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06/22/04

Address:

Ctty.

AMBULANCE REVENUE and COST REPORT

FIRE DISTRICT and SMALL RURAL COMPANY

From:

Arizona Department of Health ServicesAnnual Ambulance Financial Report

Arrowhead Mobile Healthcare, IncReporting Ambulance Service

PO Box 2588

Show Low Zip:

Report Fiscal Year

January 1,2011 To:

85902-2588

December 31, 2011

Day

/ hereby verify that Ihavedirected thepreparation oftheenclosed annual report in accordance with thereportingrequirements of the State ofArizona.

Ihavereadthis report andhereby verify that theinformation provided is true andcorrect tothebestofmy knowledge.

This report has been prepared usingthe accrualbasis of accounting.

Authorized Signature: ( ^rfun^J^ jQmZ*^ y Date: ^/^2 4/ ~> P^/ &~Print Name and Title:

Phone:

James W. Broome, President / CEO

Mail to:

520-686-7617

Arizona Department of Health ServicesBureau of Emergency Medical ServicesCertificate of Necessity and Rates Section150 North 18th Avenue, Suite 540Phoenix, AZ 85007-3248Telephone: (602)364-3150Fax: (602) 364-3567

Pagel

MAY 11 2012

BEMSTS - CON &RATES

TMFMD32.18

AMBULANCE REVENUE AND COST REPORT


AMBULANCE SERVICE ENTITY:

FOR THE PERIOD FROM:

STATISTICAL SUPPORT DATA

Line

No.

January 1,2011

(1)SUBSCRIPTION

SERVICE

TRANSPORTS

_ DESCRIPTION

1 Number ofALS Billable Transports:

2 Number of BLS Billable Transports:

3 Number of Loaded Billable Miles:

4 Waiting Time (Hrs.):

5 Canceled (Non-Billable) Runs:

AMBULANCE SERVICE ROUTINE OPERATING REVENUE

6 ALS Base Rate Revenue

7 BLS Base Rate Revenue

8 Mileage Charge Revenue

9 Waiting Charge Revenue

10

11 Nurses Charge Revenue

12 Standby Charge Revenue

Arrowhead Mobile Healthcare, Inc

TO:

*(2)TRANSPORTS

UNDER

CONTRACT

December 31, 2011

(3)TRANSPORTS

NOT UNDER

CONTRACT

2,081

355

51.498

27.9

MAY 11* 2012

Medical Supplies Charge Revenue BEMSTS- GQN &RATP9

13 TOTAL AMBULANCE SERVICE ROUTINE OPERATING REVENUE (Post to Page 3, Line 1)

SALARY AND WAGE EXPENSE DETAIL

GROSS WAGES:

14 Management and Officers/Owners

15 Paramedics and lEMTs

16 Emergency MedicalTechnician (EMT)

17 Other Personnel

18 PayrollTaxes and Fringe Benefits - All Personnel

19 Total Wages, Taxes & Benefits

316,406

450,571

312,235

30,909

191,991

(Sum Lines 14 through 18; Post to Page 3. Line 10) $ 1,302,111

Thiscolumnreports onlythose runswherea contracted discount ratewas applied." Full-time equivalents (F.T.E.) is thesumofall hours for which employees wages were paid during theyear divided by2080.

Page 2

(4)

TOTALS

2.081

355

51,498

27.9

601

$ 2,727,899

467,485

716.791

1.875

3,914.049

No. of FTE*s

1.5

11.7

12.2

1.5

26.9

TMFMD32.19



AMBULANCE SERVICE ENTITY: Arrowhead Mobile Healthcare, Inc

FOR THE PERIOD FROM: January 1,2011 TO: December 31,2011

SCHEDULE OF REVENUES AND EXPENSES

Line

No, DESCRIPTION

Operating Revenues:

1 Total Ambulance Service Operating Revenue (From: Page 2, Line13)

Settlement Amounts:

2 AHCCCS3 Medicare

J 4 Subscription Service5 Contractual

6 Other (Champus/Private Insurance)7 Total (Sum of Lines 2 through 6)

8 Total Operating Revenue (Line1 minus Line7)

Operating Expenses:

9 Bad Debt10 TotalSalaries, Wages, and Employee-Related Expenses (From: Page2, Line 19)11 Professional and Dispatch Services12 Travel and Entertainment13 Other General Administrative14 Depreciation15 Rent/Leasing16 Building/ Station17 Vehicle Expense18 Other Operating Expense19 Cost of Medical Supplies20 Interest21 Subscription Service Sales Expense

22 Total Operating Expense (Sum ofLines 9 through 21)

23 TotalOperating Incomeor (Loss) (Line 8 minusLine 22)

24 Subscription Contract Sales25 Other Operating Revenue26 Local Supportive Funding27 Other Non-Operating Income (Schedule Attached)28 Other Non-Operating Expense (ScheduleAttached)

29 NET INCOME or (LOSS) Before Income Taxes (SumofLines 23 through 27. minusLine 28)

Provision for Income Taxes:30 Federal Income Tax31 State Income Tax32 Total Income Tax (Line 30. plus Line 31)

33 Ambulance Service Net Income (Loss) (Line 29. minus Line 32)

Page 3

$ 3,914,049

315,6811,157,669

0

0

30,7551,504,105

$ 2,409,944

$ 281,8311,302,111

162,75314,76358,58379,99668,90062,031

103,27934,67752,679

4,5280

2,226,132

$ 183.812

0

0

0

258,5150

$ 442,328

145,96822,116

$ 168,084

$ 274,243

MAY 11 2012

BEMSTS-CON &RATESTMFMD32.20

Arrowhead Mobile Healthcare, IncJanuary 1, 2011 to December 1, 2011Other Non-Operating Income Schedule

Medical Records

Gain (Loss) on Sale of PropertyInterest Income

Wildland Income

Miscellaneous

Total

$723

(12,868)115

270,538

7

$258,515

Arrowhead Mobile Healthcare, IncJanuary 1, 2011 to December 1, 2011Other Non-Operating Expense Schedule

Total $0

MAY 11 2012




AMBULANCE SERVICE ENTITY: Arrowhead Mobile Healthcare, Inc

AT: December 31,2011

BALANCE SHEET

ASSETS

CURRENT ASSETS

1 Cash and Cash Equivalents $ 185,3412 Accounts Receivable 624,9993 Less: Allowance for Doubtful Accounts (293,749)4 Inventory 17,0645 Prepaid Expenses 12,9686 Other Current Assets 5,6037 TOTAL CURRENT ASSETS

9 PROPERTY & EQUIPMENT

10 Less: Accumulated Depreciation

11 OTHER NON CURRENT ASSETS

12 TOTAL ASSETS

LIABILITIES & EQUITY

CURRENT LIABILITIES

13 Accounts Payable $ 32,74614 Current Portion ofNotes Payable 1,22815 Current Portion ofLong-Term Debt16 Deferred Subscription Income17 Accrued Expenses and Other 66,08418 ~~~^~~~~^~19

$ 552,225

826,382

(332,706)

47,708

$ 1,093,609

20 TOTAL CURRENT LIABILITIES $ 100,057

21 NOTES PAYABLE

22 LONG-TERM DEBT, OTHER23 TOTAL LONG-TERM DEBT

EQUITY & OTHER CREDITS

Paid-in Capital:24 Common Stock $ 22,57825 Paid-in Capital in Excess of Par Value26 Contributed Capital27 Retained Earnings 1,025,97428 Treasury Stock (55000)29 :30 Fund Balance31 TOTAL EQUITY $ 993.552

32 TOTAL LIABILITIES & EQUITY

Page 4

MAY 11 2012



AMBULANCE SERVICE ENTITY:

FOR THE PERIOD FROM:

STATEMENT OF CASH FLOWS

Arrowhead Mobile Healthcare, Inc

January 1,2011 TO: December 31,2011

8

9

10

11

12

13

14

15

16

17

18

OPERATING ACTIVITIES:

Income (Loss) Before Income Taxes

Adjustments to Reconcile Net Income to Net CashProvidedby Operating Activities: Note: a increase in these accounts improvescash flow

Depreciation ExpenseDeferred Income Tax

Loss (gain)on Disposal of Property &Equipment

{Increase) Decrease in:

Accounts Receivable

Inventories and Other Current Assets

Prepaid Expenses

Increase (Decrease) in:

Accounts PayableAccrued Expenses and Line of CreditDeferred Subscription Income

NET CASH PROVIDED (Used) BY OPERATING ACTIVITIES

Note: a decrease in these accounts improves cash flow

Note: a increase in these accounts improves cash flow

INVESTING ACTIVITIES:

Purchases of Property & Equipment (est.)Proceeds from Disposal of Property & EquipmentPurchases of Investments

Proceeds from Disposal of InvestmentsLoans Made

Collections on Loans

Other

19 NET CASH PROVIDED (Used) BY INVESTING ACTIVITIES

FINANCING ACTIVITIES:

New Borrowings:

20 Long-Term21 Short-Term

Debt Reduction: (Net)

22 Long-Term and Short-Term (est.)23 Short-Term

24 Capital Contributions25 Distributions

26 NET CASH PROVIDED (Used) BY FINANCING ACTIVITIES27 NET INCREASE (Decrease) IN CASH28 CASH AT BEGINNING OF YEAR

29 CASH AT END OF YEAR

SUPPLEMENTAL DISCLOSURES:

Non-cash Investingand FinancingTransactions:30313233

34

442,328

79,996

12,868

(67,972)194

42,100

(1.191)(23,657)

$ 484,666

$ (143,842)

$ (143,842)

(155,427)

(17,803)

Interest Paid (Net of Amounts Capitalized)Income Taxes Paid MAY 1 1 2012

$ (173,230)

$ 167,593

$ 17,748

$ 185,341

mIrzo bra^

$ 4,528

$

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tmfmd32...79,996 68,900 62,031 103,279 34,677 52,679 4,528 0 2,226,132 $ 183.812 0 0 0 258,515 0 $...

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