Pro Forma Income Statement

Year 1 Year 2 Year 3 Year 4 Year 5

Visits 4,882 5,126 5,382 5,652 5,934

Revenue Per Visit $450 $450 $450 $450 $450

Gross Revenue
Patient Reveue $2,196,900 $2,306,700 $2,421,900 $2,543,400 $2,670,300
Gross Patient Revenue $2,196,900 $2,306,700 $2,421,900 $2,543,400 $2,670,300

Deductions from Patient Revenue 0% 0% 0% 0% 0

Contractual 30% 30% 30% 30% 30%
Total Deductions from Revenue $659,070 $692,010 $726,570 $763,020 $801,090

Net Patient Revenue $1,537,830 $1,614,690 $1,695,330 $1,780,380 $1,869,210

Operating Expenses
Salaries and Wages $625,000 $643,750 $663,063 $682,954 $703,443
Employee Benefits $156,250 $160,938 $165,766 $17,074 $175,861
Utilities $208,750 $215,013 $221,463 $228,107 $234,950
Repair/Maintenance $40,500 $41,715 $42,966 $44,255 $45,583
Housekeeping $20,000 $20,600 $21,218 $21,855 $22,510
Telephone Service $16,806 $17,310 $17,829 $18,364 $18,915
Depreciation $32,000 $32,960 $33,949 $34,967 $36,016
Malpractice $50,000 $51,500 $53,045 $54,636 $56,275
Miscellaneous/Other $20,000 $20,600 $21,218 $21,855 $22,510
Variable Medical Supply Costs $65,767 $67,740 $69,772 $71,865 $74,021
Other Non-Personnel Costs $95,351 $98,212 $101,158 104192.61 $107,318
Total Operating Expenses $1,330,424 $1,370,337 $1,411,447 $1,300,125 $1,497,404

Excess of Rev over Exp. From Operations $207,406 $244,353 $283,883 $480,255 $371,806
Cummulative Income $207,406 $451,759 $735,642 $1,215,897 $1,587,703

Net Cash from Excess Rev (excl Depreciation) $175,406 $211,393 $249,934 $445,288 $335,790
Cummulative Income Net Cash $175,406 $386,799 $636,734 $1,082,021 $1,417,811