Oklahoma Healthcare Authority- Nursing Home Facility Cost Report-State Fiscal Year June 30,2017

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1 Oklahoma Healthcare Authority- Nursing Home Facility Cost Report-State Fiscal Year June 30,2017 FAC ID FACILITY NAME FACILITY TYPE MEDICARE DAYS MEDICAID DAYS OTHER DAYS TOTAL DAYS AVAILABLE DAYS OCCUPANCY RATE SALARIES & WAGES OUTSIDE PROFESSIONAL FEES EMPLOYEE EXPENSES TAXES (NON- PAYROLL) OFFICE EXPENSES INSURANCE EXPENSES GENERAL EXPENSES DRUGS & MEDICAL SUPPLIES CAPITAL RELATED EXPENSES ADMINISTRATIVE SERVICES OTHER EXPENSES SFY2017 TOTAL EXPENSES COST PER DAY $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BILLINGS FAIRCHILD CENTER Corporation - 49,838-49,838 56, % $ 2,817, $ 158, $ 623, $ 14, $ 162, $ 139, $ 667, $ 159, $ 76, $ 199, $ 410, ,429, CENTER OF FAMILY LOVE Not-for-profit - 7,662-7,662 11, % $ 645, $ 26, $ 127, $ $ 43, $ 8, $ 107, $ 35, $ 106, $ - $ 219, ,321, HAYS HOUSE Limited Liability - 18,176-18,176 40, % $ 1,052, $ 53, $ 155, $ - $ 103, $ - $ 262, $ 36, $ 142, $ 119, $ 161, ,086, LAKE DRIVE HEALTH CARE Limited Liability - 20, ,787 21, % $ 1,192, $ 60, $ 205, $ 6, $ 110, $ 79, $ 197, $ 33, $ 163, $ 136, $ 173, ,360, OAKRIDGE HOME Limited Liability - 38,644-38,644 58, % $ 2,056, $ 111, $ 337, $ - $ 188, $ - $ 602, $ 75, $ 252, $ 132, $ 379, ,136, OKMULGEE TERRACE Limited Liability - 17,781-17,781 22, % $ 959, $ 145, $ 161, $ - $ 63, $ - $ 198, $ 33, $ 121, $ 108, $ 152, ,943, RELIANT LIVING CENTER Not-for-profit - 23,945-23,945 24, % $ 1,857, $ 38, $ 297, $ 2, $ 81, $ 26, $ 271, $ 86, $ 57, $ - $ 202, ,920, WESTVIEW LIVING CENTER Limited Liability - 20, ,405 22, % $ 1,217, $ 227, $ 259, $ 16, $ 118, $ 31, $ 210, $ 51, $ 123, $ - $ 147, ,403, WOODLAND PARK HOME Limited Liability - 17,412-17,412 40, % $ 997, $ 122, $ 140, $ 37, $ 97, $ 35, $ 163, $ 55, $ 2, $ - $ 130, ,783, REGULAR ICF/IID TOTAL'S - 214, , , % $ 12,794, $ 943, $ 2,308, $ 76, $ 969, $ 320, $ 2,682, $ 568, $ 1,046, $ 695, $ 1,977, ,385,438.80

2 SFY 08 thru Cost Comparison SFY 2017 SFY 2016 SFY 2015 SFY 2014 SFY 2013 SFY 2012 SFY 2011 SFY 2010 SFY 2009 SFY , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,478 5, % 72.21% 72.89% 73.33% 73.72% 73.19% 72.13% 69.50% 70.18% 99.83% 99.72% 99.79% 99.81% 99.77% 99.51% 99.76% 99.36% 97.68% Description: Total Per Day Total Per Day Total Per Day Total Per Day Total Per Day Total Per Day Total Per Day Total Per Day Total Per Day Total Per Day Salaries & Wages: $ $ $ $ $ $ $ $ $ $ Outside Professional Fees: $ 4.40 $ 4.98 $ 3.62 $ 3.03 $ 2.63 $ 2.45 $ 2.27 $ 2.24 $ 3.20 $ 2.47 Employee Expenses: $ $ $ $ $ $ $ $ $ $ Taxes (Non-Payroll): $ 0.36 $ 0.30 $ 0.27 $ 0.46 $ 0.54 $ 0.47 $ 0.51 $ 0.49 $ 0.46 $ 0.49 Office Expenses: $ 4.52 $ 4.42 $ 4.49 $ 5.05 $ 4.57 $ 4.62 $ 4.54 $ 4.31 $ 4.70 $ 4.58 Insurance: $ 1.49 $ 1.43 $ 1.52 $ 1.35 $ 1.39 $ 1.34 $ 1.37 $ 1.27 $ 1.40 $ 1.34 General Expenses: $ $ $ $ $ $ $ $ $ $ Drugs & Medical Supplies: $ 2.65 $ 2.71 $ 2.63 $ 2.55 $ 2.30 $ 2.50 $ 2.29 $ 2.12 $ 2.04 $ 1.91 Capital Related Cost: $ 4.87 $ 4.80 $ 4.93 $ 4.28 $ 4.63 $ 5.24 $ 5.34 $ 7.10 $ 7.07 $ 6.70 Administrative Services: $ 3.24 $ 3.53 $ 3.63 $ 4.28 $ 4.67 $ 5.12 $ 5.20 $ 5.43 $ 5.05 $ 5.03 Other Expenses: $ 9.21 $ 9.19 $ 9.16 $ 8.34 $ 8.02 $ 7.83 $ 8.02 $ 7.85 $ 8.01 $ 8.69 Total: $ $ $ $ $ $ $ $ $ $

3 Page 1 Summary Salaries & Wages: $ 12,794, $ Outside Professional Fees: $ 943, $ 4.40 Employee Expenses: $ 2,308, $ Taxes (Non-Payroll): $ 76, $ 0.36 Office Expenses: $ 969, $ 4.52 Insurance: $ 320, $ 1.49 General Expenses: $ 2,682, $ Drugs & Medical Supplies: $ 568, $ 2.65 Capital Related Cost: $ 1,046, $ 4.87 Administrative Services: $ 695, $ 3.24 Other Expenses: $ 1,977, $ 9.21 Total: $ 24,385, $

4 Page 2 Salaries and Wages Description: Total Cost Total Hours Cost Per Day Hrs Per Day Cost Per Hr Registered Nurses: $ 34, ,177 $ $ Licensed Practical Nurses: $ 1,816, ,408 $ $ Director of Nursing: $ 414, ,654 $ $ Nurse Aides: $ 4,573, ,507 $ $ 9.74 CMA Aides: $ 1,317, ,707 $ $ QMRP'S (ICF-MR Only): $ 542, ,054 $ $ Medical Director: $ 12, ,560 $ $ - Physical Therapist: $ $ $ Occupational Therapist: $ - Respitory Therapist: $ - Speech Therapist: $ - Therapy Aide/Assistant: $ - Administrator: $ 506, ,587 $ $ Assistant Administrator: $ 9, $ $ Accountant/Bookeeper: $ 44, ,227 $ $ Other Office Staff: $ 626, ,450 $ $ 9.57 Soc Serv Dir/Soc Worker: $ 57, ,569 $ $ Other Soc Serv Staff: $ 248, ,318 $ $ Activities Director: $ 12, ,017 $ $ Other Activities Staff: $ $ $ Comb Soc Serv/Activities: $ - Dietician: $ 65, ,998 $ $ Other Dietary Staff: $ 1,095, ,083 $ $ 9.44

5 Page 2 cont. Salaries and Wages Description: Total Cost Total Hours Cost Per Day Hrs Per Day Cost Per Hr Housekeeping Supervisor: $ 54, ,402 $ $ Housekeeping Staff: $ 561, ,556 $ $ 8.98 Maintenance Supervisor: $ 141, ,777 $ $ Maintenance Staff: $ 321, ,427 $ $ Laundry Supervisor: $ - Other Laundry Staff: $ 269, ,503 $ $ 8.56 Medical Records: $ - Other: $ 66, ,339 $ $ Total Salaries & Wages: $ 12,794, ,073,772 $ $ 11.92

6 Page 3 Outside Professional Fees SFY17 Contract Registered Nurse: $ 99, $ 0.46 Contract Lic. Practical Nurse: $ 16, $ 0.08 Contract Nurse Aides: $ 51, $ 0.24 Medical Director: $ 95, $ 0.45 Therapists: $ 75, $ 0.35 Consulting Social Worker: $ 33, $ 0.16 Dietician: $ 41, $ 0.19 Pharmacist: $ 50, $ 0.24 Dentist: $ 8, $ 0.04 Accountants: $ 29, $ 0.14 Legal: $ 209, $ 0.98 Housekeeping: $ - $ - Maintenance: $ 1, $ 0.01 Other: $ 226, $ 1.06 Computer Programmer: $ 3, $ 0.02 Total O/S Professional: $ 943, $ 4.40

7 Page 4 Employee Expenses Employee Benefits and Payroll Related Expenses Fica: $ 1,033, $ 4.82 Unemployment Compensation Tax: $ 56, $ 0.26 Workman's Compensation Insurance: $ 560, $ 2.61 Group Health Dental Insurance: $ 343, $ 1.60 Life Insurance: $ 20, $ 0.10 Retirement and Pension: $ 13, $ 0.06 Other Employee Benefits: $ 167, $ 0.78 Staff Development and Training Nurse Aide Competency Evaluation: $ 53, $ 0.25 Other Licensed Direct Care Training: $ 41, $ 0.19 Other: $ 19, $ 0.09 Total $ 2,308, $ 10.75

8 Page 5 Taxes Non-Payroll Related Excise Tax: $ - $ - Corporation License: $ 5, $ 0.03 Ad Valorem: $ 28, $ 0.13 Auto Tag/Registration: $ 1, $ 0.01 Other: $ 41, $ 0.19 Total Taxes Non-Payroll $ 76, $ 0.36

9 Page 6 Office Expense SFY17 Office Supplies: $ 154, $ 0.72 Office Phone: $ 80, $ 0.38 Office Utilities: $ 734, $ 3.42 Total Office Expense: $ 969, $ 4.52

10 Page 7 Insurance Non-Payroll Building Insurance: $ 121, $ 0.57 Automobile Insurance: $ 27, $ 0.13 Other Insurance: $ 171, $ 0.80 Total Insurance Expense: $ 320, $ 1.49

11 Page 8 General Expenses Dues and Publications: $ 24, $ 0.11 Public Relations: $ 68, $ 0.32 Automobile Expense: $ 136, $ 0.63 Maintenance: $ 482, $ 2.25 Laundry and Linen: $ 147, $ 0.69 Housekeeping Supplies: $ 207, $ 0.97 Food and Kitchen Supplies: $ 1,527, $ 7.12 Social Services Supplies: $ 88, $ 0.41 Total General Expenses: $ 2,682, $ 12.50

12 Page 9 Drugs & Medical Supplies Drugs and Medical Supplies: $ 384, $ 1.79 Over-the-Counter Medication: $ 170, $ 0.79 Special Adaptive Medical Equip: $ 13, $ 0.06 Total Drugs & Medical: $ 568, $ 2.65

13 Regular ICF/MR Facilities Page 10 Capital Related Cost Equipment Rent/Lease: $ 54, $ 0.26 Facility Rent/Lease: $ 773, $ 3.61 Interest Expense: $ 6, $ 0.03 Depreciation Summary Building & Improvements: $ 143, $ 0.67 Local Improvements: $ - $ - Leasehold & Improvements: $ 4, $ 0.02 Equipment: $ 62, $ 0.29 Total Depreciation: $ 210, $ 0.98 Total Capital Related Costs: $ 1,046, $ 4.87

14 Page 11 Administrative Services Home Office Expense: $ 112, $ 0.52 Owner's Non-Salary Compensation: $ 22, $ 0.10 Owner's Salaries Paid: $ 166, $ 0.77 Benefits on Owner's Salaries: $ 11, $ 0.05 Director's Fees: $ - $ - Management Fees Paid: $ 383, $ 1.79 Total Administrative Services: $ 695, $ 3.24

15 Page 12 Other Expenses Hepatitis Vaccination Costs: $ $ 0.00 Provider Fees: $ 1,673, $ 7.80 Other Costs: $ 303, $ 1.41 Total Other Costs: $ 1,977, $ 9.21

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