Complete this template by replacing the bracketed text with the relevant information.
	Current FY	Projected FY
Projected Revenues from New Project
Gross Revenue	937,610	965,738
Bad Debt	84,385	86,916
Net Revenue:	853,225	878,821
Projected Operating Expenses from New Project
Total Salaries, Wages, and Benefits	365,883	[Insert text.]
Training, Certification, Subscription, and Professional Fees	612	[Insert text.]
Purchase Services	2,152	[Insert text.]
Drugs and Supplies	90,932	[Insert text.]
Office Supplies	14,651	[Insert text.]
Advertisement/Marketing	2,000	[Insert text.]
Minor Equipment	10,924	[Insert text.]
Equipment Rental	635	[Insert text.]
Training and Traveling	4,572	[Insert text.]
Other Expenses	74,503	[Insert text.]
Total Operating Expenses	566,864	583,870
Equipment Depreciation (20%)	$420	$420
Total Expenses:	$567,284	$584,290
Total Revenue Over Operating Expenses	$285,941	$294,531

Salaries
RN basic	$35.10
Therapist (PT OT SLT)	$44.32
Differentials / per hour
Weekends and holidays	$1.25
Evening	$1.25
Nights	$1.85
BSN	$4.00
MSN	$7.00
Certification	$3.00
Cert. Nursing Assistant	$21.00
Differentials / per hour
Weekends and holidays	$1.00
Evening	$1.00
Nights	$1.25
Play therapist	$28.00
Medical Staff on Salary (no hourly rate)
Attending	$199,500
Medical Resident	$65,200
Specialty surgeons	$290,000-400,000
Director (services and programs)	$109,700-325,000
Lab Technician	$20.20
X-ray Technician	$30.40
Support Staff
Unit Secretary	$18-28
Housekeeping	$15-18
Dietary	$13-17

Pro Forma Statement Assumptions:

Assume that the population of the surrounding community and service region will continue to increase.

Staff wages and salaries include taxes, Federal Insurance Contribution Act (FICA) tax, paid time off (PTO), and employee benefits. Assume that benefits are 30% over base salary.

Assume that the nursing salaries and benefits will increase at 3% annually to keep pace with the cost-of-living increases.

Assume that hospital payer mix, current procedural terminology (CPT) code/diagnostic-related group (DRG), and reimbursement will remain constant over the next one to five years.

Assume that the demographic mix will remain static over the next five years.

Assume that the department growth will increase by 3% each year; therefore, assume that new service, program, or product growth will also 3% per year.

Assume equipment depreciation remains fixed at 20%.

Assume that the bad debt will remain fixed at 9%.

Assume that patient days for the chosen hospital department is 9064 patient days/year.

Note: The payer mix at the chosen hospital department is:

Medicare: 40%

Medicaid: 16%

Other Government: 2%

Private Insurance: 22%

Managed Care: 21%

Indemnity: 1%

Self-pay 8%