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Year 1 number of visits average charge per visit* total charges amount billed collection rate income Medicaid 1,250 $62.50 $78,125 $ 78,125 95% $74,219 Medicare

Year 1 number of visits average charge per visit* total charges amount billed collection rate income
Medicaid 1,250 $62.50 $78,125 $ 78,125 95% $74,219
Medicare 2,500 $70.59 $176,475 $ 176,475 95% $167,651
Private Insurance 100 $95.00 $9,500 $ 9,500 80% $7,600
Self Pay (sliding fee) 50 $75.00 $3,750 $ 3,750 40% $1,500
3,900 $ 267,850 $250,970
*Includes all adjustments and any co-insurance amounts for all visit types
Year 2 number of visits average charge per visit* total charges amount billed collection rate income
Medicaid 1,750 $62.50 $109,375 $ 109,375 96% $105,000
Medicare 3,500 $70.59 $247,065 $ 247,065 96% $237,182
Private Insurance 400 $95.00 $38,000 $ 38,000 85% $32,300
Self Pay (sliding fee) 200 $75.00 $15,000 $ 15,000 45% $6,750
5,850 $ 409,440 $381,232
*Includes all adjustments and any co-insurance amounts for all visit types
Year 3 number of visits average charge per visit* total charges amount billed collection rate income
Medicaid 2,000 $63.75 $127,500 $ 127,500 98% $124,950
Medicare 3,800 $72.00 $273,607 $ 273,607 97% $265,399
Private Insurance 900 $96.90 $87,210 $ 87,210 90% $78,489
Self Pay (sliding fee) 500 $76.50 $38,250 $ 38,250 50% $19,125
7,200 $ 526,567 $487,963
*Includes all adjustments and any co-insurance amounts for all visit types

Year 1 Year 2 Year 3
PPHF Grant $100,000 $100,000 $100,000
Foundation Grants $75,000 $ 50,000
Total $175,000 $150,000 $100,000

Projected Non-Staffing Costs
Year 1 Year 2 Year 3
Fringe Benefits $ 59,609 $ 60,802 $ 62,018
Travel $ 5,000 $ 5,000 $ 10,000
Training $ 35,000 $ 10,000 $ 15,000
Equipment $ 5,000 $ 2,000 $ 2,000
Supplies $ 15,000 $ 15,300 $ 15,606
Contractual $ 8,000 $ 8,160 $ 8,323
Allocated Rent $ 23,418 $ 23,769 $ 24,126
Depreciation $ 26,277 $ 35,036 $ 35,036
Insurance $ 4,004 $ 4,204 $ 4,414
Overhead Allocation $ 9,167 $ 9,442 $ 9,725
Uncollectible Income $ 21,281 $ 39,865 $ 55,177
Marketing $ 45,000 $ 15,000 $ 15,000
Indirect Charges $ 54,764 $ 56,955 $ 59,233
Total $ 311,520 $ 285,533 $ 315,659

Projected Staffing Costs
Annual Salary
FTE Year 1 Year 2 Year 3
Endocronologist 0.93 $ 158,000 $ 165,900 $ 174,195
Contract Specialists 0.30 $ 75,000 $ 78,750 $ 82,688
Nurse Practitioner 0.95 $ 84,094 $ 86,617 $ 89,215
Community Health Workers 4.00 $ 244,000 $ 251,320 $ 258,860
Reception/Office Management 1.00 $ 35,000 $ 35,700 $ 36,414
Total $ 596,094 $ 618,287 $ 641,371

Projected Capital Costs
Year 1 Year 2 Year 3
Server $ 15,000
Remodel of Office Space $ 98,550
Security System $ 2,654
Furniture $ 12,281 $ 1,000 $ 1,000
Practice Management System $ 5,000 $ 2,500 $ 2,500
Computers & Cabling $ 41,696
Total $ 175,181 $ 3,500 $ 3,500

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