EXHIBIT 4.16a FINANCIAL RATIOS FOR ALL U.S. HOSPITALS BY BED SIZE Optum & CMS Median Ratio" 200-299 300-399 Desired Beds 400+ Beds Position Ratio Hospital Industry 1-99 Beds 100-199 Beds Beds Liquidity ratios Current ratio Quick ratio Acid test ratio Days in accounts receivable Days cash on hand Average payment period, days 2.18 0.35 85 2.04 1.39 0.18 45 81 51 1.84 1.52 0.30 1.27 0.20 142 0.20 48 0.38 Above Above 50 45 56 53 Revenue, expense, and profitability ratios Operating revenue per adjusted discharge Operating expense per adjusted discharge Salary and benefit expense as a percentage of operating expense Operating margin Nonoperating revenue Return on total assets Return on net assets $7,448 $7,197 $7,086 $6,494 40% $7,121 38% 0.04 0.05 $6,766 $6,260 38% $6,407 $7.517 6,819 $7,399 38% Above Below Below 38% 0.03 0.04 0.04 0.08 0.02 0.05 0.04 0.08 0.03 0.03 0.04 0.08 Above Varies Above Above 0.04 0.05 0.05 0.09 Activity ratios Total asset turnover ratio Net fixed assets turnover ratio Age of plant ratio 1.07 2.12 10.31 0.99 Above 2.03 10.12 10.41 10.93 Below Capital structure ratios Long-term debt to net assets ratio Net assets to total assets ratio Times interest earned ratio Debt service coverage ratio 0.21 0.54 3.78 0.18 0.58 3.47 042 0.47 0.38 0.52 0.59 0.48 Below Above Above 3.50 6.36 4.24 All ratio values, except for quick acid test, and salary and benefit expense as a percentage of operating expense ratios, were obtained from Optum Insight, 2013 Almanac of Hospital Financial and Operating Indicators, 2011/2010 median value data. The quick, acid test, and salary and benefit expense as a percentage of operating expense ratios were obtained from 2010 CMS cost report data. These are true up to a certain point. For example, in general the higher the better for the current ratio, but after a certain point, the organization might be better off investing some of the excess cash