) (378,324) (144,920) 27

28 Provided below are additional supporting calculations demonstrating the revenue per call, the costs per call, and the net profit (loss) per call, based on the financial statements provided above in Exhibit 3. These calculations reflect total revenues. Calls YTD 2015 Budget 2016 Budget Ground 1,077 1,158 1,098 1,101 1,138 1,161 MedEvac Subtotal of Calls Per Year 1,572 1,496 1,399 1,334 1,424 1,453 Calls in Percentages Ground 68.5% 77.4% 78.5% 82.5% 79.9% 79.9% MedEvac 31.5% 22.6% 21.5% 17.5% 20.1% 20.1% Revenue Per Call - Ground $ 1, $ 1, $ 1, $ $ 1, $ 1, Cost Per Call - Ground $ 1, $ 1, $ 1, $ 1, $ 1, $ 1, Net Profit/(Loss) Per Call - Ground $ (64.64) $ (136.60) $ (250.41) $ (722.93) $ (336.13) $ (127.47) Tax Base Revenue Per Ground $ 1, $ $ $ $ $ Overall Cost Per Call - Ground $ 1, $ 1, $ 1, $ 1, $ 1, $ 1, Net Profit/(Loss) Per Call - Ground $ (522.94) $ (658.09) $ (647.51) $ (632.10) $ (691.29) $ (495.74) As seen above, call volumes have fluctuated year to year but were anticipated to be slightly higher in 2015 than in 2014, and are projected to be an additional 2% higher in

29 EMS AIR/MEDEVAC AMBULANCE SERVICES BUDGET KEY ASSUMPTIONS The following are key assumptions relating to the expenses categories included within the EMS Air/MedEvac Ambulance Service of SJIEMS. A description of items included in the EMS Air/MedEvac Ambulance Service subsection of the financial statement breakdown is provided below. The budgeted financial statement is provided following the Major Highlights section of this report. In addition to budgeted financial statements there are several revenue and cost statistics provided. EMS AIR/MEDEVAC AMBULANCE SERVICES The major revenue sources for this service line include Service Fees (EMS Air/MedEvac Ambulance Service) which are reduced by patient refunds issued, and Reimbursements/Refunds/Rebates. There are no minor revenue sources directly related to the EMS Air/MedEvac Ambulance Service. The EMS Air/MedEvac Ambulance bears costs associated with Administration, Operations, and Facilities, as noted in the Administration, Operations, and Facilities report section. Included in Salaries and Benefits are personnel expenses, and their directly related benefit expenses that impact all functions and operations of the EMS Ground Ambulance service line. Allocations include Paramedics split 96/4 between EMS Ground and EMS Air/MedEvac services respectively. EMTs allocated 74/26. Medical Program Director allocated 60/40. Volunteer Appreciation 80/20. EMS Uniform Costs 20/80. The following expense categories were shared between EMS Ground and EMS Air, based upon respective call volumes: Medical Supplies, Medications, Preparedness expenses, Medical Exams, Minor Medical Equipment, EMS Equipment Maintenance and Repairs, Contracted Services including Medical Claims Billing Services and Contracted Services-Dispatch. Laundry and District costs are considered to be shared equally between the two service lines. Portable Equipment and Vehicle Insurance costs allocated 90/10 respectively between EMS Ground and EMS Air/MedEvac service lines. The following expense categories are considered to be direct expenses associated with the EMS Air/MedEvac Ambulance service and are allocated at 100%: Flight Nurses, CAMTS Accreditation fees, Air Transport Contract costs, and Excess Liability Insurance. 29

30 The following expenses are shared between EMS Ground and EMS Air/MedEvac service lines: Travel costs associated with staff training and education are split 20/80 between EMS Ground and EMS Air/MedEvac services respectively. Tuition costs associated with staff training and education are allocated 57/43, based on the specific individuals budgeted to receive continuing education and the respective service lines they work within. Training costs are allocated at 80/20. Dues and Membership costs are allocated 20/80, based on the specific individuals budgeted to receive association dues and membership benefits and the respective service lines they work within. MAJOR HIGHLIGHTS The 2016 budget items noted below have been recommended for revision. amount and subsequent explanation is provided. The revision EMS AIR/MEDEVAC AMBULANCE SERVICE Major Revenue Sources Air Ambulance Service Revenues were increased from $1,547,188 to $1,585,500 to reflect what is most likely to occur based on recent year s historical performance. The previously projected increase was a conservative estimate. Based on review of historical trends, recent payer mix data, and current 2015 call volumes, it was determined this amount was previously underestimated. Expenses Salaries and Benefit expenses were reduced by the following: o EMT salaries were reduced by $5,000 to reflect a more accurate rate based on the negotiations completed subsequent to the original budget s preparation. o Provider L&I expenses were decreased by $5,600 to reflect the 2015 projected numbers. Radio Equipment expense was increased by $5,000 to reflect the additional cost associated with upgrading of radios and pagers. EMS Equipment Repairs and Maintenance was increased by $5,000 to reflect the anticipated cost associated with the agencies antenna repairs. Contract Services is increased by $26,000 to reflect actual repair and maintenance fees due to ongoing medical equipment and repairs. This line item was understated in the last 2015 budget. 30

31 EMS Billing Services was increased by $10,002 to reflect more accurately the end of 2015 projected numbers. Tuition expenses were reduced to reflect the currently anticipated costs in This resulted in a reduction of $510. District Costs are anticipated to be overstated for As a result this expense item has been increased by $2,000. Dues and Memberships costs are adjusted to reflect the currently anticipated costs in This resulted in an decreased of $5,000. Dispatch fees were adjusted in the original budget to reflect the rate change based on achieving the next tier of billing rates as a result of dispatch volumes experienced. A closer review of this expense items has resulted in a reduction of anticipated expenses of $12,000. Ground-to-flight percentages were changed to depict more accurately the costs associated with Flight Only dispatch of approximately $50,000. CAMTS recertification will occur in The anticipated costs are $8,000. Dues and Memberships costs are adjusted to reflect the currently anticipated costs in This resulted in an increase of $2,000. Medical supplies were decreased by $10,000 due to re-organization and work by staff to cuts costs and back up supplies where possible. Medications costs were decreased by $1,000 due to work by staff to re-organize back up supplies. Contracted Services Air Transport fees has been increased to reflect the increase in call volumes, the annual Medicare fee schedule reimbursement rate changes, and elimination of the -2% sequestration from Medicare that was figured into the fees in years past. In 2015, an additional payment (approximately $60,000) was made to Island Air Inc. to make sure that invoices were paid in the 60 day limit set forth by the contract and will not be a recurring event in However, a contract negotiation is anticipated to incur increases in this area. The line item of Air Transport Fee was increased by $142,000 to accommodate increases in Island Air Inc. s (IAI) expenses due to the purchase of a new plane. $100,000 of the increase was taken from EMS reserves. In order for contractual agreement to allow for funds to be dispersed to IAI a new contract will need to be finalized on or prior to 29 February

32 Proposed Changes in 2016 Adjusted Base Flight Fee to Industry Avg. 42, , Projected 2016 Budget 770, , Increase with contract revision Adjusted from negotiations 100, , , REVISED BUDGET PROPOSAL EMS AIR/MEDEVAC AMBULANCE SERVICES The 2016 Revised Budget associated with the EMS Air/MedEvac Ambulance Services is provided in Exhibit 5, Summary format. The full line item detail financial statement for these cost centers can be found in Exhibit 6. 32

33 EXHIBIT PROPOSED BUDGET REVISION: EMS AIR/MEDEVAC AMBULANCE SERVICES (SUMMARY VERSION) San Juan Island EMS EMS Air/MedEvac Ambulance Services Period Approved Proposed Actuals Actuals Actuals Annualized Budget Budget EMS Air/MedEvac Ambulance Services /31/ Income Totals by Category: Major Revenue Sources Service Revenues Air Ambulance 1,510,357 1,711,435 1,654,746 1,667,316 1,547, % 1,585,500 Patient Refunds (6,296) (10,957) (3,264) - (6,481) -0.4% (6,453) Reimbursements/Refunds/Rebates 40,539 10,302 16,207 6,252 12, % 6,400 Subtotal Major Revenue Sources 1,544,601 1,710,779 1,667,690 1,673,568 1,552, % 1,585,447 Minor Revenue Sources Total Revenues 1,544,601 1,710,779 1,667,690 1,673,568 1,552,707 1,585,447 Operational Expense by Departments Allocated Administration/Operations 190, , , , , % 212,480 Allocated Facilities 5,637 13,324 13,409 12,084 11, % 11,383 Subtotal Administration/Operations/Facilities 196, , , , , % 223,862 EMS Air Ambulance Expenses Salaries and Benefits 109, , , , , % 487,035 Medical Supplies 36,447 17,091 14,464 13,923 14, % 12,479 Medical Equipment - 7,595 3,726 5,891 1, % 2,582 Laundry % 550 Equipment (Expensed Items) 3,148 1, ,669 1, % 2,152 Equipment Repairs/Maintenance 5,770 5,194 3,818 9,924 3, % 6,239 Travel Costs - 6,532 4,769 8,077 4, % 4,800 Billing Services 37,184 38,646 19,410 32,244 20, % 22,699 Education/Training 6,217 6,230 2,187 2,307 2, % 2,575 Dues & Fees 14,009 23,791 3,886 5,927 13, % 12,800 Dispatch 29,533 20,325 19,644 19,926 21,946 50,000 Air Transport 778, , , , , ,000 Contracted Services - Air Transport 808, , , , , % 920,000 Insurance Expenses 722 5,482-7,754 6, % 6,462 Subtotal EMS Air/MedEvac Ambulance 1,021,077 1,425,948 1,164,165 1,363,641 1,164, % 1,480,372 Total Operating Expenses 1,217,126 1,588,841 1,337,854 1,533,018 1,348,627 1,704,234 Net Profitability (Revenues - Expenses) 327, , , , ,080 (118,787) 33

34 EXHIBIT PROPOSED BUDGET REVISION: EMS AIR/MEDEVAC AMBULANCE SERVICES (EXPANDED VERSION) San Juan Island EMS EMS Air/MedEvac Ambulance Services Period Actuals Actuals Actuals Annualized Approved Budget Proposed Budget EMS Air/MedEvac Ambulance Services /31/ Income Totals by Category: Major Revenue Sources Service Revenues Air Ambulance 1,510,357 1,711,435 1,654,746 1,667,316 1,547,188 1,585,500 Patient Refunds (6,296) (10,957) (3,264) - (6,481) (6,453) Reimbursements/Refunds/Rebates 40,539 10,302 16,207 6,252 12,000 6,400 Subtotal Major Revenue Sources 1,544,601 1,710,779 1,667,690 1,673,568 1,552,707 1,585,447 Minor Revenue Sources Total Revenues 1,544,601 1,710,779 1,667,690 1,673,568 1,552,707 1,585,447 Operational Expense by Departments EMS Administrator 25,000 25,000 24,700 13,781 21,800 48,000 Office Manager 13, Executive Assistant - 13,803 13,606 12,795 12,794 12,794 Facilities Manager Operations Director 11,599 11,831 11,662 11,320 11,126 11,135 Prevention Coordinator 10, Logistics Coordinator 11,964 9,696 9,540 8,102 9,100 8,200 Outreach Coordinator - 11,951 12,223 10,785 11,492 11,492 Vacation/Holiday (cashed) 6,350 2, FICA 18,025 6,100 6,439 5,458 6,100 6,100 L & I 1,339 1,078 2,010 2,551 2,000 2,600 Retirement 10,125 6,096 9,923 7,930 10,600 10,000 Uniforms 5, Medical 30,484 24,717 27,405 24,359 27,200 26,000 Deferred Comp. 1,740 1,080 1,211 2,064 1,260 2,400 Unemployment 110 2, Cell Phone Stipend - Admin HRA Account 3, Moving Allowance 3,064-1,000-2,900 1,000 Flight Memberships Salaries and Benefits 152, , ,103 99, , ,421 Superintendent Salary SJCPHD Salary & Benefits Pass-through Revenue Office Supplies 2,995 1, Software 1,845 5,686 8,794 7,814 7,500 7,000 Office Equipment Postage 465 1,221 1, ,000 1,500 Office Expenses 5,305 9,048 11,132 9,606 10,200 9,400 Telephone 2,832 2,350 2,496 2,031 2,400 2,000 Advertising 11,550 4,488 3,418 3,772 2,500 4,000 Accounting Services 1,505 4, ,400 5,500 7,500 Legal Services 1,101 9,798 1,810 16,325 25,000 32,000 State Auditor 3,682-8,006-5,000 5,000 Professional Services 6,289 13,969 10,295 34,725 35,500 44,500 General Insurance , Election Costs 2,359-6,930 2,166-7,500 County Auditor-Warrants 3, ,885 3,431 3,000 3,000 Elections and Warrants 5, ,815 5,597 3,000 10,500 Administrative Fees Per Diem 1, Mileage 2,406 1,271 1, Lodging 2, Travel Costs 5,985 2,037 2, Allocated Administration/Operations 190, , , , , ,480 34

35 San Juan Island EMS EMS Air/MedEvac Ambulance Services Period Actuals Actuals Actuals Annualized Approved Budget Proposed Budget EMS Air/MedEvac Ambulance Services /31/ Allocated Facilities Building Insurance 2,547 2,774 4,378 2,766 2,883 2,883 Interest GO Bonds til ,401 6,108 5,924 6,200 6,000 Interest Expense Bond Interest Expense - 6,401 6,108 5,924 6,200 6,000 Building/Fixtures Structures 359 1, , Station/Building Supplies 1, Building Repairs & Maintenance 2,123 1,771 1,242 1, Electricity Water Utilities 966 1,896 1,463 1,585 1,650 1,600 Equipment Allocated Facilities 5,637 13,324 13,409 12,084 11,783 11,383 Subtotal Administration/Operations/Facilities 196, , , , , ,862 EMS Air Ambulance Expenses Paramedics 19,566 12,909 14,326 14,578 14,480 14,600 EMTs 71,193 60,467 59,655 62,517 65,000 63,700 Flight Nurses - 301, , , , ,500 Medical Program Director 14,500 20,302 20,002 20,001 20,000 25,000 Vacation / Holiday - cashed - 2,623 1, Provider FICA - 8,833 9,026 9,552 9,203 9,597 Provider L&I - 1,786 2,565 3,282 4,023 3,287 Provider Retirement - 7,024 7,954 9,015 8,282 8,940 Provider Medical - 9,247 9,054 8,291 11,306 9,860 Deferred Comp , ,117 1,052 EMS Uniforms - Provider - 9,200 8,143 4,175 4,000 4,000 Cell Phone Stipend Provider Volunteer Appreciation 3,143 3,903 2,722 1,644 2,400 2,000 Moving Allowance 2,500 Salaries and Benefits 109, , , , , ,035 Medical Supplies 35,972 11,870 11,211 9,829 10,758 8,606 Medical Exams Medications - 5,216 3,183 4,006 3,442 3,658 Preparedness Medical Supplies 36,447 17,091 14,464 13,923 14,415 12,479 Medical Equipment - 7,595 3,726 5,891 1,076 2,582 Laundry Equipment (Expensed Items) 3,148 1, ,669 1,076 2,152 EMS Equipment Maint/Repair ,227 - Contract Services 5, , Contract Services/Maintenance - 5,194 3,818 7, ,239 Equipment Repairs/Maintenance 5,770 5,194 3,818 9,924 3,873 6,239 Per Diem - Provider - 1, Mileage - Provider - 3,150 2,472 4,795 1,600 3,200 Lodging - Provider - 2,150 1,661 2,984 2,400 1,200 Travel Costs - 6,532 4,769 8,077 4,800 4,800 Billing Services 37,184 38,646 19,410 32,244 20,547 22,699 Tuition 2,184 3, ,294 1,075 Training 4,034 2,874 1,218 1,360 1,500 1,500 Education/Training 6,217 6,230 2,187 2,307 2,794 2,575 Dues & Memberships 3,724 5,513 3,251 4,980 3,200 4,800 District Costs 2, ,500 - CAMTS Accreditation 7,730 18, ,000 8,000 Marine Boat Fees Certifications/ District/Licensing Fees 10,285 18, ,500 8,000 Dues & Fees 14,009 23,791 3,886 5,927 13,700 12,800 Dispatch 29,533 20,325 19,644 19,926 21,946 50,000 Air Transport 778, , , , , ,000 Contracted Services - Air Transport 808, , , , , ,000 Portable Equipment Insurance Excess Liability Insurance due to Air Evac - 4,738-6,738 5,615 5,615 Vehicle Insurance Insurance Expenses 722 5,482-7,754 6,462 6,462 Subtotal EMS Air/MedEvac Ambulance 1,021,077 1,425,948 1,164,165 1,363,641 1,164,574 1,480,372 Total Operating Expenses 1,217,126 1,588,841 1,337,854 1,533,018 1,348,627 1,704,234 Net Profitability (Revenues - Expenses) 327, , , , ,080 (118,787) 35

36 Provided below are additional supporting calculations demonstrating the revenue per call, the costs per call, and the net profit (loss) per call based on the financial statements provided above in Exhibit 5. Calls YTD 2015 Budget 2016 Budget Ground 1,077 1,158 1,098 1,101 1,138 1,161 MedEvac Subtotal of Calls Per Year 1,572 1,496 1,399 1,334 1,424 1,453 Calls in Percentages Ground 68.5% 77.4% 78.5% 82.5% 79.9% 79.9% MedEvac 31.5% 22.6% 21.5% 17.5% 20.1% 20.1% Revenue Per Call - Ground $ 1, $ 1, $ 1, $ $ 1, $ 1, Cost Per Call - Ground $ 1, $ 1, $ 1, $ 1, $ 1, $ 1, Net Profit/(Loss) Per Call - Ground $ (64.64) $ (136.60) $ (250.41) $ (722.93) $ (336.13) $ (127.47) Tax Base Revenue Per Ground $ 1, $ $ $ $ $ Overall Cost Per Call - Ground $ 1, $ 1, $ 1, $ 1, $ 1, $ 1, Net Profit/(Loss) Per Call - Ground $ (522.94) $ (658.09) $ (647.51) $ (632.10) $ (691.29) $ (495.74) As seen above, call volumes have fluctuated year to year but for the current year were anticipated to be slightly higher than There will be a change in medical personnel supervising SJIEMS ground 911 calls. Dr. Michael Sullivan formerly supervised both the ground 911 program and the flight program, but now will be only the county Medical Program Director. The new Agency Supervising Physician for the ground 911 program is Dr. Sean Stone, and negotiations are underway to acquire a new Supervising Physician for the flight program. 36

37 EMS CONSOLIDATED FINANCIAL STATEMENTS BUDGET The consolidated financial statements and budget, Exhibit 7, is a summary view. Exhibit 8 is the full itemized, expanded view. This is the format in which prior year budgets were prepared. Details relating to various changes in line items can be found within the specific cost center and service line budgets. 37

38 EXHIBIT PROPOSED BUDGET REVISION: SAN JUAN ISLAND EMS CONSOLIDATED FINANCIAL STATEMENT (SUMMARY VERSION) San Juan Island EMS Consolidated EMS Services EMS Ground & Air Ambulance Services Period Approved Proposed Actuals Actuals Actuals Annualized Budget Budget /31/ Income Totals by Category: Major Revenue Sources Tax Revenues 1,200,519 1,000, , , ,700 1,078,978 Grant Revenues 3,134 1,272 3,953 2,809 1,500 13,000 Service Revenues 1,988,936 2,304,742 2,061,156 2,120,630 1,935,829 1,994,500 Patient Refunds (8,198) (14,530) (4,009) - (8,000) (8,000) Reimbursements/Refunds/Rebates 50,674 12,877 20,259 7,816 15,000 8,000 Subtotal Major Revenue Sources 3,235,066 3,304,529 3,036,503 3,100,166 2,894,029 3,086,478 Minor Revenue Sources Donation/Contribution Revenues 3,568 1,000 1, ,000 1,000 Loan Repayments - - 2,470 1,886 2,250 - Miscellaneous Revenues - 1, Sale of Assets/Capital Asset Revenues - 8, ,980 7,200 8,000 4,000 Interest Income , Subtotal Minor Revenue Sources 3,641 10, ,320 10,293 12,550 5,500 Total Revenues 3,238,707 3,314,832 3,626,822 3,110,459 2,906,579 3,091,978 Operational Expense by Departments Allocated Administration/Operations 847, , , , , ,178 Allocated Facilities 56, , , , , ,825 Subtotal Administration/Operations/Facilities 903, , , , , ,003 EMS Ground and Air/MedEvac Expenses Salaries and Benefits 820,972 1,176,268 1,198,569 1,241,608 1,253,100 1,280,000 Medical Supplies 115,747 75,647 67,228 64,714 67,000 58,000 Medical Equipment - 33,617 11,832 18,708 5,000 12,000 Laundry 905 1,638 1,004 1,073 1,200 1,100 Equipment (Expensed Items) 9,999 4,873 1,135 13,295 5,000 10,000 Equipment Repairs/Maintenance 18,325 23,584 17,745 36,722 18,000 29,000 Travel Costs - 8,165 5,962 10,096 6,000 6,000 Billing Services 118, ,050 90, ,848 95, ,500 Education/Training 25,248 22,175 8,343 9,002 10,510 10,000 Dues & Fees 23,720 29,107 6,996 8,374 22,000 17,000 Dispatch 93,789 89,961 91,301 72, ,000 90,000 Air Transport 778, , , , , ,000 Contracted Services 872, , , , , ,000 Community Outreach 6,400 26,930 13,789 14,783 21,000 19,500 Insurance Expense 7,220 12,182-16,898 14,082 14,082 Vehicle Maintenance & Expenses 57,980 46,892 26,870 31,402 28,000 27,500 Subtotal EMS Ground and Air/MedEvac 2,076,980 2,576,335 2,203,157 2,449,669 2,276,865 2,549,682 Total Operating Expenses 2,980,851 3,351,080 3,003,962 3,174,741 3,080,823 3,355,685 Net Profitability (Revenues - Expenses) 257,856 (36,248) 622,861 (64,282) (174,244) (263,707) 38

39 EXHIBIT PROPOSED BUDGET REVISION: SAN JUAN ISLAND EMS CONSOLIDATED FINANCIAL STATEMENT (EXPANDED VERSION) San Juan Island EMS Consolidated EMS Services EMS Ground & Air Ambulance Services Period Approved Proposed Actuals Actuals Actuals Annualized Budget Budget /31/ Income Totals by Category: Major Revenue Sources Property Tax Revenue 1,193, , , , ,000 1,072,278 Leasehold Tax 5,379 3,251 4,989 4,774 5,000 5,000 Timber Harvest Tax - Private Land 59 1, Payment In-Lieu of Property Tax (DNR) 1, ,500 1,500 Tax Revenues 1,200,519 1,000, , , ,700 1,078,978 Dept of Health Trauma Grant (Fire) 3,134 1,272 3,953 2,809 1,500 3,000 Other grants ,000 Grant Revenues 3,134 1,272 3,953 2,809 1,500 13,000 Program Fees 22,246 35,254 28,526 21,684 25,873 29,000 Ground Ambulance/Aid Car/Bls 456, , , , , ,000 Air Ambulance 1,510,357 1,711,435 1,654,746 1,667,316 1,547,188 1,585,500 Service Revenues 1,988,936 2,304,742 2,061,156 2,120,630 1,935,829 1,994,500 Patient Refunds (8,198) (14,530) (4,009) - (8,000) (8,000) Reimbursements/Refunds/Rebates 50,674 12,877 20,259 7,816 15,000 8,000 Subtotal Major Revenue Sources 3,235,066 3,304,529 3,036,503 3,100,166 2,894,029 3,086,478 Minor Revenue Sources Donations - - 1, ,000 - Contributions/Donations--Private Sources 3,568 1, ,000 Donation/Contribution Revenues 3,568 1,000 1, ,000 1,000 Loan Repayments - - 2,470 1,886 2,250 - Miscellaneous Revenues - 1, Sale of Fixed Assets ,980 7,200 8,000 4,000 Capital from Old EMS Building - 8, Sale of Assets/Capital Asset Revenues - 8, ,980 7,200 8,000 4,000 Interest Income , Subtotal Minor Revenue Sources 3,641 10, ,320 10,293 12,550 5,500 Total Revenues 3,238,707 3,314,832 3,626,822 3,110,459 2,906,579 3,091,978 Operational Expense by Departments EMS Administrator 125, , ,500 68, , ,000 Office Manager 67, Executive Assistant - 69,015 68,030 63,977 63,970 63,970 Facilities Manager Operations Director 57,996 59,155 58,311 56,602 55,630 55,675 Prevention Coordinator 51, Logistics Coordinator 59,819 48,480 47,701 40,510 45,500 41,000 Outreach Coordinator - 59,756 61,115 53,927 57,460 57,460 Vacation/Holiday (cashed) 31,749 10,981 4, FICA 90,127 30,499 32,193 27,291 30,500 30,500 L & I 6,695 5,392 10,051 12,755 10,000 13,000 Retirement 50,626 30,479 49,614 39,652 53,000 50,000 Uniforms 29, ,000 1,000 Medical 152, , , , , ,000 Deferred Comp. 8,700 5,400 6,057 10,320 6,300 12,000 Unemployment , ,675 1,500 2,500 Cell Phone Stipend - Admin - 1,600 1, HRA Account 15, Moving Allowance 15,319-5,000-14,500 5,000 Flight Memberships - 1, Salaries and Benefits 762, , , , , ,105 Superintendent Salary SJCPHD 47,500 47,500 59,280 59,280 59,280 59,280 Salary & Benefits Pass-through Revenue (75,000) (75,000) (93,750) (84,030) (83,000) (83,000) Office Supplies 14,973 9,461 3,954 4,843 2,500 3,500 Software 3,691 11,371 17,588 15,628 15,000 14,000 Office Equipment - 1,244 2,326 1,193 1,000 1,000 Postage 930 2,442 2,165 1,169 4,000 3,000 Office Expenses 19,594 24,518 26,033 22,833 22,500 21,500 39

40 San Juan Island EMS Consolidated EMS Services EMS Ground & Air Ambulance Services Period Actuals Actuals Actuals Annualized Approved Budget Proposed Budget /31/ Telephone 14,160 11,749 12,479 10,156 12,000 10,000 Advertising 23,100 8,975 6,836 7,544 5,000 8,000 Accounting Services 3,011 8, ,801 11,000 15,000 Legal Services 2,203 19,596 3,620 32,649 50,000 40,000 State Auditor 7,364-16,011-10,000 10,000 Professional Services 12,578 27,938 20,590 69,450 71,000 65,000 General Insurance 2,056 2,158-5,315 4,093 4,093 Election Costs 4,718-13,861 4,332-15,000 County Auditor-Warrants 6,355 1,836 5,770 6,863 6,000 6,000 Elections and Warrants 11,074 1,836 19,630 11,195 6,000 21,000 Administrative Fees Per Diem 6, , Mileage 12,031 6,357 5,912 2,451 2,500 2,500 Lodging 11,875 3,290 3,986 1,315 1,200 1,200 Travel Costs 29,927 10,184 10,108 4,085 4,900 4,200 Allocated Administration/Operations 847, , , , , ,178 Allocated Facilities Building Insurance 25,472 27,744 43,779 27,660 28,825 28,825 Interest GO Bonds til ,006 61,080 59,237 62,000 60,000 Interest Expense Bond Interest Expense - 64,006 61,080 59,237 62,000 60,000 Building/Fixtures - 1, Structures 3,590 11,531 8,403 13,541 5,000 4,000 Station/Building Supplies 17,642 4,307 4,018 3,264 3,000 3,500 Building Repairs & Maintenance 21,232 17,707 12,421 16,805 8,000 7,500 Electricity 5,356 9,153 7,119 8,751 9,000 9,000 Water 4,306 9,805 7,507 7,098 7,500 7,000 Utilities 9,662 18,958 14,626 15,849 16,500 16,000 Equipment - 4,826 2,180 1,285 2,500 1,500 Allocated Facilities 56, , , , , ,825 Subtotal Administration/Operations/Facilities 903, , , , , ,003 EMS Ground and Air/MedEvac Expenses Paramedics 489, , , , , ,000 EMTs 273, , , , , ,000 Flight Nurses - 301, , , , ,500 Volunteer Officers 1,450 3,030 5,740 10,968 11,000 11,000 Medical Program Director 36,250 50,754 50,004 50,003 50,000 50,000 Vacation / Holiday - cashed - 19,950 11, Provider FICA - 67,187 68,654 72,658 70,000 73,000 Provider L&I - 13,584 19,514 24,963 30,600 25,000 Provider Retirement - 53,427 60,500 68,576 63,000 68,000 Provider Medical - 70,337 68,868 63,067 86,000 75,000 Deferred Comp - 7,600 8,643 7,560 8,500 8,000 EMS Uniforms - Provider - 11,500 10,178 5,219 5,000 5,000 Cell Phone Stipend Provider 4,598 2,870 1, Volunteer Appreciation 15,714 19,514 13,610 8,220 12,000 10,000 Moving Allowance ,500 Salaries and Benefits 820,972 1,176,268 1,198,569 1,241,608 1,253,100 1,280,000 40

41 San Juan Island EMS Consolidated EMS Services EMS Ground & Air Ambulance Services Period Actuals Actuals Actuals Annualized Approved Budget Proposed Budget /31/ Medical Supplies 114,240 52,536 52,107 45,685 50,000 40,000 Medical Exams ,000 1,000 Medications - 23,084 14,794 18,621 16,000 17,000 Preparedness 1, Medical Supplies 115,747 75,647 67,228 64,714 67,000 58,000 Medical Equipment - 33,617 11,832 18,708 5,000 12,000 Laundry 905 1,638 1,004 1,073 1,200 1,100 Equipment (Expensed Items) 9,999 4,873 1,135 13,295 5,000 10,000 EMS Equipment Maint/Repair ,000 - Contract Services 18, , Contract Services/Maintenance - 23,584 17,745 25,998 3,000 29,000 Equipment Repairs/Maintenance 18,325 23,584 17,745 36,722 18,000 29,000 Per Diem - Provider - 1, , Mileage - Provider - 3,938 3,089 5,994 2,000 4,000 Lodging - Provider - 2,688 2,077 3,730 3,000 1,500 Travel Costs - 8,165 5,962 10,096 6,000 6,000 Billing Services 118, ,050 90, ,848 95, ,500 Tuition 5,078 7,804 2,255 2,203 3,010 2,500 Training 20,170 14,371 6,088 6,799 7,500 7,500 Education/Training 25,248 22,175 8,343 9,002 10,510 10,000 Dues & Memberships 4,655 6,891 4,063 6,225 4,000 6,000 District Costs 5, , ,000 - CAMTS Accreditation 7,730 18, ,000 8,000 Marine Boat Fees 6,225 3,688 1,663 1,155 5,000 3,000 Certifications/ District/Licensing Fees 19,065 22,216 2,933 2,150 18,000 11,000 Dues & Fees 23,720 29,107 6,996 8,374 22,000 17,000 Dispatch 93,789 89,961 91,301 72, ,000 90,000 Air Transport 778, , , , , ,000 Contracted Services 872, , , , , ,000 Outreach Supplies - 16,574 5,878 10,590 15,000 12,000 Outreach Equipment , ,000 1,000 Wilderness Classes 6,400 10,032 6,470 3,842 5,000 6,500 Community Outreach 6,400 26,930 13,789 14,783 21,000 19,500 Portable Equipment Insurance Excess Liability Insurance due to Air Evac - 4,738-6,738 5,615 5,615 Vehicle Insurance 6,293 6,503-9,294 7,745 7,745 Insurance Expense 7,220 12,182-16,898 14,082 14,082 Motor Vehicle Parts 12, ,088 3,401 2,000 2,500 Vehicle Maint/Repair 29,584 33,823 12,253 18,799 15,000 15,000 Fuel and Oil 15,511 12,189 13,528 9,203 11,000 10,000 Vehicle Maintenance & Expenses 57,980 46,892 26,870 31,402 28,000 27,500 Subtotal EMS Ground and Air/MedEvac 2,076,980 2,576,335 2,203,157 2,449,669 2,276,865 2,549,682 Total Operating Expenses 2,980,851 3,351,080 3,003,962 3,174,741 3,080,823 3,355,685 Net Profitability (Revenues - Expenses) 257,856 (36,248) 622,861 (64,282) (174,244) (263,707) 41

42 Provided below are additional supporting calculations demonstrating the revenue per call, the costs per call, and the net profit (loss) per call based on the financial statements provided above in Exhibit 8. 42