HOSPITAL ACCOUNTINGS STATISTICS Hospital Accounting and Statistics Charitable Institutions may obtain a copy of this book free of charge by request of their proper officer upon the Treasurer of the Presbyterian Hospital, 41 East 70th Street, New York City. Other copies may be secured from E. P. Dutton & Co., for the price of $1.25 each, postage paid, enclosed with order. Hospital Accounting and Statistics 3rd Edition Compiled and Arranged by William V. S. Thome Treasurer and Member of the Board of Managers of The Presbyterian Hospital in the City of New York, Chairman of the Executive Com- mittee and Member of the Board of Governors of the Woman's Hospital in the State of New York, Member of the Board of Directors of the Manhattan Maternity and Dispensary. Author of the booklet entitled "A Central Purchasing Agency for the Hospitals of New York" (The Hospital Bureau of Standards and Supplies was organized in New York in March, 1910, in accordance with the suggestions outlined in the booklet referred to, and has now been in successful operation for a period of six years and includes a membership of forty-one hospitals of which twenty-four are located outside the limits of Greater New York). New York E. P. Dutton & Co. 1916 PREFACE As a result of numerous conferences in the years 1906 and 1908 between the Superintendents, Treasurers and Accountants of some of the larger hospitals the Schedules shown in the first thirteen pages of this book and the "Instructions regarding Distri- bution of Hospital Operating and Corporation or Other Current Expenses" were agreed upon as illustrating desirable forms in which hospitals might present their financial reports and statistics. The object was to encourage and assist hospitals in adopting a simple and intelligentsystemof accountingapprovedbycertifiedpub- lic accountants and by those experienced in hospital management. The forms of accounts and statistics described (with slight modifications to suit the special requirements of certain hospitals) would readily set forth in a nearly uniform manner the statements of revenue and expenses, assets and liabilities, etc., desired by most hospital managers and by the public for their information and for intelligent comparison with similar reports or statements of other hospitals. Unless such accounts and statistics are made up on some uni- form basis they are apt to be misleading and valueless for purposes of comparison. The method of accounting herein described has now been adopted as standard by a large number of hospitals throughout the United States and Canada. The Hospital Saturday and Sunday Association of New York City (now known as The United Hospital Fund of New York), in its Thirty-third Annual Deport for the year ended September 30, 1912, pages 42 and 43, stated as follows: "Improvement in Hospital Statistics and Accounts" "Under the instruction of the Trustees a new form of Schedule was introduced for the reports of hospitals to this Association, prepared in consultation with hospital authorities and experts in accounting and statistics. It -was well received by the hospitals, and has been the means of securing fuller and more significant data regarding the 'Work Done,' the 'Expenses,' and the 'In- come' of the Associated Hospitals. The results are tabulated in the large 'Statistical Sheet' inserted at the end of this report, and will interest general contributors and those responsible for hospital management. " It is evident that the requirement by the Association of these de- tailed reports has called attention to defects in methods of keeping accounts and statistics to some degree, and has led to improvement. This is one of the main objects of the Association and points the way to greater economy and efficiency in hospital management. "The new Schedule for reports to the Association calls for items which the management of any well-regulated hospital should know. The labor of preparing it is reduced to a minimum since it is in harmony with the data required by the State Board of Charities and with the Uniform System of Accounts and Statistics already in use among the leading hospitals of this and other cities and which all would find it advantageous to adopt." At a meeting held on May 14, 1913, the Philadelphia County Medical Society appointed a Committee on Hospital Efficiency "for the purpose of considering ways and means by which the efficiency of the hospitals in Philadelphia may be increased." After making a very careful and thorough study of the hospital situation in Philadelphia the Committee on June 17th and Novem- ber 26, 1913, and on October 21, 1914, submitted its reports con- taining a summary of the facts gathered and, based on these facts, a series of recommendations. One of these recommendations was: "That the County Medical Society urge every hospital in Philadelphia, public or private: "To adopt a uniform system of hospital records and reports in order to furnish a common basis for the comparison of financial records and statistics and medical records and statistics. "To use as a basis for the proposed system of uniform reports the forms recommended to other hospitals by various institutions in New York and other cities in the volume entitled Hospital Accounting and Statistics." The third edition of this book published herewith differs slightly from the previous August, 1908, edition, as it describes in more detail the manner in which pay-rolls may be paid and how proper record of Unclaimed Wages may be entered on the books of the Superintendent and how the Superintendent's Bank Accounts and Petty Cash Book may be kept, which points were not referred to in such detail in the previous edition. It also describes how a "Reserve for Depreciation of Hospital Properties and Equipment" may be established, if desired, and how entries showing credits and debits thereto may be made. September, 1916. CONTENTS PAGES Schedule 1, Statement of Current Revenue ..... 2,3 " 2, Statement of Current Expenses . . . . . 4,5,6 " 3, Surplus and Deficit Account ...... 7 " 4, Balance Sheet, Treasurer's ...... 8,9 " 5, Statement of Increase or Decrease of Principal of Capital Reserve Funds ........ 10 " 6, Statistics Concerning Patients . . . . .11,12,13 Instructions regarding Distribution of Expenses . . . . 14 to 22 Advantages of Uniform and Intelligent Financial Reports and Statistics . 23 Applicability of this System of Accounting to all Sorts of Charitable Institutions .......... 24 Double Entry System of Bookkeeping ...... 24 Superintendent's Accounts . . . . . . 25 to 54, 94 to 103 Vouchers .......... 25,26 Pay Rolls . . . . . . . . . . 26,27,28 Unclaimed Wages ......... 27,30 Time Checks .......... 28 Advances Paid Account Salaries and Wages . . . . 29,30 Voucher Register ......... 31,32 Card Ledger Accounts with Pay Patients . . . . . 32 to 35 Bill Register . . . . . . . . . . 35 to 37 Cash Book . . . . . . . . . . 37 to 39 Receipt Book .......... 39, 40 Cash Remittances by Treasurer to Superintendent .... 41, 42 ' " " " Superintendent to Treasurer .... 42 Superintendent's Bank Accounts ....... 42,43 Petty Cash Book ....... 43, 44 Journal and Journal Entries . . . . . 44,45 General Material Account ..... 45,46 Sale of Supplies not carried in General Material Account ... 46 How Supplies Donated may be charged to Current Expenses, if desired . 47 Entries to be made by Superintendent in opening a new set of books . 47, 48 Superintendent's Ledger Accounts . . . . . . . 49 to 52 Trial Balance. ....... 52 Monthly Report of Superintendent to Treasurer . . . . 53,54 Superintendent's Month and To Date Statements of Revenue, Expenses and Statistics .......... 53 Treasurer's Accounts . . . . . . . . 55 to 93 Cash Book . . . . . . . . . . 55 to 58 Journal and Journal Entries . . . . . . . 58 to 63 Entries to be made by Treasurer in opening a new set of books . 64, 65 CONTENTS PAGES Treasurer's General Ledger Accounts 66 to 80 Trial Balance ........ 80 Income Ledger Accounts . . . . . . 80 to 89 Amortization or Accumulation of Bonds . . . . . 90,91 Treasurer's Endowed Bed Ledger Accounts . . . . . 92, 93 Method of Figuring Cost per Patient per Day ..... 94 Exhibit A, Form of Voucher . . . . . . . . 95, 96 " B, " "Pay Roll 97,98 " C, " " Voucher Register ...... 99, 100 " D, " " Card Ledger Accounts with Pay Patients . . 101 " E, " " Bill Register 102 " F, " " Cash Book 103 Hospital Accounting and Statistics SCHEDULE 1 Detailed Statement of Current Revenue HOSPITAL EARNINGS (OR OPERATING EARNINGS): Private Room Patients 1907 1906 Board of Friends of Patients .... Ward Pay Patients .... Special Nursing • • •. fDispensary •(■Emergency Ward • • • • Ambulance Fees «... Miscellaneous • • • • Total Hospital Earnings OTHER REVENUE OR INCOME: From the Public Treasury *Donations from Individuals to meet Current Expenses Donations from Churches to meet Current Expenses From The United Hospital Fund of New York Donations, Special Net Receipts from Entertainments, Fairs, Fetes, etc *Legacies, unrestricted Income from Investments held in Endowed Bed Fund Income from Investments held in General Endowment Fund Income from Investments held in Other Funds (enumerate) the income of which is to be used to meet Operating Expenses, Schedule 2, and is not to be added to the principal Income from unrestricted Investments Miscellaneous Total other Revenue or Income fOr Out Patient Department. *The amounts shown for Unrestricted Donations or Legacies should include the value of investments (not including accrued interest) given to the Hospital without restriction. Note.-It may be found preferable to credit "Unrestricted Legacies" direct to Endowment Fund and not to consider them a part of Current Revenue. 2 SCHEDULE 1-Continued 3 APPROPRIATIONS FROM SPECIAL FUNDS TO MEET CURRENT EXPENSES: *(Show appropriation from each fund sepa- rately.) 1907 1906 Total Appropriations from Special Funds to meet Current Expenses Grand Total Current Revenue Excess of Current Expenses over Current Revenue - - - Total *Note.-Reference should be made to some page or pages in the Annual Re- port showing briefly the purpose for which each special fund is to be used. SCHEDULE 2 Detailed Statement of Current Expenses Including Operating, Corporation and Other Salaries, Officers and Clerks Office Expenses Stationery, Printing and Postage Telephone and Telegraph Legal Expenses Miscellaneous 1907 1906 Total Administration Expenses . ADMINISTRATION EXPENSES: Salaries and Wages: Physicians . Anesthetists Supt. of Nurses, Assistant and Instruc- tors Nurses Special Nurses Orderlies Special Orderlies Ward Employes Pharmacy Employes Medical and Surgical Supplies: Apparatus and Instruments Medical and Surgical Supplies, Alcohol, Liquors, Wines, etc Clothing, etc., for use of Patients in Hos- pital Equipment for Nurses: Uniforms Books Instruments Uniforms, etc., for Staff and Orderlies Pathological j Salaries and Labor.. Department: ( Supplies . j Salaries and Labor.. 'Dispensary: i c .. ' Supplies ( Salaries and Labor.. 'Emergency Ward: j a r ( Supplies Visiting and Home ( Salaries (District) Nursing: 1 Supplies „ „ ~ ( Salaries and Labor.. X-Ray Service: } „ i Supplies Total Professional Care of Patients.... PROFESSIONAL CARE OF PATIENTS Pathological Department: 4 'Dispensary: 'Emergency Ward: Visiting and Home (District) Nursing: *Or Out-Patient Department 4 SCHEDULE 2-Continued 5 DEPARTMENT EXPENSES: 1907 1906 j Labor Ambulance: { Supplies ( Salaries and Labor.. Training School: I o r ( Supplies _ ( Labor Housekeeping: S d r ( Supplies „ ( Labor Kitchen: j ~ .. ( Supplies T ( Labor Laundry: 1 ( Supplies Steward's Department: Labor Provisions: Bread Milk and Cream Groceries Butter and Eggs Fruits and Vegetables Meat, Poultry and Fish Total Steward's Department Total Department Expenses GENERAL HOUSE AND PROPERTY EXPENSES: Electric Lighting Fuel, Oil and Waste Gas Ice Insurance Maintenance, Real Estate and Buildings Maintenance, Machinery and Tools Plumbing and Steamfitting Rent Miscellaneous Total General House and Property Exps. Total Operating Expenses 6 SCHEDULE 2-Continued CORPORATION EXPENSES: Salaries, Officers and Clerks 1907 1906 Office Expenses Stationery, Printing and Postage Legal Expenses Interest on Mortgages or Loans Payable Taxes Miscellaneous Total Corporation Expenses CURRENT EXPENSES FROM SPECIAL FUNDS FOR STATED PURPOSES: *(Show expenditure from each fund separately.) Total Current Expenses from Special Funds for Stated Purposes Grand Total Current Expenses Excess of Current Revenue over Current Expenses Total *Note.-Reference should be made to some page or pages in the Annual Report showing briefly the purpose for which each special fund is used. 1907 1906 1907 1906 Grand Total Current Revenue, Schedule 1 Book Value of "Sites and Grounds," "Build- ings," "Furniture and Fixtures," " Machinery and Tools," " Appa- ratus and Instruments," "Ambulances, Live Stock, etc.," or other " Hospital Properties and Equipment," Schedule 4, sold during the year Amount collected during year from Insurance Companies account Hospital Proper- ties or Equipment damaged or de- stroyed by fire, etc Profit on sale of "Sites and Grounds," "Build- ings" or Other Hospital Properties and Equipment Profit on Investments Sold Unclaimed Overpayments by Patients, not liable to be claimed, transferred to surplus Unclaimed Wages, not liable to be claimed, transferred to surplus Amount charged off Endowed Bed Fund or Other Fund Reserve account liability of Hospital having ceased Grand Total Current Expenses (Schedule 2) Capital Expenditures: Additions to Sites and Grounds Additions and Betterments, Buildings Furniture and Fixtures (If charged to Capital Account) New Machinery and Tools do Apparatus and Instruments do Ambulances, Live Stock, etc. do Miscellaneous Total Capital Expenditures Uncollectible Superintendent's Accounts Re- ceivable charged off Uncollectible Treasurer's Accounts Receiv- able charged off Loss and Depreciation charged off Invest- ment Accounts or other Current Asset Accounts. (Show items separately if desired) Total Deficit for the Year Total Surplus for the Year * Total * Total Note.-In the above Schedule the revenue, profits, etc., are shown first on the left side and the expenses, losses, etc., next on the right side, which is the reverse to the order in which the items appear in the corresponding ledger account. This is in accordance with approved accounting practice based on the theory that ordinarily revenue must be received before expenses can be paid. * Totals must agree. Surplus and Deficit Account SCHEDULE 3 7 SCHEDULE 4 Comparative Balance Sheet for Years Ended September 30, 1907 and 1906 CAPITAL ASSETS: 1907 1906 Increase Decrease Hospital Properties and Equipment: Sites and Grounds Buildings Furniture and Fixtures Machinery and Tools Apparatus and Instruments Ambulances, Live Stock, etc Miscellaneous t Total Investments: Mortgages Receivable Bonds Stocks Other Investments Total Capital Assets CURRENT ASSETS: Cash in hands of Treasurer Cash in hands of Superintendent Loans and Notes Receivable Treasurer's Accounts Receivable Superintendent's Accounts Re- ceivable Accounts Receivable from Pub- lic Treasury General Material on Hand Advances: Interest Purchased Prepaid Insurance Other Prepaid Expenses Total Current Assets Grand Total Assets Deficit t Total 8 SCHEDULE 4 Comparative Balance Sheet for Years Ended September 30, 1907 and 1906 CAPITAL LIABILITIES: 1907 1906 Decrease Increase * Capital Account (Hospital Prop- erties and Equipment) * Reserve for Depreciation of Hos- pital Properties and Equip- ment (if any) . * Bonds Outstanding or Mortgages Payable on Hospital Prop- erty (if any) f Total Endowed Bed Fund Account Partly Endowed Bed Fund Ac- count General Endowment Fund Ac- count Other Fund Reserve Accounts (List each separately.) Total Capital Liabilities CURRENT LIABILITIES: Loans and Notes Payable Audited Vouchers Unpaid or Ac- counts Payable Over-Payments by Patients Unclaimed Wages Advance Payments by Patients Total Current Liabilities Grand Total Liabilities '' Surplus I Total *Note.-For detailed explanation concerning "Capital Account" and "Re- serve for Depreciation of Hospital Properties and Equipment," and " Bonds Out- standing or Mortgages Payable on Hospital Property " see pages 73, 74 and 75. tThe total book value of "Hospital Properties and Equipment," as shown under the heading Capital Assets should equal the total of the amounts shown as " Capital Account," " Reserve for Depreciation of Hospital Properties and Equip- ment," and Bonds Outstanding or Mortgages Payable on Hospital Property as shown under the heading Capital Liabilities. t These totals should agree. 9 Description of Funds Amount Sept. 30, 1906 Received During Year Expended During Year Amount Sept. 30, 1907 Increase Decrease TOTAL The purpose of each Fund may be explained by a footnote or by reference to some page or pages of the Annual Report on which such information is given. Information for this Schedule is obtained from the Treasurer's General Ledger Accounts of such Funds. Statement Showing Increase or Decrease of Principal of all Capital Reserve Funds During Year Ended September 30, 1907 SCHEDULE 5 10 SCHEDULE 6 Comparative Statistics for Years Ended September 30,1907 and 1906 HOSPITAL WARDS AND PRIVATE ROOMS 1907 1906 Patients in Hospital First of Year: In Medical Wards, Male Female In Surgical Wards, Male Female In Private Rooms, Male Female Total Patients Admitted During Year: To Medical Wards, Male .... .... Female .... .... .... .... To Surgical Wards, Male .... - .... Female .... .... .... .... To Private Rooms, Male .... .... Female .... .... .... .... Total .... .... Total Patients Treated in Hospital Wards and Private Rooms During Year: Male .... .... Female .... .... .... .... Patients Discharged During Year: Cured .... .... Improved .... .... Unimproved .... .... Transferred to other institutions .... .... Died .... .... Total .... .... Patients in Hospital End of Year: In Medical Wards, Male .... .... Female .... .... .... .... In Surgical Wards, Male .... .... Female .... .... .... .... In Private Rooms, Male .... .... Female .... .... .... .... Total .... .... 11 12 SCHEDULE 6-Continued Total Patient Days Treatment: Free Ward .... .... Endowed Bed .... Pay Ward .... .... Private Room .... .... Total .... .... Percentage: Free Ward Days .... .... Endowed Bed Days .... .... Pay Ward Days .... .... Private Room Days .... .... Average Patients per Day: Free Ward .... .... Endowed Bed .... .... Pay Ward .... .... Private Room .... .... Total .... .... Average Days per Patient in Hospital .... .... Daily Average Cost per Private Room Patient .... .... Daily Average Cost per Ward Patient .... .... EMERGENCY WARD (OR OUT PATIENT DEPARTMENT) 1907 1906 Patients under Treatment first of year, Male... Female. Patients Admitted during year Male... Female. Total Patients Treated during year. .Male... Female. Patients Discharged during year Patients under Treatment end of year, Male... Female. Visits made to Emergency Ward during year. Average Visits made per day Average Visits per Patient Daily Average Cost per Emergency Ward Patient SCHEDULE 6-Continued 13 DISPENSARY (OR OUT PATIENT DEPARTMENT): 1907 1906 Former Patients Treated during year, Male... Female. New Patients Admitted during year, Male... Female. Total Patients Treated during year, Male... Female. Visits made to Dispensary during year Average Visits per day Average Visits per Patient Daily Average Cost per Dispensary Patient.. Ambulance Calls during year .... .... Average Calls per day .... .... Average Cost per Ambulance Call .... .... Patients Treated by Ambulance Surgeon in Emergency Ward and Transferred .... .... Patients Treated by Ambulance Surgeon and left at place of call or transferred direct to other Institutions or to their homes .... .... AMBULANCE VISITING OR HOME (DISTRICT) NURSING No. of Patients Visited .... .... No. of Visits Made .... .... Average Visits per day .... .... Average cost per visit .... .... Total Patients Treated during year in all De- partments .... .... Average Patients per day in all Departments. .... .... Daily average number of Employes Boarded in Hospital .... .... Daily Cost per capita for Provisions for all persons supported .... .... SUMMARY INSTRUCTIONS REGARDING DISTRIBUTION OF EXPENSES INCLUDING OPERATING, CORPORATION, AND OTHER ADMINISTRATION EXPENSES 1. Salaries, Officers and Clerks This account includes the salaries of general officers of the Hospital and their assistants or clerks, whose salaries are not directly chargeable to any department. This account should not include salaries of officers or clerks, who are exclusively engaged with the management of the corpo- ration, estate or sources of revenue outside of the ordinary receipts of the hospital proper. If certain officers or clerks are partly engaged in this manner, a proper proportion of their salaries should be charged accordingly. 2. Office Expenses This account includes car fares, express charges, messenger service, subscriptions to newspapers and periodicals, office furni- ture and fixtures, and such other office supplies as are not properly chargeable to any other subdivision of Administration Expenses or to Corporation Expenses. 3. Stationery, Printing and Postage. This account includes the cost of printing annual reports, blank books, blank forms, paper, stationery, stationery supplies, etc., used in the general work of the hospital. It should not include expenditures of this nature made for corporation purposes. The following is a list of the more important items which may be chargeable to this account: Arm rests Binders Blank cards Blank paper Blank tablets Blotters Blotting paper Calendars Carbon paper Cardboard Cards Circulars Copy (impression) books Dating stamps Envelopes Erasers Eyelet punches. Eyelets Hektographs Indexes Ink Inkstands Invoice books Legal cap paper Letter paper Manifold paper Mimeographs Mucilage Mucilage brushes Notices Numbering stamps Oil paper Orders 14 DISTRIBUTION OF EXPENSES 15 Paper Paper baskets Paper clips Paper cutters Paper fasteners Paper files Paper weights Pencil erasers Pencils Penholders Pen racks Pens Pins Postage Printed cards Printed tablets Rubber bands Rubber stamps Rulers Ruling pens Scrap books Sealing wax Seals Shears Shipping tags Shorthand books Sponge cups . Sponges Telegraph blanks Tissue (impression) paper Twine Typewriter supplies Waste baskets Water holders Wrapping paper, etc. 4. Telegraph and Telephone. This account includes all expenditures, account telegraph messages, rent of telephones, salaries of operators or maintenance of telephones and telephone lines. 5. Legal Expenses. This account includes all fees and retainers paid for services of attorneys, costs of suits and all legal and court expenses in- curred in the operation of the Hospital. It should not include expenditures of this nature made for corporation purposes. 6. Miscellaneous. This account includes such other Administration Expenses as are not directly chargeable to any of the foregoing accounts, or to Corporation Expenses. PROFESSIONAL CARE OF PATIENTS 7. Salaries and Wages. This account includes the salaries and wages of employes under the various headings named. 8. Medical and Surgical Supplies. This account includes the cost of apparatus and instruments, medical and surgical supplies, and alcohol, liquors, wines, etc., purchased for the general use of the Hospital, not specifically chargeable to any department. It would not, however, include the purchase of new and addi- tional apparatus and instruments in large quantities, which should be charged to capital account, under the heading provided therefor. 9. Clothing, etc., for Use of Patients in Hospital. This account includes the cost of clothing, slippers, tooth- 16 DISTRIBUTION OF EXPENSES brushes, etc., for patients' use while in the hospital. If any such articles are made in the hospital the cost of the material used and labor employed should be charged to this account. 10. Equipment for Nurses. This account includes the cost of uniforms, books and instru- ments, if furnished to the nurses by the Hospital. If uniforms, books and instruments are purchased by the Hospital, to be paid for later by the nurses, they should be charged to the General Material Account, and that account should be credited when these are paid for by the nurses. 11. Uniforms, etc., for Staff and Orderlies. This account includes the cost of uniforms, operating gowns, etc., for staff and orderlies. If any such articles are made in the hospital the cost of the material used and labor employed should be charged to this account. 12. Pathological Department. (a) Salaries and Labor. This account includes the salaries and wages of physicians, assistants, and any other employes in this department, including amounts paid for cost of labor in making repairs or maintaining the equipment of this department. (6) Supplies. This account includes the cost of all apparatus and instruments, medical and surgical supplies, and any other supplies whatsoever, which are properly chargeable to this de- partment; also, the cost of any materials used in making repairs or maintaining the equipment of this department. 13. Dispensary or Out-Patient Department. (a) Salaries and Labor. This account includes the salaries and wages of physicians, assistants, nurses, and any other em- ployes in this department. (&) Supplies. This account includes the cost of all apparatus and instruments, medical and surgical supplies, and any other supplies whatsoever, which are properly chargeable to this depart- ment. 14. Emergency Ward or Out-Patient Department. (a) Salaries and Labor. This account includes the salaries and wages of physicians, assistants, nurses, and any other em- ployes in this department. (&) Supplies. This account includes the cost of all apparatus and instruments, medical and surgical supplies, and any other supplies whatsoever, which are properly chargeable to this depart- ment. DISTRIBUTION OF EXPENSES 17 15. Visiting or Home (District) Nursing. (a) Salaries. This account includes the salaries of nurses or other employes in this service. (b) Supplies. This account includes the cost of all medical and surgical supplies, food, clothing, or any other supplies pur- chased for this service for use of patients. 16. X-Ray Service. (a) Salaries and Labor. This account includes the salaries and wages of physicians, operators and any other employes in this service. (5) Supplies. This account includes the cost of apparatus and supplies which are properly chargeable to this service. DEPARTMENT EXPENSES 17. Ambulance. (a) Labor. This account includes the wages of all employes in this department; also the cost of any other labor in connection with making repairs or maintaining the equipment of this department. (b) Supplies. This account includes the cost of all equip- ment and supplies of any nature which are properly chargeable to this department; also, the cost of any material used in making repairs or maintaining the equipment of this department. It should not include, however, new and additional equipment, such as ambulances, live stock, etc., as it is considered more proper to charge such new equipment to capital account, under the heading provided therefor. 18. Training School. (a) Salaries and Labor. This account includes the salaries and wages of officers, instructors, and any other employes which are chargeable exclusively to the cost of operating and maintain- ing the training school, and which can not properly be charged to any other account. (&) Supplies. This account includes the cost of supplies and materials which are directly chargeable to the cost of operating and maintaining the training school exclusively, but does not include the cost of supplies for housekeeping, kitchen, laundry, steward's department, and general house and property expenses in connection with the training school, which should be charged under their respective headings elsewhere, together with other expenses of similar character for the general hospital, as it does not seem desirable to further subdivide the training school account. 18 DISTRIBUTION OF EXPENSES 19. Housekeeping. (a) Labor. This account includes the salaries and wages of the housekeeper and all persons employed in this department, including waitresses, chambermaids, scrubwomen, porters, etc.; also, all persons employed in making and maintaining house- keeping supplies and in cleaning, etc., chargeable to the general hospital and training school, and not chargeable to any other department. (&) Supplies. This account includes the cost of furniture and fixtures, such as beds, bedding, chairs, tables, tableware, linen, and all other housekeeping supplies. It also includes the repairs of same. It should not include, however, large quantities of new and additional furniture, as it is considered more proper to charge these to capital account, under the heading provided therefor. 20. Kitchen. (a) Labor. This account includes wages and labor of all persons employed in this department, in connection with the preparation and general distribution of all food. (6) Supplies. This account includes the cost of all kitchen utensils, fuel used in the kitchen range and other supplies and materials chargeable to the operation and maintenance of the kitchen, not including, however, provisions mentioned under the heading of steward's department. 21. Laundry. (a) Labor. This account includes the wages of employes engaged in this department or the cost of laundry work done out- side. It also includes the cost of any labor in connection with repairs or maintenance of equipment of this department. (&) Supplies. This account includes the cost of all supplies used in this department, including the materials used in connection with operating and maintaining the equipment of this department. 22. Steward's Department. (a) Labor. This account includes the wages of all persons employed in receiving, storing and distributing the supplies of this department. (&) Provisions. Bread.-This account includes the cost of all bread, cake, pastry, etc., purchased. Milk and Cream.-This account includes the cost of all milk, cream, cheese and ice cream purchased. DISTRIBUTION OF EXPENSES 19 Groceries.-This account includes the cost of all groceries, canned goods, flour, dried fruit, etc. Butter and Eggs.-This account includes the cost of all butter and eggs. Fruits and Vegetables.-This account includes the cost of all fresh fruits and fresh vegetables. Meat, Poultry and Fish.-This account includes the cost of all meat, whether fresh, dried or smoked, and of poultry, game, fish and all sea food. GENERAL HOUSE AND PROPERTY EXPENSES 23. Electric Lighting. This account includes the cost of all labor, supplies and ma- terials used in connection with operating and maintaining the electric lighting plant, not including, however, the cost of main- taining machinery used in connection with same, which is charge- able to maintenance, machinery and tools. It includes the cost of maintaining electric lamps, fixtures or wiring, but does not include the cost of operating steam plant or dynamos, which is chargeable to maintenance, machinery and tools. This account of electric lighting includes the cost of any electric light, if fur- nished from outside. 24. Fuel, Oil and Waste. This account includes the cost of all fuel, oil and waste used in connection with operating and maintaining the powder, lighting and heating plant, but does not include the cost of fuel used in the kitchen or laundry range. 25. Gas. This account includes the cost of all gas. 26. Ice. This account includes the cost of all ice. (If Refrigerating Plant is used, indicate by foot-note.) 27. Insurance. This account includes the cost of all insurance for account of the hospital, except fidelity insurance, which should be charged to Miscellaneous Administration expenses. 28. Maintenance Real Estate and Buildings. This account includes the cost of all labor and materials used in connection wTith repairs and maintenance of real estate and buildings in the hospital group. It includes the cost of repairs 20 DISTRIBUTION OF EXPENSES to fences, sidewalks, and the cost of keeping sidewalks and grounds in good order, shoveling snow, etc. This account should not be charged with repairs and renewals of furniture and fixtures such as beds, bedding, chairs, tables, tableware, etc., which are chargeable to housekeeping supplies. This account does not include the cost of new and additional real estate and buildings. It is thought more proper to charge the cost of these to capital account, under the headings provided for sites and grounds or buildings. 29. Maintenance, Machinery and Tools. This account includes the cost of all labor or materials used in connection with repairs, maintenance and renewals of boilers, stationary engines, dynamos, pumps, elevators and other machinery, including the shafting, belting and other appliances for running machinery and all tools and fixtures used in connection therewith. It includes the wages of engineers, firemen, elevator-men, etc., not directly chargeable to other accounts. This account should not include the cost of expensive new machinery and tools, except in so far as these replace old machinery and tools. It is considered that new additional machinery and tools are more properly chargeable to this heading under capital account. 30. Plumbing and Steamfitting. This account includes the cost of all labor and materials used in connection with repairs and renewals of all water, gas or steam pipes and fittings. 31. Rent. This account includes the cost of rental of buildings used in connection with hospital work. 32. Miscellaneous. This account includes the cost of any labor and materials chargeable to general house and property expenses, not included in any of the headings already provided for. CORPORATION EXPENSES 33. Salaries Officers and Clerks. This account includes salaries of officers and clerks, who are exclusively engaged with the management of the corporation, estate or other sources of revenue outside of the ordinary receipts of the hospital proper. If certain officers or clerks are partly engaged in this manner DISTRIBUTION OF EXPENSES 21 a proper proportion of their salaries should be charged accordingly. 34. Office Expenses. This account includes such corporation expenses as car fares, express charges, messenger service, subscriptions to newspapers and periodicals, office furniture and fixtures and such other office supplies as are not properly chargeable to any other subdivision of Corporation Expenses or Administration Expenses. 35. Stationery, Printing and Postage. This account includes expenditures of this nature for corpora- tion purposes and for soliciting Donations, etc. 36. Legal Expenses. This account includes expenditures of this nature made for corporation purposes. 37. Interest on Mortgages and Loans Payable. This heading explains itself. 38. Taxes. This account includes all taxes, if any, paid on property used for hospital purposes. Taxes paid on property held for investment and not used for hospital purposes should be debited to income, if any, from such investment. If there is no income from such investment, these expenses may be debited to the capital account of such invest- ment, if the prospective value of the investment seems to justify such action. Otherwise such taxes may be charged as a part of Corporation Expenses. 39. Miscellaneous. To this account should be charged any other corporation current expenses not properly chargeable to any of the other headings provided, including petty current expenses paid on account of investments. Current expenses other than petty current expenses paid on property held for investment and not used for hospital purposes should be debited to income, if any, from such investment. If there is no income from such investment, these expenses may be debited to the capital account of such investment if the prospective value of the investment seems to justify such action. Otherwise such expenses may be charged as a part of Corporation Expenses. 40. Current Expenses from Special Funds for Stated Purposes. (Show expenditure from each fund separately.) This account explains itself. 22 DISTRIBUTION OF EXPENSES CAPITAL EXPENDITURES 41. To Sites and Grounds Account, Buildings Account, Furni- ture add Fixtures Account, Machinery and Tools Account, Appa- ratus and Instruments Account, or Ambulances, Live Stock, etc., Account, under the heading "Capital Expenditures" (Schedule 3) may be charged the cost of any such new and additional Hos- pital Property or Equipment to such extent as it does not renew or replace property or equipment already in use and to such ex- tent as it increases the value or efficiency of the assets concerned. Ordinarily it would hardly seem worth while to charge small expenses of such nature to Capital Account unless the aggregate amount of such small expenditures, in the opinion of the hospital officials concerned, seemed to justify such action. APPENDIX Advantages of Uniform and Intelligent Hospital Financial Reports and Statistics Some advantages to hospitals or other similar institutions of adopting financial and statistical reports in form similar to that recommended in this book are as follows: First.-It provides an intelligent and accurate system of accounting, which has proved entirely satisfactory to a number of different institutions, and is recommended by many practical hospital experts and by certified public accountants. Second.-The system of bookkeeping herein recommended involves less work, considering results obtained, than any other system of accounting heretofore recommended for general adop- tion by hospitals. Third.-Where a uniform system of accounts and statistics is used by different hospitals, comparisons can be made on a fair and intelligent basis. These comparisons are of much value and interest not only to officials of hospitals, but also to the public who may be interested in the work and results obtained by such institutions. Fourth.-As many hospitals and other similar institutions are largely maintained by contributions from the public, such insti- tutions should inform the public by means of comprehensive and uniform financial reports and statistics as to assets and liabilities, revenue and expenses, work accomplished and cost of same. Where such information is furnished in some uniform manner it is much more easily understood by all interested, than if each different institution makes reports in some manner peculiar to itself with which the public is not familiar. Object of this Appendix In order to explain as clearly as possible to those who are not accountants just what forms and account books may be used and how the various entries and statements may be made in keeping accounts in accordance with this system, there are given in this Appendix descriptions and illustrations of the forms and entries used by The Presbyterian Hospital in the City of New York. 23 24 DOUBLE ENTRY BOOKKEEPING Applicability of this System of Accounting to all Sorts of Charitable Institutions With slight modifications to suit varying conditions, the sys- tem of accounting described herein should be applicable to any hospital, large or small. In the case of small institutions, many of the subdivisions shown on the schedules and elsewhere, if not needed, may be omitted entirely, which would simplify the state- ments and accounts. For very large hospitals or for those doing special work, it may be desirable to have some additional or different subdivisions than those shown in the Schedules, but the method of keeping the accounts, and the general arrangement of the forms and statements should be about the same in any case. The same system of accounting with proper modifications of details could likewise be applied in keeping the accounts of any other kind of charitable institution. Double Entry System of Bookkeeping Under the double entry system of bookkeeping, now generally used by up-to-date corporations, any expense incurred or paid, or any loss or depreciation charged must be debited to some General Ledger Account, and credited to another, and any reve- nue, receipt or profit accrued or received must be credited to some General Ledger Account and debited to another. If the debit sides of all these Ledger Accounts are then totaled, the results should equal the sum of all the totals on the credit side of all Ledger Accounts. In these same General Ledger Accounts, if the difference only in the totals of the entries on the debit side and the credit side, or the balance of each account is entered upon what is called a Balance Sheet on the debit side of the Balance Sheet, opposite accounts in which the debits exceed the credits, and on the credit side of the Balance Sheet, opposite accounts in which the credits exceed the debits, the total of all these balances on the debit side of the Balance Sheet should, of course, agree with the total of all the balances on the credit side of the Balance Sheet, if the entries have been correctly made and footed. If these totals do not agree, it is evident some error has been made, which must be found and rectified. The advantages of this double entry system of accounting are that it enables its users to easily and accurately test the correctness SUPERINTENDENT'S VOUCHERS 25 of the entries and footings made on the books, and to determine the proper debit or credit balance of any General Ledger Account. SUPERINTENDENT'S ACCOUNTS The following paragraphs describe the various forms used in the Superintendent's office of the Presbyterian Hospital and the manner in which entries are made to the accounts referred to. Vouchers Vouchers are used for convenience to provide a uniform size and kind of blank on which to describe each respective bill, as illustrated on Exhibit A. They also bear suitable certificates for clerks and officials to sign, stating that all extensions, additions and calculations in the account have been examined and found correct, and that the account has been properly entered on the books and has not been previously entered or paid, and also that the account is correct and has been incurred for the benefit of the Hospital. Provision is also made so that the party in whose favor a voucher is made may sign his receipt thereon of the amount called for by the voucher. On the back of each voucher it is found convenient to print all of the headings adopted in the classification of expenses, to which any expense paid by voucher might be charged, not includ- ing pay-roll expenses, as a similar provision can be made on the back of some of the pay-roll sheets, so that distribution of pay- rolls to the proper headings can be recorded on the back of the last sheet of the pay-roll in the same way, as the pay-roll is treated as one voucher. A clear record may thus be kept on each voucher and in a Voucher Register showing to what account or accounts each voucher has been charged. Vouchers should be consecutively numbered, to correspond with the number given in the Voucher Register. It is suggested that each voucher be dated with the date that the Cash Book shows it has been paid. After being paid vouchers should be filed for reference in consecutive numerical order, so they may be easily referred to if desired. The vouchers only are usually sent out of the Superintendent's office between the 10th and 15th of each month, when bills for the preceding month are ready for payment, having been approved 26 SUPERINTENDENT'S PAY-ROLLS by the Superintendent and some member of the Board of Man- agers. Where special discounts are offered for more prompt payment vouchers may be paid more promptly. As the Su- perintendent has a complete record of each voucher on his Voucher Register and also has in his office the original bills to which each voucher refers, the extra labor and expense of making separate checks is not considered necessary. Considerable labor will be saved if vouchers are made in the form of and used as a check, as illustrated on Exhibit A. When such vouchers are mailed in payment of bills, they are almost invariably receipted and returned promptly to the Hospital through the bank at which they are payable. Expenses Paid by Vouchers through the Superintendent's Office It will simplify the keeping of accounts if all current expenses indicated on Schedule 2 and capital expenditures indicated on Schedule 3 are paid by vouchers through the Superintendent's office. Large bills for prepaid insurance may be paid, when rendered, direct by the Treasurer and apportioned monthly to Operating Expenses, as explained in footnote under heading Prepaid Insur- ance Account on page 73. Expenditures for assessments, which may increase the value of property held in investment account or for additions and better- ments to property held in investment account, may be paid direct by Treasurer's check and charged on the Treasurer's books to the investment account concerned to the extent that such expen- ditures increase the value of the investment concerned. Taxes and current expenses, other than petty current expenses, on property held for investment may be paid direct by Treasurer's check and charged against income, if any, of the investment concerned. If there is no income it may be found preferable to charge such expenses to capital account of the investment con- cerned, if the prospective value of the property seems to justify so doing. Otherwise such expenses may be paid by Superinten- dent's voucher and charged as a part of Corporation Expenses. Pay-Rolls A sample pay-roll sheet is illustrated on Exhibit B. The dis- tribution of pay-roll expenses is printed on the back of only a AND UNCLAIMED WAGES 27 small percentage of the pay-roll sheets, as this distribution need be shown only on the last sheet of the monthly pay-roll, from which the expenses chargeable to each account can be posted to the Voucher Register, as is done in the case of other vouchers. It will be found convenient to have pay-roll sheets printed in loose leaf form so that they can be carried in suitable binder in the order and number desired, in order to properly protect them, and so that when no longer needed for frequent reference these pay-roll sheets can be removed from the binder and can be properly filed. Pay-Rolls and Unclaimed Wages At the end of each month when the pay-roll is made up, or semi-monthly, if pay-rolls are paid semi-monthly, the Superin- tendent makes a voucher in favor of himself for the amount of the pay-roll, lists this voucher on his Voucher Register in the usual manner, and draws from his Voucher Bank Account the amount of cash referred to. The total amount of the pay-rolls listed on the Voucher Reg- ister each month is posted directly to the credit side of a ledger account entitled "Salaries and Wages" and is not included in the total amount of vouchers registered during the month that is posted to the credit side of Voucher Account. On pay-day the pay-clerk in the Superintendent's office puts the amount of cash due each employe (except those who may already have been paid by time-check, as explained later) in a separate envelope bearing a number which corresponds with a number assigned to such employe on the pay-roll. He then visits each of the different departments of the hospital and in the pres- ence of the head of that department, or his or her representative, who can identify employes, distributes cash to parties entitled thereto, who acknowledge receipt of same by signing their names in the signature column of the pay-roll. In case some employes are not on hand ready to receive their pay the Superintendent may hold such unclaimed wages in his safe for a period not to exceed two weeks, to see if they are called for, and if not by that time claimed, they may then be redeposited in the Superintendent's General Cash Bank Account. There- after, as any such unclaimed wages are called for, it has been found preferable to pay these by checks drawn on the Superintendent's General Cash Account. 28 SUPERINTENDENT'S TIME CHECKS In case an employe is not present on pay-day to collect his cash and desires to have his pay forwarded by mail, the Super- intendent redeposits in the bank the cash, if any, he may be hold- ing in his safe for account of such employe and sends him a check drawn against the Superintendent's General Cash Bank Account for the amount due. Where pay-checks are drawn the check number and date should be noted opposite the employe's name in the signature column on the pay-roll. As salaries and wages are paid by cash or by check the total amount paid out on that account (including payments made by pay-roll cash to reimburse Petty Cash Account for time-checks paid or for Advances on account of salaries made through Petty Cash) is entered from time to time in the column headed "Sala- ries and Wages Paid" on the credit side of the General Cash Book. At the end of each month the total of this column is posted direct to the debit side of the "Salaries and Wages Account" on the Superintendent's Ledger, as shown later. Time Checks In case employes leave the service of the Hospital and it is desired to pay them their salary or wages before the regular monthly pay-roll is made up. Time Checks in the following form are issued and properly certified and record of same is kept on a stub as indicated. No 190 Favor of No THE PRESBYTERIAN HOSPITAL TIME CHECK-NOT NEGOTIABLE Occupation. . . . Gbis Certifies, That.. has worked.. at $ per cents. Time given has been noted in time booh opposite name Amount $ New York 190.. Days Rate Amount $ Issued by employed as ... .days in month of 190.. and is entitled to dollars and SUPERINTENDENT Received payment in full, Witness ADVANCES PAID ON ACCOUNT OF SALARIES AND WAGES 29 When such time-checks are receipted by the parties in whose favor they are made, they are then paid in cash and are carried in the Superintendent's Petty Cash Account until the next regular pay-day. When the pay-roll is made up records of time-checks issued are noted thereon as indicated on Exhibit B, and the Super- intendent's Petty Cash Account is reimbursed from the pay-roll cash the amount of money advanced from his "Petty Cash," as shown by the receipted time-checks carried in his Petty Cash. These receipted time-checks should then be filed with the receipted pay-rolls as evidence that the employes concerned had received their pay. Advances Paid on Account of Salaries and Wages If pay-rolls are paid twice a month it should be entirely un- necessary to make any payments on account of salaries or wages in advance of pay-day, except perhaps in some cases to employes leaving the service to whom time-checks may be given and cashed in advance of the regular pay-day. If, however, pay-rolls are paid only once a month and if, in cases of emergency, it is deemed advisable to pay certain em- ployes, who are not leaving the service, part of their salary or wages on account before pay-day, part payments in cash may be made from Petty Cash and entered in detail on the credit side of the Superintendent's Petty Cash Book. For such payment a receipt should be taken from the employe concerned reading about as follows: THE HOSPITAL, New York 19... This certifies that is entitled to Dollars on account for services rendered during Head of Department or Chief Cleric Received the above named amount These receipts for advance salary or wages should be carried by the Superintendent in his Petty Cash Drawer. 30 CARD RECORD OF UNCLAIMED WAGES At the end of the month, when the pay-envelopes are made up, these receipts should be returned to the employes concerned in their pay-envelopes together with the remaining amount of cash due them for services rendered during the month, and receipt for payment in full should be taken from the employe concerned in the signature column of the monthly pay-roll, and Petty Cash should be reimbursed with pay-roll cash accordingly. Card Record of Unclaimed Wages In order to facilitate keeping track of exactly what unclaimed salaries and wages go to make up the total amount of unclaimed salaries and wages at any time, a small card record is kept for each individual to whom unclaimed salary or wages may be due. This card record is made when any unclaimed salaries or wages are deposited by the Superintendent in the bank. Each card shows the name of the person, the individual monthly reference number on the pay-roll, the amount of salary or wages due and the month for which such amount is due. As salaries or wages formerly unclaimed, are called for, refer- ence is made to the card record of the individual concerned, which facilitates reference to the original pay-roll. Superintendent's checks are then issued accordingly and the card record for the individual concerned is then destroyed and the number and date of the pay-check is noted on the pay-roll in the signature column opposite the name of the party paid unless the latter acknowledges receipt by signing the pay-roll. At the end of each month, when the Superintendent's Ledger Account of Salaries and Wages is balanced, the balance shown on the credit side must agree with the total amount of unclaimed salaries or wages, as shown in detail on the card records of such unclaimed salaries and wages referred to above. Unclaimed Wages Transferred to Surplus and Deficit Account through the Treasurer's Books From time to time the Superintendent carefully examines the card records of unclaimed wages and before closing his books at the end of each fiscal year he authorizes Journal Entry No. 5 as shown on page 45, whereby salaries and wages unclaimed for more than one year, which probably will never be claimed, are SUPERINTENDENT'S VOUCHER REGISTER 31 credited to Superintendent's Account with Treasurer, if such action is approved by the proper official. SUPERINTENDENT'S VOUCHER REGISTER In order to avoid making separate entries to General Ledger Accounts for each individual expense incurred, and so that en- tries need be made for the totals only at the end of each month, and to economize time and labor in recapitulating results, a Super- intendent's Voucher Register is used with headings properly arranged in separate columns to correspond closely with the classification of expenses agreed upon, as illustrated on Exhibit C. It will be found advantageous to have a Voucher Register in loose leaf form, as it is economical to have at least several hundred pages of the Voucher Register printed at one time. On account of the size and weight of these pages, however, the book will be lighter and more easily handled if only a part of these pages are inserted in the binder at one time. If there are apt to be only two or three bills per month for any one subdivision of expenses, it is not necessary to have a separate column for such a subdivision, but it may be grouped with some other expenses under the proper general heading and in a vertical column headed Distribution, the subdivision to which it belongs can be indicated on the same line. For smaller Institutions than the Presbyterian Hospital having less monthly bills to pay and less subdivisions of expenses, a cor- respondingly smaller Voucher Register than that illustrated on Exhibit C would be entirely suitable. For a small hospital, for example, all Administration Expenses may be entered in one vertical column headed Administration Expenses, and in the column headed "Distribution" the sub- division or subdivisions of Administration Expenses to which any vouchers are chargeable may be designated. In such cases where the monthly entries in any one column are not very numerous, it would not be difficult at the end of each month to recapitulate the total amounts chargeable to each subdivision of expenses. After all the vouchers for the month have been entered upon the Voucher Register, it is then a simple matter to make the necessary footings and recapitulation, so as to show the total expenses for each and all of the different subdivisions called for by the classification of expenses (Schedules 2 and 3). 32 SUPERINTENDENT'S CARD LEDGER These totals which represent expenses incurred, but are not cash transactions, are then both debited and credited direct to the proper General Ledger accounts, as indicated hereafter. References should be made on the Voucher Register to the pages of the Ledger on which totals are posted. The figures required to show the details of Current Expenses (Schedule 2) and Capital Expenditures (Schedule 3) are taken by the Superin- tendent direct from the Voucher Register. SUPERINTENDENT'S CARD LEDGER ACCOUNTS WITH EACH PAY PATIENT In order to keep proper records of amounts due and amounts paid, a Card Ledger Account is kept with each pay patient on a card illustrated on Exhibit D. On these cards, pay patients are numbered consecutively for reference, beginning with No. 1, the first of each fiscal year, so that by these numbers it is easy to see how many different pay patients are admitted each month during the year. On a separate card for each pay patient are shown the amounts due from him for board and attendance, special nursing, telephone messages and other miscellaneous expenses incurred for his ac- count, and total amount due accruing during each month. Pay- ments received for account of Pay Patients are entered at once on the Superintendent's Cash Book, from which they are posted daily to the proper Patient's Card Ledger Account in the column provided therefor. Keeping Record of Amounts Due for Special Nursing and Other Charges In order that the Superintendent's office may have correct information as to the number of days or nights of special nursing for which different patients are to be charged, small special nursing time tickets 3}^" x 3" (put up in pads of 50) may be used, reading as shown below. White color may be used for the special day nurse time ticket and a darker color for the special night nurse time ticket, so these can be easily distinguished. Each morning the Superintendent of Nurses has these time tickets for the previous day and night delivered at the Superintendent's office. ACCOUNTS WITH PATIENTS 33 SPECIAL NURSING Day 191... Patient Private Room No Ward Nurse Important.-Special Nursing Time Tickets for the preceding night or day must be delivered to the Superintendent's office before 10 a.m. each morning. A small form about x 2^" reading as shown below may be used by the telephone operator, on which to record telephone charges to be made against patients. These memoranda of tele- phone charges are also sent daily to the Superintendent's office. TELEPHONE CALL Phone No Name Charge $ Date 19 In case expensive medicine, drugs, mineral waters or liquors, etc., are furnished to patients, memoranda of charges to be made for such articles and the name of the patient and the date may be made on small pieces of paper. The special nursing time tickets and the memoranda showing telephone or other charges may be conveniently filed in an alpha- betically indexed envelope according to the name of the patient concerned, and all time tickets and memoranda of charges which concern the same patient may be fastened together with a paper fastener. When the bill clerk is ready to make out his bills against pa- tients he can readily refer to the special nursing time tickets, if any, and other memoranda of charges and thus see what extra charges should be billed against any particular patient, and from these memoranda he can also obtain necessary information as to charges to enable him to insert these on the card ledger account at the end of each month or when the patient is discharged. At nearly all hospitals it is customary to make bills payable one week, ten days or two weeks in advance depending somewhat 34 SUPERINTENDENT'S ACCOUNTS WITH PAY PATIENTS upon the character of the service and probable stay of patients in the hospital. It will ordinarily be found desirable to establish the practice of rendering bills against pay patients when they enter the hospital and on or about certain fixed dates each month, beginning with the first of each month and having the last period billed for each month include the last day of the month, providing it is expected that the patient concerned will be in the hospital at such time. Where such practice is established and the bill clerk knows that on or about certain dates he sent bills to all pay patients in the hospital who should receive them, it is not necessary to keep any further records of just when bills are sent out. It may be found convenient to only bill patients for telephone and other minor charges on the last bill rendered to the patient concerned during each month, as this will involve less labor and may avoid disputes as to whether such minor charges have been billed for or paid for before. Record of amounts due for use of operating room or for fee for services of the Pathological Department or similar charges may be made direct on the Patients' Card Ledger Account and may be charged for on the first bill rendered thereafter. The following paragraphs will explain just what is meant by " Ad- vance Payments by Patients" and "Overpayments by Patients." "ADVANCE PAYMENTS BY PATIENTS" are payments made by them for care or services, etc., to be rendered during some succeeding month. "OVERPAYMENTS BY PATIENTS" are payments made by them for services or care, etc., never rendered. As the Hospi- tal offers to refund these "overpayments" to patients concerned, when they leave the Hospital, and as they are liable to be claimed by such patients at any time, the amount to the credit of "Over- payments by Patients" Account is carried as a liability of the Hospital on the Superintendent's Ledger. From time to time under authority of the proper officials of the Hospital a part of the amount standing to the credit of "Overpayments by Patients" Account, which represents overpayments which have not been claimed for a long time and will probably not be claimed, is trans- ferred by Journal Entry, No. 2, as indicated on page 45 to Super- intendent's Account with Treasurer. At the end of each month when all of the amounts due from SUPERINTENDENT'S BILL REGISTER 35 each patient for such month and all of the amounts paid by each patient during such month have been entered on their respective cards, the information called for by the headings shown on the back of each card can then be posted in the proper column or columns namely: "Accounts Receivable of previous months paid during month," "Advance Payments by Patients during month," "Overpayments by Patients during month," "Accounts Receivable accruing during month," and "Amount Due Accruing during month or Overpayments by Patients paid by Advance Payments of previous months." On these cards the totals of all figures for any one month which may be entered in any of the columns headed: "Total Amount Due accruing during month," "Accounts Receivable of previous months paid during month," "Advance Payments by Patients during month," "Overpayments by Patients during month," must equal the totals of all figures for the same month, which may be entered in any of the columns headed: "Total Cash Payments during month," "Accounts Receivable accruing during month," "Amounts Due accruing during month or Overpayments by Patients paid by Advance Payments of previous months." At the end of each month the figures for such month from each of these Card Ledger Accounts are then entered upon a Bill Register described below for the purpose of securing the totals of all such accounts. The figures, if any, showing "Overpayments by Patients refunded during month," are posted direct from the Cash Book to the cards in the column bearing that heading, in order to com- plete the record on that card, but it is not necessary to enter these figures on the Bill Register, as "Overpayments by Patients re- funded during month" are debited direct from the Cash Book to the Ledger account "Overpayments by Patients," as shown later. SUPERINTENDENT'S BILL REGISTER At the end of each month a recapitulation of the Card Ledger Accounts of all Pay Patients is made in the Superintendent's Bill Register, a sample page of which is shown on Exhibit E. In recapitulating the accounts of Pay Patients, the accounts of 36 SUPERINTENDENT'S BILL REGISTER Private Room Patients are entered together alphabetically and totaled, and the accounts for Ward Pay Patients are entered together alphabetically and totaled. In this way the totals in the columns on the Bill Register headed " Cash Payments received during month " as regards Private Room Patients and as regards Ward Pay Patients can be checked with similar totals shown on the Superintendent's Cash Book at the end of the month, with which they must agree if postings have been properly made. The total earnings and cash receipts for the month from the Dispensary, Emergency Ward, X-Ray Service, Sale of Junk, Telephone Tolls, and other Miscellaneous Hospital Earnings (Schedule 1) are like- wise posted in detail on the Bill Register at the end of each month. The amount due for and cash received for General Material sold during month figured at cost price (profit, if any, on sales of General Material being credited to Miscellaneous Hospital Earn- ings) is likewise posted on the Bill Register. If these entries for each month are correctly made on the Bill Register in the columns provided therefor, the grand total of the total figures shown in the columns headed: "Total Amount Due accruing during month," "Accounts Receivable of previous months paid during month," "Advance Payments by Patients during month," " Overpayments by Patients during month," must equal the grand total of the totals shown in columns headed: "Total Cash Payments received during month," "Accounts Receivable accruing during month," "Amounts Due Accruing during month or Overpayments by Patients paid by Advance Payments of previous months." After all entries for the month are made on the Bill Register, the totals of the columns having the following headings are then debited and credited direct to the proper Superintendent's General Ledger Accounts, as follows: "Total Amount Due (Hospital Earnings, Schedule 1) accruing during month is debited to "Bill Account" and credited to "Super- intendent's Account with Treasurer." "Cost price of General Material sold during month" is debited to "Bill Account" and credited to "General Material Account." "Advance Payments by Patients during month" is debited to "Bill Account" and credited to "Advance Payments by Patients Account." SUPERINTENDENT'S CASH BOOK 37 "Overpayments by Patients during month" is debited to "Bill Account" and credited to "Overpayments by Patients Account." "Amount Due accruing during month or Overpayments paid by Advance Payments of previous months" is debited to "Advance Payments by Patients Account" and credited to "Bill Account." "Total Cash Payments received during month," as shown by the Superintendent's Bill Register, should agree with Cash re- ceived by the Superintendent during month in payment of Bills rendered patients and including Dispensary, Emergency Ward, and Other Miscellaneous receipts account Hospital Earnings and Cash received account General Material sold, as shown in the recapitulation at the end of the month in the Superintendent's Cash Book, described later. These total Cash Payments received during month account Hospital Earnings are credited direct from the Cash Book to "Bill Account" on the Superintendent's General Ledger, as indi- cated later, and it is therefore not necessary to post this item from the Bill Register. It is not necessary to post from the Bill Register totals in the columns headed: "Accounts Receivable of previous months paid during month " and "Accounts Receivable accruing during month," as the amount of "Accounts Receivable of previous months paid during month" is already included in "Total Cash Payments received during month" and the amount of "Accounts Receiv- able accruing during month" is already included in "Total Amount Due accruing during month" referred to above. Reference should be made on the Bill Register to the pages of the Superintendent's ledger on which each total is posted. From the totals shown in the first four columns of the Bill Register the Superintendent secures the necessary information to show the amount of Hospital Earnings for each month as indi- cated on Schedule 1. SUPERINTENDENT'S CASH BOOK In order to avoid making separate entries to General Ledger Accounts for each item of cash received or cash paid out, a Cash Book is used in the Superintendent's office with headings arranged 38 SUPERINTENDENT'S CASH BOOK to economize time and labor in recapitulating totals, so as to readily show total cash receipts and expenditures for each month, under the desired classifications. A sample page of the Superin- tendent's Cash Book is shown on Exhibit F. The total amount of Cash on hand at first of month plus the cash received during month as shown on the debit side of the Cash Book, less the total amount of cash paid out during month as shown on the credit side of the Cash Book, will indicate at any time the amount of cash that should be in the hands of the Super- intendent. At the end of each month a recapitulation of the total amount of cash received by the Superintendent during the month should be made on the debit side of his Cash Book in about the following form: Cash on hand at first of month, not including Petty Cash Cash Received during Month Account Hospital Earnings: From Private Room Patients From Ward Pay Patients From Dispensary From Emergency Ward From Other Miscellaneous Hospital Earnings Total cash received during month account Hospital Earnings Cost price of General Material sold during month ..... Cash received from Petty Cash Account during month.. Cash Received from Treasurer during month *Total At the end of each month a recapitulation of the total amount of cash paid out by the Superintendent during the month should be made on the credit side of his Cash Book in about the following form: Vouchers Paid during month Salaries and Wages paid during month Cash refunded to Patients by Superintendent during month account "Overpayments by Patients" for care or services never rendered and not to be rendered Cash remitted to Treasurer during month account cash received by Superintendent in payment of Bills rendered Patients and in- cluding Dispensary, Emergency Ward, and other Miscellaneous receipts, account Hospital Earnings or account General Material Sold Cash advanced to Petty Cash Account during month Cash on hand at end of month, not including Petty Cash *TotaI *These totals should agree. SUPERINTENDENT'S RECEIPT BOOK 39 It is not customary for the Superintendent to remit to the Treasurer cash received account "Advance Payments by Patients" during month for services to be rendered in succeeding months or "Overpayments by Patients" for care or services never rendered until such accounts are finally disposed of in the manner indicated. The Cash in hands of Superintendent includes the amount of "Advance Payments by Patients" and "Overpayments by Patients" for which he is chargeable at any time. If these above mentioned totals are recapitulated at the end of each month on the Superintendent's Cash Book, this Cash Book can be considered as the Superintendent's Cash Ledger Account, and there will be no necessity of his carrying a Cash Account on his Ledger in addition. The total "Cash Received during month account Hospital Earnings," as shown on the debit side of the Superintendent's Cash Book, is credited direct at the end of the month to "Bill Account" on the Superintendent's Ledger. "Cash received from Treasurer during month" is credited direct to "Superintendent's Account with Treasurer" on the Superintendent's Ledger. The total "Vouchers Paid during month," as shown on the credit side of the Superintendent's Cash Book, is debited direct at the end of the month to "Voucher Account" on the Super- intendent's Ledger. "Salaries and Wages Paid during month" is debited direct to "Salaries and Wages Account" on the Superintendent's Ledger. "Cash Refunded to Patients by Superintendent during month account Overpayments by Patients" is debited direct to "Over- payments by Patients Account" on the Superintendent's Ledger. "Cash remitted to Treasurer during month" account cash received by Superintendent account Hospital Earnings and General Material Sold is debited direct to "Superintendent's Account with Treasurer." Proper references are made on the Cash Book in each case to the pages of the ledger to which postings are made. SUPERINTENDENT'S RECEIPT BOOK In the Superintendent's office at the Presbyterian Hospital it has been found convenient and desirable to have cheap forms of receipts printed in duplicate with five receipts per page reading as follows: 40 SUPERINTENDENT'S RECEIPT BOOK THE PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK 3939 191 Received from For Board and Attendance to................................................ Days from To Inclusive, $ SPECIAL NURSING Days from To Inclusive, $ Nights from To Inclusive, $ Other Charges................................................. $ $ $ C. IRVING FISHER, M.D., Supt., Per The original and duplicate receipts are consecutively numbered and are bound, five per page, in book form, 625 receipts per book. The original receipts are printed on cheap white paper and are per- forated so they may be easily detached. The duplicate receipts, which remain in the book for record, are printed on buff paper and are not perforated. A cheap canvas board binder is used to hold these receipt books while in use and is made in slip cover form so that a book may be inserted or removed as required. One of these receipts is made out in duplicate each time a patient's bill is paid or when any other payment is received at the Superintendent's office and the originals given to parties making payments. This form facilitates giving promptly detailed receipts for payments, and by having all payments received re- corded in such a book they can readily be posted from there to the Cash Book at the convenience of the bookkeeper. It fre- quently happens that some clerk, other than the one who receives the cash, may be using the Cash Book and, therefore, the dupli- cate receipts referred to above are found convenient as original memoranda entries of payments received. The total of the du- plicate receipts plus the amount of the cash on hand at the first of the month should equal the total of the debit side of the Cash Book for the same period. This method, therefore, provides a check upon the accuracy of the clerk receiving payments in the Superintendent's office. CASH REMITTANCES BY TREAS. TO SUPT. 41 It is felt that the advantages in using receipts as described more than justify the labor involved. CASH REMITTANCES BY TREASURER TO SUPERINTENDENT At the Presbyterian Hospital, where pay-rolls are paid about the nineteenth of each month for the first fifteen days of the month and where pay-rolls for the last half of each month are paid about the fourth of the following month, it is customary for the Super- intendent, about the tenth or twelfth of each month, to make a careful estimate of the probable amount of the pay-roll for the first half of that month. This he does by knowing exactly what the pay-roll was for the first half of the previous month and by considering the probable amount of increase or decrease due to increase or decrease in force made since the previous month. By the tenth or twelfth of each month the Superintendent also knows, from his Voucher Register, the total amount of properly approved audited vouchers covering bills for the previous month, which, at the Presbyterian Hospital it is the practice to pay about the fifteenth of the month, except as noted below. The Superintendent then draws a draft on the Treasurer for the amount of money he expects to require to pay the pay- roll for the first half of the month plus the total amount of his audited vouchers for the previous month, as shown by his Voucher Register not including pay-roll charges shown by the Voucher Register. If any two members of the Executive Committee, approve and sign this draft it is forwarded to the Treasurer and authorizes him to remit to the Superintendent a check for the amount requested. Likewise about the twenty-fifth or twenty-seventh of each month the Superintendent draws a draft on the Treasurer for the estimated amount of the pay-roll for the last half of the month. A check for this amount, in due course, is forwarded to him by the Treasurer upon receipt of a draft signed by two members of the Executive Committee authorizing such remittance. Inasmuch, however, as there is always a large percentage of monthly bills on which a discount of one or two per cent, can be obtained if payments are made within ten days from date of invoice, it has been found advantageous to avail of such discounts, when there is no question about the correctness of the bill, by 42 SUPERINTENDENT'S BANK ACCOUNTS paying such bills promptly. For that purpose the Treasurer has given to the Superintendent for deposit in the latter's "Voucher Bank Account" a working fund of about $7,000.00 on which the Superintendent can temporarily draw, until the working fund is reimbursed by the usual remittances from the Treasurer to the Superintendent. CASH REMITTANCES BY SUPERINTENDENT TO TREASURER About the fifteenth and thirtieth of each month, or oftener if desired, the Superintendent remits to the Treasurer a check on account of cash received by Superintendent in payment of bills against patients and including Dispensary, Emergency Ward and other Miscellaneous Receipts account Hospital Earnings or for General Material Sold. THE SUPERINTENDENT'S BANK ACCOUNTS The Superintendent will ordinarily find it most convenient to have two separate accounts with the bank in which he deposits funds, as this will facilitate balancing his bank accounts or locating any error. The first account is called the "Superintendent's Voucher Bank Account" or simply "Superintendent's Voucher Account." In this account the Superintendent deposits the checks he re- ceives from the Treasurer and also any cash receipts that are treated as credits to current expenses. From this account are paid the voucher checks drawn by the Superintendent in favor of various parties for current expenses or capital expenditures of the Hospital paid through his office. The second account is called the "Superintendent's General Cash Bank Account" or simply "Superintendent's Account." In this account is deposited the cash received through the Super- intendent's office account Hospital Earnings, General Material sold and also unclaimed wages deposited temporarily in this ac- count and any remittances of surplus cash or checks from the Superintendent's Petty Cash Account described later. From the Superintendent's General Cash Account are paid by Superintendent's check, some pay-checks and also checks covering refunds on account of overpayments made by or on SUPERINTENDENT'S PETTY CASH BOOK 43 account of patients (as the endorsement on the check serves as a receipt for the payment), and the various remittances made by the Superintendent to the Treasurer on account of Hospital Earnings, and also checks in favor of the Superintendent for advances to Petty Cash to enable him to pay minor Miscellaneous Hospital Petty Cash Expenditures and to cash such time-checks or other checks, etc., as are absolutely necessary. In order to allow the Superintendent sufficient funds in his General Cash Account to enable him to make necessary advances to his "Petty Cash" he should be allowed to keep a small balance in that account, instead of remitting promptly the entire amount of Hospital Earnings collected by him to the Treasurer. SUPERINTENDENT'S PETTY CASH BOOK In order to economize space in the Superintendent's General Cash Book, and to have some suitable record in which certain Petty Cash expenditures can be originally entered before they are finally grouped together and covered by suitable vouchers in the usual manner, it will be found advantageous and economical for the Superintendent to have a Petty Cash Book in addition to his General Cash Book. This Petty Cash Book should have on each page columns headed as follows: PETTY CASH FOR MONTH Cr. .191 Dr. Date Description Receipts Time-Checks Miscellaneous If many advances on account of salaries and wages are paid before pay-day, it may be found advisable to insert another credit column in the Petty Cash Book with the heading "Advance Pay- ments on Account of Salaries and Wages." By having debit and credit entries on the same page, but in separate columns as indicated, there is great economy in space as compared with having separate debit and credit pages, as in the General Cash Book, as nearly all of the entries made in the Petty Cash Book are for minor disbursements. The disbursements recorded in the Petty Cash Book would be 44 SUPERINTENDENT'S JOURNAL for cashing of time-checks in advance of pay-day, for advances on account of salaries and wages, for miscellaneous petty cash ex- penditures, which, in due course are to be covered by a suitable voucher in favor of the Superintendent to reimburse Petty Cash, and cash returned to the Superintendent's General Cash Account, when more cash than necessary accumulated in the Petty Cash Account. The only receipts recorded in the Petty Cash Book would be advances from the Superintendent's General Cash Account and cash received to reimburse Petty Cash for the miscellaneous petty cash expenditures referred to above and pay-roll cash received on pay-day to reimburse Petty Cash Account for time-checks cashed and for advances account salaries and wages paid. If at any time the Superintendent had in his cash drawer more cash or checks to the credit of his Petty Cash Account than would be needed in the immediate future, he should deposit a part of this in the bank and debit his General Cash Account and credit his Petty Cash Account accordingly. If the Petty Cash Book is balanced at the end of each month this Petty Cash Book can be considered as the Superintendent's Petty Cash Ledger Account, and there will be no necessity of his carrying a Petty Cash Account on his ledger in addition. SUPERINTENDENT'S JOURNAL As will be seen from the preceding paragraphs nearly all entries made in the Superintendent's General Ledger Accounts are posted direct from his Cash Book, Voucher Register or Bill Register. In order, however, to indicate to what ledger accounts items not entered on any of the three books mentioned are debited and credited, a Superintendent's Journal is kept. Each Journal Entry should be dated. At the present time at the Presbyterian Hospital only five kinds of Journal Entries, as indicated below, are occasionally found necessary in the Superintendent's office: September 30, 1907 1. Superintendent's Account with Treasurer, Dr To Bill Account Cr For Uncollectible Accounts Receivable charged off during month, as reported to Treasurer. (Give details.) SUPERINTENDENT'S JOURNAL 45 September 30, 1907 2. Overpayments by Patients Account, Dr To Superintendent's Account with Treasurer.... Cr For accumulated, unclaimed Overpayments by Patients for services not ren- dered and not to be rendered, which Overpayments are not liable to be claimed by patients and are therefore transferred, by authority of the proper official, to Sur- plus and Deficit Account through the Treasurer's books as explained hereafter. (Give details.) (This journal entry would ordinarily be used only at the close of each fiscal year.) September 30, 1907 3. General Material Account, Dr To Superintendent's Account with Treasurer.... Cr Account surplus amount of General Material found by inventory to be on hand above that heretofore shown by General Material Account. September 30, 1907 4. Superintendent's Account with Treasurer, Dr To General Material Account Cr Loss or depreciation of General Material, as shown by inventory. September 30, 1907 5. Salaries and Wages Account, Dr To Superintendent's Account with Treasurer... .Cr. For accumulated unclaimed wages which are not likely to be claimed and are, therefore, transferred to "Surplus and Deficit Account" through the Treasurer's Books by authority of the proper official. (Give details.) (This journal entry would ordinarily be used only at the close of each fiscal year.) When Journal Entries Number 1 or 2 are made, proper nota- tions should likewise be made on each of the "Pay Patients Card Ledger Accounts" concerned, in order to complete such records. When postings are made from Journal Entries to General Ledger Accounts, proper notations should be made on the Journal to show the pages of the Ledger to which each item is posted and proper reference should be made in each of these ledger accounts to the page of the Journal from which each posting is made. SUPERINTENDENT'S GENERAL MATERIAL LEDGER ACCOUNT In some hospitals certain materials are purchased to be sold later, which are not properly chargeable to current expenses. When such articles are purchased in quantity for resale it will be found advisable to charge same to a General Material Account 46 SUPERINTENDENT'S GENERAL MATERIAL LEDGER ACCOUNT and credit the cost of these articles when sold to the same account. The balance on the debit side of this account should at any time represent the cost price of general material on hand, as shown on page 51. For instance, at many hospitals it is the practice to have a standard style and quality of uniform for nurses such as dresses, aprons, bibs, caps, collars and cuffs. The materials used in mak- ing these uniforms are often purchased by the hospital in quantity and resold to nurses at cost price or at cost price plus a small percentage of five or ten per cent, to cover handling charges, etc. Any amount received to cover handling charges is shown on the Bill Register and Cash Book as Miscellaneous Hospital Earn- ings. At the end of each fiscal year, or oftener if necessary, an inventory at cost price should be taken of general material actu- ally on hand. If this inventory shows an excess or a shortage of general material on hand as compared with the amount shown by General Material Account this discrepancy may be corrected by Journal Entries 3 or 4. SALE OF SUPPLIES CREDITED TO CURRENT EXPENSES While the sale by the hospital of supplies not carried in Gen- eral Material Account and which have previously been charged to current expenses should ordinarily be discouraged as an unde- sirable practice, it may at times and under certain circumstances be found expedient to allow doctors or nurses, etc., to purchase from the Hospital certain articles, such as rubber gloves, ther- mometers, scissors, etc. If this is permitted the amounts received up to the cost price of such articles should be shown on the Cash Book and under the proper headings on the Voucher Register in red ink as a credit to Current Expenses as shown on Exhibit C and the cash received to cover the cost of articles sold should be deposited in the Superintendent's Voucher Bank Account. The profit, if any, on account of such sales should be shown on the Cash Book and the Bill Register as a Miscellaneous Hospital Earning and the cash received on account of profit should be deposited in the Superintendent's General Cash Account. When entries are made on the debit side of the Superintend- ent's General Cash Book to show the amount of cash received on account of the sales referred to, such entry should indicate, in ENTRIES BY SUPT. IN OPENING NEW SET OF BOOKS 47 the Miscellaneous Column, the cost of the material sold, and under the column headed "Other" under Hospital Earnings, the amount of profit or handling charges. HOW SUPPLIES DONATED MAY BE CHARGED TO CURRENT EXPENSES, IF DESIRED xn case supplies of such nature as those ordinarily charged to current expenses are donated to the hospital, and if it is desired to show the value of such supplies as a charge against current expenses in order to determine the total expenses involved in caring for patients, the following method may be used. The Superintendent may make a voucher in favor of the Treasurer for the amount of the estimated value of the supplies donated, which is entered in the Voucher Register and Cash Book in the usual manner and charged to the proper subdivision of current expenses. When the Treasurer receives this voucher he enters the amount in his Cash Book as a special donation. ENTRIES TO BE MADE BY SUPERINTENDENT IN OPENING A NEW SET OF BOOKS In case the Superintendent of a hospital or other similar insti- tution is about to adopt this system of accounting and has not already on his books general ledger accounts such as "Bill Ac- count," "Advance Payments by Patients Account," "Over- payments by Patients Account," "General Material Account," "Voucher Account" and "Superintendent's Account with Treas- urer," he may open such accounts by making Journal Entries in about the following form and debiting and crediting his General Ledger Accounts accordingly: September 30, 1907 Superintendent's Cash Account (Cash Book), Dr ' To Superintendent's Account with Treasurer... .Cr For Cash on Hand September 30, 1907, not including Advance Payments by Patients or Overpayments by Patients. September 30, 1907 Superintendent's Cash Account (Cash Book), Dr To Advance Payments by Patients Account.... Cr Account Advance Payments on hand September 30, 1907. 48 ENTRIES BY SUPT. IN OPENING NEW SET OF BOOKS September 30, 1907 Superintendent's Cash Account (Cash Book), Dr To Overpayments by Patients Account, Cr Account Overpayments on hand September 30, 1907. September 30, 1907 Superintendent's Cash Account (Cash Book), Dr To Salaries and Wages Account Cr Account Unclaimed Wages due September 30, 1907. September 30, 1907 Bill Account, Dr To Superintendent's Account with Treasurer.. . .Cr For Accounts Receivable due September 30, 1907. September 30, 1907 General Material Account, Dr To Superintendent's Account with Treasurer Cr For General Material on hand September 30, 1907. September 30, 1907 Superintendent's Account with Treasurer, Dr To Voucher Account Cr For Audited Vouchers Unpaid September 30, 1907. SUPERINTENDENT'S GENERAL LEDGER ACCOUNTS The following examples will illustrate the various Ledger Accounts it has been found necessary to keep in the Superintend- ent's office in the Presbyterian Hospital and the manner in which entries to same are posted. When entries are made to these Ledger Accounts the pages of the books from which they are posted are referred to in each case. 1. SUPERINTENDENT'S CASH ACCOUNT See explanations under heading "Superintendent's Cash Book," page 39. 2. BILL ACCOUNT Dr. Crc *Total from previous month Total from previous month Amount of bills accrued Cash received by Superin- during month (Hospital tendent during month in Earnings, Schedule 1), as payment of Bills rendered shown by Bill Register, in- Patients and including cluding monthly earnings Dispensary, Emergency of Dispensary, Emergency Ward, and other Miscel- Ward, and other Miscel- laneous receipts account laneous Hospital Earnings Hospital Earnings and or Bills accrued, including cash received account Bills for General Material General Material Sold, as sold during month per Cash Book Advance Payments by Pa-- Amounts due accruing dur- tients during month, as ing month or Overpay- per Bill Register ments by Patients paid by Overpayments by Patients Advance Payments of pre- during month, as per Bill vious months, as per Bill Register Register Uncollectible Accounts Re- ceivable charged off dur- ing month, as per Journal Entry 1 Total Total Difference in totals equals "Accounts Receivable." 49 50 SUPERINTENDENT'S LEDGER ACCOUNTS 3. ADVANCE PAYMENTS BY PATIENTS ACCOUNT Dr. Cr. Total from previous month .... t Total from previous month Amounts due accruing dur- Advance Payments by Pa- , ing month or Overpay- tients during month, as ments by Patients paid by per Bill Register Advance Payments of pre- vious months, as per Bill Register Total Total Difference in total equals " Advance Payments by Patients." 4. OVERPAYMENTS BY PATIENTS ACCOUNT Dr. Cr. Total from previous month .... f Total from previous month Overpayments by Patients Overpayments by Patients refunded to them during during month, as per Bill month, as per Cash Book .. Accumulated unclaimed Overpayments by Pa- tients transferred to Su- perintendent's Account with Treasurer, as per .. Register Journal Entry 2 Total Total Difference in totals equals "Overpayments by Patients." 5. SALARIES AND WAGES ACCOUNT Dr. Cb. Total from previous month .... Salaries and Wages paid to employes during the month, as per Cash Book .... fTotal from previous month Amount of Pay-Roll vouch- ers registered during month as per Voucher Accumulated unclaimed wages transferred to Su- perintendent's Account with Treasurer as per Journal Entry No. 5 , Register The balance shown on the credit side indicates amount of "Unclaimed Wages" and should agree with the total amount of unclaimed wages, as shown by the card records referred to on page 30. SUPERINTENDENT'S LEDGER ACCOUNTS 51 6. GENERAL MATERIAL ACCOUNT Dr. Cr. *Total from previous month .... Total from previous month General Material purchased Cost price of General Ma- during month, as per terial sold during month, Voucher Register as per Bill Register (profit Surplus amount of General on sales, if any, having Material found by inven- been credited to Miscel- tory to be on hand, as per laneous Hospital Earn- Journal Entry 3 ings) Loss or depreciation of Gen- eral Material, as shown by inventory, as per Journal Entry 4 Total Total Difference in total equals "General Material on Hand." 7. VOUCHER ACCOUNT Dr. Cr. Total from previous month t Total from previous month Vouchers (not including Pay- Amount of vouchers (not Roll vouchers) paid during including Pay-Roll vouch- month, as per Cash Book ers), registered during month, as per Voucher Register Total Total 8. SUPERINTENDENT'S ACCOUNT WITH TREASURER Difference in totals equals "Audited Vouchers Unpaid." Dr. Cr. * Total from previous month .... Total from previous month Grand Total Current Expen- Amount of bills accrued ses, Schedule 2, during (Hospital Earnings, month, as per Voucher Schedule 1), as shown by Register .. Bill Register, including Capital Expenditures,Sched- monthly earnings of Dis- ule 3, during month, as pensary, Emergency Ward per Voucher Register and Other Miscellaneous Cash received by Superin- Hospital Earnings or bills tendent in payment of accrued during month bills rendered patients Cash received during month and including Dispensary, by Superintendent from Emergency Ward, and Treasurer, as per Cash Other Miscellaneous Re- Book ceipts account Hospital Surplus Amount of General Earnings, and cash re- Material found to be on ceived account General hand, as per Journal En- Material Sold, and re- try 3 mitted to Treasurer dur- Accumulated unclaimed 52 SUPERINTENDENT'S TRIAL BALANCE 8. SUPT'S ACCOUNT WITH TREASURER-Continued Dr. Cr. ing month, as per Cash Overpayments by Patients Book .. to be transferred to Sur- Uncollectible Accounts Re- plus and Deficit Account, ceivable charged off dur- as per Journal Entry 2 ing month, as per Journal Accumulated unclaimed Entry 1 .. wages to be transferred to Loss or Depreciation of Gen- Surplus and Deficit Ac- eral Material charged off count, as per Journal during month, as per Jour- Entry 5 nal Entry 4 Total Total Difference in totals equals balance shown by "Superintendent's Account with Treasurer" and must agree with balance shown in "Treasurer's Account with Superintendent " on the Treasurer's General Ledger. SUPERINTENDENT'S TRIAL BALANCE Between the sixth and eighth of each month, after all entries for the previous month to each Ledger Account have been made, totals footed and balance of each account determined, the Super- intendent makes his Trial Balance in the following form by add- ing the debit and credit balances of these accounts, the totals of which must agree if all entries have been properly made: Cash in hands of Superintendent, including Petty Cash Accounts Receivable General Material on Hand Dr. Cr. Balance shown by Superintendent's Account with Treasurer Advance Payments by Patients for services to be ren- dered Overpayments by Patients for services not rendered and not to be rendered Unclaimed Wages Audited Vouchers Unpaid Totals, which should be equal *At the first of each fiscal year under the headings "Bill Account," "General Material Account," and "Superintendent's Account with Treasurer," the balance shown on the debit side of each account at the end of the previous month should be shown on the debit side only as "Balance at first of Year" instead of "Totals from previous months." tAt the first of each fiscal year under headings " Advance Payments by Patients Account" and "Overpayments by Patients Account," "Salaries and Wages Ac- count," and " Voucher Account," the balance shown on the credit side of each ac- count at the end of the previous month should be shown on the credit side only as "Balance at first of year" instead of "Totals from previous month." MONTHLY REPORT OF SUPERINTENDENT TO TREASURER Between the sixth and eighth of each month the Superintend- ent sends to the Treasurer a report in the form shown on the following page, which is a detailed statement of the "Superin- tendent's Account with Treasurer." The balance as shown by this account, if correct, must agree with the balance of the corresponding ledger account on the books of the Treasurer, entitled "Treasurer's Account with Superin- tendent." This report of the Superintendent also includes a copy of his Trial Balance. SUPERINTENDENT'S MONTHLY STATEMENTS OF REVENUE, EXPENSES, AND STATISTICS In order to enable the Superintendent to complete in his office Detailed Statement of Current Revenue (Schedule 1), it is custom- ary for the Treasurer, about the sixth of each month, to for- ward to the Superintendent the information in regard to details of Current Revenue (Schedule 1) (other than Hospital Earnings) during previous month, as shown by the Treasurer's books. At the Presbyterian Hospital it is customary to have state- ments showing details of Revenue, Expenses and Statistics called for on Schedules 1 to 6 inclusive, for each month, prepared and ready for inspection by the Executive Committee at their meeting on the second Tuesday of the succeeding month. COMPARATIVE MONTH AND TO DATE STATEMENTS A book is also kept showing in comparative form the amount of each of the subdivisions of revenue, expenses, and statistics referred to in Schedules 1, 2, 3 and 6 for each month, and for the period from the first of the fiscal year to the end of each month, during the current and previous years. This record is most useful and interesting and shows clearly and exactly how revenue, expenses and statistics, during the current year, compare in detail by months, and up-to-date, with those of previous years and just where any increases or decreases have occurred. It enables the management to promptly locate any extravagances. This book also facilitates securing promptly after the close of each fiscal year correct totals for that year of the details called for by the Schedules. 53 Dr. Cr. Total from previous month Grand Total Current Expenses (Schedule 2) during month, as per Voucher Register Capital Expenditures (Schedule 3) during month. (Show expenditures for each account separately) Total Capital Expenditures (Schedule 3) during month, as per Voucher Register Cash remitted to Treasurer during month, as per Cash Book, account Hospital Earnings and General Material sold Loss or Depreciation of General Material charged off as per Journal Entry 4 Uncollectible Accounts Receivable charged off as per Journal Entry 1. Total from previous month Hospital Earnings (Schedule 1) during month, as per Bill Register.. fAccumulated unclaimed Overpayments by Patients to be trans- ferred to Surplus and Deficit Account, as per Journal Entry 2.... fAccumulated Unclaimed Wages to be transferred to Surplus and Deficit Account as per Journal Entry 5 Cash received by Superintendent from Treasurer during month, as per Cash Book Surplus amount of General Material found to be on hand, as per Jour- nal Entry 3 Balance as shown by Superintendent's Account with Treasurer *Grand Total *Grand Total *Grand Totals must agree. fThese entries would ordinarily be used only at the close of each fiscal year. Current Expenses from Special Funds during month SUPERINTENDENT'S TRIAL BALANCE AT END OF MONTH Dr. Cr. (Show expenditures from each Fund separately) Cash on hand, including Petty Cash Accounts Receivable General Material on hand Superintendent's Account with Treasurer Advance payments by Patients Overpayments by Patients Unclaimed Wages Audited Vouchers Unpaid - Total Totals, which must agree REPORT OF SUPERINTENDENT TO TREASURER FOR MONTH OF 54 TREASURER'S ACCOUNTS The following paragraphs describe the various books used in the Treasurer's office of the Presbyterian Hospital and the manner in which entries are made to the accounts referred to. All Donations to the Presbyterian Hospital are paid direct to the Treasurer and are acknowledged by him and put through his accounts and do not appear in the Superintendent's Accounts. TREASURER'S CASH BOOK A Cash Book ruled in the ordinary manner is suitable for use in the Treasurer's office, if, as is the case at the Presbyterian Hos- pital, he receives and makes comparatively few payments during the month under this system of accounting. If Unrestricted Donations received are numerous it is advisable for the Treas- urer to keep a record of these in a separate book and enter only the total amount of Unrestricted Donations received during each month in his Cash Book, at the end of such month, or more fre- quently if desired. All cash received is entered in detail on the debit side of the Cash Book and must be credited to some General Ledger account and may, in some cases, as explained later, also be credited to any Income Ledger account concerned. All cash paid out, as shown by the stubs of the Treasurer's Check Book, is entered in detail on the credit side of the Cash Book and must be debited to some General Ledger account and may, in some cases, also be debited to any Income Ledger account concerned. All Payments made by the Treasurer are by check. Reference is made on the Cash Book to show the page of the General or Income Ledger to which each account is posted. It is customary at the Presbyterian Hospital for the purpose of simplifying accounts to pay all expenses of the Treasurer's office, which come under the headings "Corporation Expenses" or "Current Expenses from Special Funds for Stated Purposes" (Schedule 2), by voucher through the Superintendent's office. All appropriations from Special Funds to meet Current Expenses on account of such Funds are included in the remittances by check made by the Treasurer to the Superintendent described on page 41. Taxes and other current expenses than petty current expenses and Capital Expenditures on account of property held as invest- 55 56 TREASURER'S CASH BOOK ment and not used for hospital purposes are ordinarily paid direct by check by the Treasurer and debited to the proper income or investment account, but if there is no income from the invest- ment, it may be found preferable to pay current expenses and taxes on such investment by Superintendent's voucher and charge same as a part of Corporation Expenses. The total amount of cash on hand at first of month and all cash received during the month as shown on the debit side of the Cash Book, including Donations received, less the total of all cash paid out during the month, as shown on the credit side of Cash Book should at any time equal the amount of Cash in hands of Treasurer. As there may not be very many entries on the Treasurer's Cash Book during the month, which are to be debited or credited to the same accounts, it will probably not be worth while at the end of the month to make any further recapitulation of cash received or cash paid out, but postings can be made direct from the original entries in the Cash Book, with the understanding, however, that the total only of all items to be posted to the same ledger account may be posted in a lump sum. AT THE END OF EACH MONTH CASH PAID OUT BY TREAS- THE TOTAL AMOUNT OF CASH PAID DURING MONTH FOR EACH OF THE ACCOUNTS IN- DICATED MAY BE DEBITED URER DURING MONTH MAY RESPECTIVELY DIRECT TO CONSIST MOSTLY OF THE THE FOLLOWING GENERAL FOLLOWING: LEDGER ACCOUNTS: Cash paid to Superintendent To Treasurer's Account with Superin- tendent. Investments Purchased, not including Interest Purchased To "Bonds Account," "Mortgages Interest Purchased Receivable Account," "Stocks Ac- count" or Other Investment Account concerned. To Interest Purchased Account. Loans and Notes Receivable made.... To Loans and Notes Receivable Ac- Loans and Notes Payable paid count. To Loans and Notes Payable Account. Mortgages Payable paid To Mortgages Payable Account. Insurance Prepaid To Prepaid Insurance Account. Cash paid account taxes or other than petty current expenses on account of Investments To Proper Income or Investment Other Miscellaneous payments Account. To proper account. TREASURER'S CASH BOOK 57 AT THE END OF EACH MONTH THE TOTAL AMOUNT OF CASH RECEIVED DURING MONTH FROM EACH OF THE SOURCES INDICATED MAY BE CREDITED CASH RECEIVED BY TREASURER DURING MONTH RESPECTIVELY DIRECT TO THE FOLLOWING GENERAL MAY CONSIST MOSTLY OF THE FOLLOWING: LEDGER ACCOUNTS: Cash received from Superintendent . Treasurer's Account with Superintendent. Donations, Unrestricted Donations Unrestricted Account. Legacies, Unrestricted , Legacies Unrestricted Account. Income from Investments held in Endowed Bed Fund . Income from Investments held in Endowed Bed Fund Account. Income from Investments held in General Endowment Fund , Income from Investments held in General Endowment Fund Account. Income from Investments held in Other Funds (enumerate sepa- rately) the income of which is to be used to meet general current expenses , Income from Investments held in Other Fund Accounts (treat each separately). Income from Unrestricted Investments not held in any Reserve Fund . Income from Unrestricted Investments Account. Other Miscellaneous Revenue or Income . To proper account. Cash received account sale of any Hospital Properties and Equip ment, or Cash received from Insurance Companies account damage by fire To the proper subdivision Account of Hospital Properties and Equipment, Schedule 4, to which it belongs. To the Investment Account to which it belongs, "Stocks Account," Cash received account sale of any Investment "Bonds Account," "Mortgages Receivable Account," etc. Cash received account Loans or Notes Payable .To Loans and Notes Payable Account. Cash received account Loans or Notes Receivable .To Loans and Notes Receivable Account. Cash received account Treasurer's Accounts Receivable .To Accounts Receivable Account. Cash received account Interest Purchased . To Interest Purchased Account. Cash received account Prepaid Insurance .To Prepaid Insurance Account. Cash received account Endowed Bed Fund . To Endowed Bed Fund Account. Cash received account Partly Endowed Bed Fund . To Partly Endowed Bed Fund Account. Cash received account General Endowment Fund . To General Endowment Fund Account. Cash received account Any other Fund Reserve . To Proper Reserve Fund Account. Cash received from some other source or account .To Proper Account. 58 TREASURER'S JOURNAL ENTRIES At the Presbyterian Hospital it has not been found necessary for the Treasurer to keep any Cash Account on his General Ledger, as the Cash Book itself answers that purpose. TREASURER'S JOURNAL As it is necessary for the Treasurer to debit or credit to his General Ledger Accounts or to his Income Ledger Accounts items which are not cash transactions, and which are not posted direct from his Cash Book, it is necessary for him to make use of a Jour- nal, wherein he records for reference first the account to which each item is debited and then the account to which such item is credited, and also notes further information desirable regarding details. When postings are made from Journal Entries to General Led- ger Accounts or to Income Ledger Accounts, proper notations should be made on the Journal to show the pages of the ledgers to which each item is posted and proper reference should be made in each of these ledger accounts to the page of the journal from which each posting is made. Samples of such Journal Entries are as follows: 1. Treasurer's Account with Superintendent, Dr To Hospital Earnings Account Cr September 30, 1907 Amount of bills accrued during month (Hospital Earnings, Schedule 1), as shown by Bill Register; including monthly earnings of Dispensary, Emergency Ward, and other Miscellaneous Hospital Earnings, as reported by Superintendent to Treasurer. September 30, 1907 2. Treasurer's Account with Superintendent, Dr To Surplus and Deficit Account Cr Surplus Amount of General Material found by inventory to be on hand, as reported by Superintendent. Unclaimed Overpayments by Patients, not liable to be claimed, remitted by Superintendent to Treasurer. Unclaimed Wages, not liable to be claimed, remitted by Superintendent to Treasurer. September 30, 1907 3. Surplus and Deficit Account Dr To Treasurer's Account with Superintendent.... Cr Grand Total Current Expenses (Schedule 2), during month, as per Voucher Register, as reported by Superintendent. TREASURER'S JOURNAL ENTRIES 59 And Total Capital Expenditures (Schedule 3), during month, as per Voucher Register. (Show amount for each account separately, as reported by Superintend- ent, see page 54.) And Superintendent's Uncollectible Accounts Receivable charged off during month, as reported by Superintendent. And Loss or Depreciation of General Material charged off, as reported by Superintendent. September 30, 1907 4. Grand Total Current Revenue for month (Schedule 1) consisting of: Hospital Earnings Account Dr And Donations, Unrestricted Account... .Dr And Legacies, Unrestricted Account Dr And Income from Investments held in Endowed Bed Fund Account Dr And Income from Investments held in General En- dowment Fund Account Dr And Income from Investments held in Other Fund Accounts (enumerate) Dr (The income of which is to be used to meet Operat- ing Expenses (Schedule 2), and is not to be added to the principal.) And Income from Unrestricted Investments Ac- count Dr And Appropriations from Special Funds to meet Current Expenses Account Dr (Enumerate each separately.) And any other accounts, composing Grand Total Current Revenue for month Dr To Surplus and Deficit Account Cr For amounts transferred from such accounts to Surplus and Deficit Account. September 30, 1907 5. Sites and Grounds Account Dr Or Buildings Account Dr Or Furniture and Fixtures Account Dr Or Machinery and Tools Account Dr Or Apparatus and Instruments Account. .Dr Or Ambulances, Live Stock, etc., Account.Dr Whichever account is concerned. To Capital Account (Hospital Properties and Equipment) Cr For Capital Expenditures for such accounts during month (Schedule 3), as per Voucher Register, as reported by Superintendent. Value of gifts in shape of Hospital Properties and Equipment (Schedule 4), received during month, if capitalized. 60 TREASURER'S JOURNAL ENTRIES September 30, 1907 6. Sites and Grounds Account Dr Or Buildings Account Dr Or Other Hospital Properties and Equipment Ac- counts (Schedule 4) Dr To Surplus and Deficit Account Cr .... For profit on sale of such property. (Give details.) September 30, 1907 7. Capital Account (Hospital Properties and Equip- ment) Dr... To Sites and Grounds Account Cr Or Buildings Account Cr Or Furniture and Fixtures Account Cr Or Machinery and Tools Account Cr Or Apparatus and Instruments Account Cr Or Ambulances, Live Stock, etc., Account Cr Whichever account is concerned. For actual net loss or damage account sale, fire or demolition, etc., of Hospital Properties and Equipment (Schedule 4) during month, if not covered by Reserve for Depreciation. If any Reserve for Depreciation has been established covering part of the book value of the property, which has been lost or damaged, it would be preferable to use Journal Entry 22 as regards that part of the actual net loss or damage that is covered by a Reserve for Depreciation. September 30, 1907 8. Bonds Account Dr Or Stocks Account Dr Or Other Investments Accounts Dr To Surplus and Deficit Account Cr For Profit on Bonds, Stocks or Other Investments sold during month as per Income Ledger. (Give details.) See pages 83 and 85. September 30, 1907 9. Mortgages Receivable Account Dr Or Bonds Account Dr Or Stocks Account Dr Or Other Investments Accounts Dr To General Endowment Fund Account.. Cr Or Other Fund Accounts Cr Value of "Mortgages Receivable," "Bonds" (not including interest accrued), "Stocks," or "Other Investments" Restricted given to these Reserve Fund Ac- counts during month. (Give full details.) TREASURER'S JOURNAL ENTRIES 61 September 30, 1907 10. Surplus and Deficit Account Dr To Mortgages Receivable Account Cr Or Bonds Account Cr Or Stocks Account Cr Or Other Investments Accounts Cr Or Loans and Notes Receivable Account. .Cr Whichever account is concerned. Loss or Depreciation charged off during month. Loss on sale of Bonds, Stocks or Other Investments during month as per Income Ledger. (Give details.) See pages 84 and 86. September 30, 1907 11. Partly Endowed Bed Fund Dr To Endowed Bed Fund Cr Amounts transferred to Endowed Bed Fund from Partly Endowed Bed Fund, account completion of such Endowments during month. (Give details.) September 30, 1907 12. Endowed Bed Fund Account Dr Or Partly Endowed Bed Fund Account .Dr Or General Endowment Fund Account. .Dr Or Other Fund Reserve Account Dr To Surplus and Deficit Account Cr Amount charged off such accounts and credited to Surplus and Deficit Account during month, account liability of Hospital having ceased. (Give details.) September 30, 1907 13. Loans and Notes Payable Account Dr To Loans and Notes Payable Account Cr For Loans and Notes Payable renewed during month, by signing of new notes and cancellation of old notes, where it is desired to avoid the necessity of exchanging checks. September 30, 1907 14. Mortgages Receivable Account Dr Or Bonds Account Dr Or Stocks Account Dr Or any Other Investment Account Dr To Donations, Unrestricted Account Cr Or To Legacies, Unrestricted Account Cr For Value of Mortgages Receivable, Bonds, Stocks, or Other Investments unrestricted, not including accrued interest, given to Hospital during month. (Give details.) 62 TREASURER'S JOURNAL ENTRIES September 30, 1907 15. Mortgages Receivable Account Dr.... To Investment Account Concerned.. .Cr Value of Mortgages Receivable received during month in full or part payment for property sold. September 30, 1907 16. Surplus and Deficit Account Dr To Treasurer's Accounts Receivable Cr For Uncollectible Treasurer's Accounts Receivable charged off during month. (Give details.) September 30, 1907 17. Sites and Grounds Account Dr Or Buildings Account Dr . Or Other Hospital Properties and Equipment Accounts (Schedule 4) Dr To Capital Account (Hospital Properties and Equipment) Cr .... For Appreciation in value of such property. (Give details.) September 30, 1907 18. Treasurer's Accounts Receivable Account. Dr.. To Income from Investments held in any account concerned Cr Or To any Reserve Fund Account con- cerned Cr Or to any Other Revenue or Income Ac- count (Schedule 1), concerned Cr For amounts accrued and due during month and unpaid. (Give details.) September 30, 1907 19. Capital Account (Hospital Properties and Equip- ment) Dr To Surplus and Deficit Account Cr For Book Value of "Sites and Grounds," "Buildings," "Furniture and Fixtures," "Machinery and Tools," "Apparatus and Instruments," "Ambu- lances, Live Stock, etc.," or other "Hospital Properties and Equipment," Schedule 4, sold during the month, or for amount collected during month from insurance companies for such properties damaged or destroyed by fire, as shown by Treas- urer's Cash Book, and as already posted from the Treasurer's Cash Book direct or by Journal Entry to the credit side of each particular ledger account of the sub- division of "Hospital Properties and Equipment" concerned. TREASURER'S JOURNAL ENTRIES 63 September 30, 1907 20. Capital Account (Hospital Properties and Equip- ment) Dr To Reserve for Depreciation of Hospital Properties and Equipment Cr .... For estimated accrued depreciation during the year ending September 30, 1907, as follows: Buildings (from 1J^ to 3%) Furniture and Fixtures ( " 2 " 5%) Machinery and Tools ( " 3 " 10%) Apparatus and Instruments ( " 3 " 10%) Ambulances, Live Stock, etc. ( " 5 " 10%) (of book values) (usually at rate of) September 30, 1907 21. Reserve for Depreciation of Hospital Properties and Equipment Dr To Capital Account (Hospital Properties and Equipment) Cr For extraordinary repairs or renewals made during month to Buildings, Furni- ture and Fixtures, Machinery and Tools or any other Hospital Properties and Equipment, Schedule 4, which may be chargeable to Reserve for Depreciation and to cover which sufficient Reserve for Depreciation on the property concerned has been established. September 30, 1907 22. Reserve for Depreciation Dr To Site and Grounds Account Cr Or Buildings Account Cr Or Furniture and Fixtures Account Cr Or Machinery and Tools Account Cr Or Apparatus and Instruments Account. Cr Or Ambulances, Live Stock, etc., Account.Cr Whichever account is concerned. For actual net loss or damage account sale, fire or demolition, etc., of Hospital Properties and Equipment (Schedule 4) during month, which is covered by Reserve for Depreciation. (See note under Journal Entry 7.) ENTRIES TO BE MADE BY TREASURER IN OPENING A NEW SET OF BOOKS In case the Treasurer of a hospital or other similar institution is about to adopt this system of accounting and has not already on his books General Ledger Accounts, such as "Bonds Account," "Mortgages Receivable Account," "Stocks Account," "Other Investment Accounts" or other asset ledger accounts showing respectively the various kinds and book values of Bonds, Mort- gages Receivable, Stocks, Other Investments, or other assets on hand, he may open such accounts on his new General Ledger by making suitable entries, to proper accounts to which such assets are debited and credited, as shown for instance by the following sample Journal Entries: Bonds Account Dr To Endowed Bed Fund Cr September 30, 1907 For the following bonds on hand September 30, 1907, if held in Endowed Bed Fund. (Give list of bonds in detail and book value of each, to be inserted in Journal Entry and in "Bonds Account" on ledger.) September 30, 1907 Stocks Account Dr To any Special Fund Account Cr For the following stocks on hand September 30, 1907, if held in such Special Fund. (Give list of stocks in detail and book value of each, to be inserted in Journal Entry and in "Stocks Account" on ledger.) September 30, 1907 Mortgages Receivable Account Dr To Surplus and Deficit Account Cr For the following Mortgages Receivable on hand September 30, 1907, if un- restricted and not held in any Reserve Fund. (Give list of Mortgages Receivable in detail and book value of each, to be inserted in Journal Entry and in "Mortgages Receivable Account" on ledger.) September 30, 1907 Accounts Receivable Account Dr To Surplus and Deficit Account Cr For Accounts Receivable due September 30, 1907. (Give details.) 64 TREASURER'S JOURNAL ENTRIES 65 September 30, 1907 Surplus and Deficit Account Dr To General Endowment Fund Account. .Cr Or To any other Reserve Fund Account. Cr For amount of such Restricted Funds to offset which no Investments or other Assets are held. September 30, 1907 Sites and Grounds Account Dr Or Buildings Account Dr Or Furniture and Fixtures Account Dr Or Machinery and Tools Account Dr Or Apparatus and Instruments Account .Dr Or Ambulances, Live Stock, etc., Account.Dr .... To Capital Account (Hospital Properties and Equipment) Cr For the following Sites and Grounds (Give book values) Or Buildings " Or Furniture and Fixtures " " " Or Machinery and Tools " " " Or Apparatus and Instruments " " " Or Ambulances, Live Stock, etc " " " Owned by the Institution September 30, 1907. Likewise in opening a new set of books if it is necessary for the Treasurer to open new General Ledger Accounts to show Liabili- ties already existing, such as "Mortgages Payable" or "Loans and Notes Payable," etc., Journal Entries showing to what ac- counts such items are debited and credited might be made as follows: September 30, 1907 Surplus and Deficit Account Dr To Mortgages Payable Account Cr Or To Loans and Notes Payable Account. Cr For Mortgages Payable, (List in detail) Or For Loans or Notes Payable, (List in detail) existing as a liability September 30, 1907. In order to open the "Treasurer's Account with Superintend- ent" the following journal Entry would be made: Treasurer's Account with Superintendent..Dr To Surplus and Deficit Account Cr For Cash advanced to Superintendent September 30, 1907. September 30, 1907 TREASURER'S GENERAL LEDGER ACCOUNTS In the Treasurer's office General Ledger Accounts are kept with the Superintendent; also for Hospital Earnings and for each of the other subdivisions shown under the general heading of Other Revenue or Income on Schedule 1, and for each of the headings shown on Schedule 4, except those shown in the Super- intendent's Trial Balance heretofore mentioned. It will be found convenient at large hospitals to have the Treasurer's General Ledger in loose leaf form, with lock, as in that style of ledger, accounts can be at all times kept in the order desired and when new accounts are opened the new ledger sheet can be inserted in its proper place. Considerable time and labor will thus be saved in posting, or in referring to the different ac- counts when desired and the ledger will not be unnecessarily large or heavy. If a loose leaf Treasurer's General Ledger is used, for the same reasons it will also be found convenient to have a loose leaf Treas- urer's Income Ledger, referred to on page 80, and to include this Income Ledger in the same binder in which the Treasurer's General Ledger Accounts are bound. The following illustrations will show how entries are made to these General Ledger Accounts: 1. TREASURER'S CASH ACCOUNT See explanations under heading "Treasurer's Cash Book," page 58 2. TREASURER'S ACCOUNT WITH SUPERINTENDENT Dr. Cr. Total from previous month §Total from previous month Amount of bills accrued Grand Total Current Ex- (Hospital Earnings, penses, Schedule 2, during Schedule 1), as shown month, as per Voucher by Bill Register, includ- Register, as reported by ing monthly earnings of Superintendent and as per Dispensary, Emergency Journal Entry 3 Ward and other miscella- Total Capital Expenditures, neous Hospital Earnings Schedule 3, during month or bills accrued during as per Voucher Register, 66 TREASURER'S GENERAL LEDGER ACCOUNTS 67 2. TREASURER'S ACCOUNT WITH SUPERINTENDENT-Continued Dr. Cr. month, as reported by as reported by Superin- Superintendent, as per tendent, as per Journal Journal Entry 1 Entry 3 Cash paid to Superintendent Cash received by Treasurer during month, as per from Superintendent dur- Treasurer's Cash Book ing month, as per Treas- Surplus Amount of General urer's Cash Book Material found to be on Uncollectible Accounts Re- hand during month, as re- ceivable charged off dur- ported by Superintendent, ing month, as reported by as per Journal Entry 2 Superintendent, as per Unclaimed overpayments Journal Entry 3 by Patients credited to Loss or Depreciation of Surplus and Deficit Ac- General Material charged count, as per Journal En- off during month, as re- try 2 ported by Superintendent, Unclaimed Wages credited to Surplus and Deficit Ac- count, as per Journal En- try 2 as per Journal Entry 3 Total Total Difference in totals equals balance shown by "Treasurer's Account with Super- intendent," and must agree with balance shown by "Superintendent's Account with Treasurer" on the Superintendent's General Ledger. 3. HOSPITAL EA1 ININGS ACCOUNT Dr. Cr. Total from previous month Total from previous month Amount of Hospital Earn- Amount of bills accrued ings. Schedule 1, trans- (Hospital Earnings, ferred to Surplus and Schedule 1), as shown Deficit Account, as per by Bill Register, includ- Journal Entry 4 ing monthly earnings of Dispensary, Emergency Ward, and other Miscel- laneous Hospital Earn- ings or bills accrued dur- ing month, as reported by Superintendent, as per Journal Entry 1 Total Total This account will balance monthly. 68 TREASURER'S GENERAL LEDGER ACCOUNTS 4. DONATIONS, UNRESTRICTED ACCOUNT Dr. Cr. Total from previous month Total from previous month Amount of Unrestricted Amount of Unrestricted Do- Donations transferred to nations received during Surplus and Deficit Ac- month, as per Treasurer's count, as per Journal En- Cash Book try 4 Value of "Mortgages Re- ceivable" or "Bonds" or "Stocks," or "Other In- vestments " unrestricted given to Hospital during month, as per Journal Entry 14 Total Total This account will balance monthly, Ledger Accounts of "Legacies, Unrestricted Account" may be treated in the same manner as "Donations, Unrestricted Account." ENDOWMENT FUND Dr. Cr. Total from previous month Total from previous month Taxes or other than petty Cash received during month current expenses, if any. account Income from In- charged directly against vestments held in this ac- income from this invest- count, as per Treasurer's ment, as per Treasurer's Cash Book Cash Book Amount of Income from In- Net Income during month vestments held in this from Investments held in Account accrued and due this account transferred during month and unpaid to Surplus and Deficit and transferred to "Ac- Account, as per Journal counts Receivable," as Entry 4 per Journal Entry 18 Total. Total 5. INCOME FROM INVESTMENTS HELD IN GENERAL This account will balance monthly. The General Ledger Accounts "Income from Investments held in Endowed Bed Fund Account" or "Income from Investments held in any other Fund Ac- count" (Income only of which is to be used to meet Current Expenses, and is not to be added to the principal) or " Income from Unrestricted Investments Account " or Other Miscellaneous Revenue Accounts should be treated in a similar manner to some of those described above. The amount of monthly Income from Investments held in Endowed Bed Fund, General Endowment Fund or any other Fund, the income only of which is to be used to meet Current TREASURER'S GENERAL LEDGER ACCOUNTS 69 Expenses, is also shown by the Treasurer's Income Ledger Ac- counts of such funds, as described on pages 88 and 89, and should agree with amounts of Income from Investments held in such Funds, as shown on the respective General Ledger Accounts. Dr. Cr. *TotaI from previous month Total from previous month Capital Expenditures on this Sites and Grounds sold dur- account during month, as ing month, as per Treas- per Voucher Register, as urer's Cash Book reported by Superintend- Depreciation or Loss ent, as per Journal En- charged off during month. try 5 and credited to this ac- Value of Sites and Grounds count, as per Journal En- given to Hospital during try 7 month, if capitalized, as per Journal Entry 5 For Appreciation in value of Sites and Grounds, as per Journal Entry 17 For Profit on Sale of Sites and Grounds, as per Jour- nal Entry 6 Total Total 6. SITES AND GROUNDS ACCOUNT Difference in totals equals value of "Sites and Grounds," as shown on Books and on Balance Sheet. 7. BUILDINGS ACCOUNT Dr. Cr. *TotaI from previous month Total from previous month Capital Expenditures on this Buildings sold during account during month, as month, as per Treasurer's per Voucher Register, as re- Cash Book ported by Superintendent, Cash received during month as per Journal Entry 5 from Insurance Com- Value of Buildings given to panies in settlement of fire Hospital during month, if loss, as per Treasurer's capitalized, as per Journal Cash Book Entry 5 Actual Net Loss or Damage For Appreciation in value of caused by sale, fire or de- Buildings, as per Journal molition, charged off dur- Entry 17 ing month and credited For Profit on Sale of Build- to this account, as per ings, as per Journal Entry Journal Entry 7 or 22 6 Total Total Difference in totals equals value of "Buildings," as shown on Books and on Balance Sheet. 70 TREASURER'S GENERAL LEDGER ACCOUNTS Note-The Ledger Accounts "Furniture and Fixtures Account," "Machinery and Tools Account," "Apparatus and Instruments Account," "Ambulances, Live Stock, etc.. Account" or any other accounts belonging to Hospital Properties and Equipment (Schedule 4), should be worded in manner similar to "Sites and Grounds Account," and "Buildings Account," as shown above. 8. MORTGAGES RECEIVABLE ACCOUNT Dr. Cr. *Total from previous month Total from previous month Mortgages Receivable pur- Mortgages receivable sold chased during month, not or paid off during month including accrued interest (enumerate), as per Treas- (enumerate), as per Treas- urer's Cash Book urer's Cash Book Loss or Depreciation charged Value of Mortgages Receiv- off during month and able unrestricted given to credited to this account, Hospital during month (enumerate), as per Jour- as per Journal Entry 10 nal Entry 14 Value of Mortgages Receiv- able restricted given to Hospital during month (enumerate), as per Jour- nal Entry 9 Value of Mortgages Receiv- able received during month in full or part pay- ment for property sold, as per Journal Entry 15 .... Total Total Difference in totals equals amount of "Mortgages Receivable," as shown on Books and on Balance Sheet. "Loans and Notes Receivable" made or paid off are treated in a General Ledger Account in the same manner as Mortgages Receivable purchased or paid off. Dr. Cr. *Total from previous month .... Total from previous month Bonds purchased during Bonds sold during month month, not including ac- (enumerate), as per Treas- crued interest (enumer- urer's Cash Book ate), as per Treasurer's Loss or Depreciation charged Cash Book off during month credited Value of Bonds unrestricted, to this account, as per not including accrued in- Journal Entry 10 terest, given to Hospital Loss on sale of Bonds during during month (enumer- month, as per Journal ate), as per Journal Entry 14 Entry 10 9. BONDS ACCOUNT TREASURER'S GENERAL LEDGER ACCOUNTS 71 9. BONDS ACCOUNT-Continued Dr. Cr. Value of Bonds restricted, not including accrued in- terest, given to Hospital during month (enumer- ate), as per Journal Entry 9 Profit on bonds sold during month, as per Journal En- try 8 Total Total Difference in totals equals amount of " Bonds," as shown on Books and on Balance Sheet. Note-The Ledger Account of "Stocks Account" (Schedule 4), should be worded in a manner similar to "Bonds Account," as shown above. For Other Miscellaneous Investments it will be found advisable to keep a separate General Ledger Account in each case, to which capital expenditures on account of such investments should be debited and capital receipts credited. For instance, if the investment were in the form of an unoccu- pied dwelling house, not producing any revenue, the General Ledger Account for same might be treated in the following manner: 10. DWELLING HOUSE, UNFURNISHED, AND LOT, 900 EAST 70th ST., N. Y. Dr. Cr. Value of property, unre- Loss or Depreciation charged stricted given to Hospital off during month, as per during month, as per Journal Entry 10 Journal Entry 14 Cash received during month Taxes and other than petty in full or part payment current expenses during account sale of this prop- month, which may be erty, as per Treasurer's charged to this Account Cash Book (if there is no income Value of Mortgages Re- from this investment), ceivable received during as per Treasurer's Cash month in full or part pay- Book ment account sale of this Profit on property sold dur- property, as per Journal ing month, as per Journal Entry 15 Entry 8 Loss on property sold dur- ing month, as per Journal Entry 10 Total Total 72 TREASURER'S GENERAL LEDGER ACCOUNTS If all of this property is sold the totals as shown above should agree. If a part only or none of this property is sold, the balance on the debit side of this account will show the book value of the remaining property at any time. 11. TREASURER'S ACCOUNTS RECEIVABLE ACCOUNT Dr. Cr- Total from previous month Total from previous month Amounts accrued and due Cash received during month during month and unpaid. account Treasurer's Ac- as per Journal Entry 18 counts Receivable, as per Treasurer's Cash Book Uncollectible Treasurer's Accounts Receivable charged off during month, as per Journal Entry 16 Total Total Difference in totals equals "Treasurer's Accounts Receivable," as shown on Books and on Balance Sheet. 12. INTEREST PURCHASED ACCOUNT Dr. Cr. *Total from previous month Total from previous month Accrued Interest Purchased Cash received account In- during month when Mort- terest Purchased collected. gages Receivable, Bonds, as per Treasurer's Cash etc., are purchased, as per Book Treasurer's Cash Book Total Total Difference in totals equals "Interest Purchased," as shown on Books and on Balance Sheet. Dr. Cr. *Total from previous month Total from previous month Insurance prepaid during month, as per Treasurer's Cash Book Cash received from Super- intendent during month to pay for Insurance Total charged to Current Ex- penses, which had pre- viously been prepaid, as per Treasurer's Cash Book Total 13. PREPAID INSURANCE ACCOUNT Difference in totals equals "Prepaid Insurance," as shown on Books and on Balance Sheet. TREASURER'S GENERAL LEDGER ACCOUNTS 73 APPORTIONING INSURANCE CHARGES When large bills for insurance of various kinds are rendered they should, when approved, be paid direct by Treasurer's check. Amounts so paid should be entered on the credit side of the Treasurer's Cash Book and should be debited to Prepaid Insurance Account. The Treasurer should keep in his office and also furnish to the Superintendent a statement showing how much of any prepaid insurance is properly chargeable each month to current expenses, so that each month the Superintendent can make a voucher in favor of the Treasurer for such an amount accordingly and thus include the proper charge in current expenses. When the Treasurer receives the Superintendent's voucher check he debits his cash account and credits Pre- paid Insurance Account accordingly. If original bills for certain kinds of insur- ance are very small it may be thought best to pay these direct by voucher through the Superintendent's office and not apportion the charges over a series of months during which the insurance is in effect. 14. CAPITAL ACCOUNT (HOSPITAL PROPERTIES AND EQUIPMENT) Dr. Cr. Actual Net Loss or Damage § Total from previous month account sale, fire or demo- Capital Expenditures, lition, charged off Hos- Schedule 3, during month, pital Properties and as per Voucher Register, Equipment, Schedule 4, as reported by Superin- during month and cred- tendent, as per Journal ited to proper accounts Entry 5 on Treasurer's General Value of gifts in shape of Ledger, as per Journal "Hospital Properties and Entry 7 Equipment," Schedule 4, Book Value of "Sites given to Hospital during and Grounds," " Build- month, if capitalized, and ings," "Furniture and debited to proper account Fixtures, " " Machinery on Treasurer's General and Tools," "Apparatus Ledger, as per Journal and Instruments," "Am- Entry 5 bulances. Live Stock, Appreciation in value of etc.," or other "Hospital "Sites and Grounds," Properties and Equip- "Buildings," or other ment," Schedule 4, sold Hospital Properties and during the month, or for Equipment as per Jour- amount collected during nal Entry 17 month from insurance companies for such prop- erties damaged or de- stroyed by fire, as per Journal Entry 19 Total. Total Difference in totals equals " Capital Account " (Hospital Properties and Equip- ment), as shown on Books and on Balance Sheet. 74 TREASURER'S GENERAL LEDGER ACCOUNTS Note-"Capital Account" ("Hospital Properties and Equipment") may be considered as practically a subdivision of "Surplus and Deficit Account." The balance standing to the credit of "Capital Account" is really a part of the surplus of the hospital. "Capital Account," which represents the book value of the hospital's equity in its working plant, plus "Reserve for Depreciation of Hospital Properties and Equipment," if any such account is established, plus bonds outstanding or mort- gages payable on Hospital Property, if any, should equal the total book value of the assets of the hospital, which compose its working plant or Hospital Properties and Equipment, Schedule 4, such as "Sites and Grounds," "Buildings," "Furni- ture and Fixtures," "Machinery and Tools," "Apparatus and Instruments" and " Ambulances, Live Stock, etc." By keeping this "Capital Account" (Hospital Properties and Equipment) out of "Surplus and Deficit Account" as here indicated, the amount of the deficit, if any, up to the amount of the Reserve Fund Accounts, as shown by the " Surplus and Deficit Account, " will represent the exact amount which the Reserve Funds of the Hospital have been encroached upon. The amount of surplus, if any, as shown by the "Surplus and Deficit Account, " will represent the amount of surplus, which the hospital may have to its credit, not including the equity the hospital may have in its working plant or Hospital Properties and Equipment. RESERVE FOR DEPRECIATION OF HOSPITAL PROPERTIES AND EQUIPMENT In case it is desired to establish a "Reserve for Depreciation of Hospital Prop- erties and Equipment" (without disturbing the cost values and without reducing book values below the values at which such properties may be insured) to show the estimated amount of depreciation or deferred up-keep on "Buildings," "Furniture and Fixtures," "Machinery and Tools" or on other Hospital Properties and Equip- ment, Schedule 4, the amounts of this estimated depreciation may at the end of each fiscal year be debited to "Capital Account" and credited to "Reserve for Depreciation of Hospital Properties and Equipment" by a journal entry similar to No. 20. This "Reserve for Depreciation" would practically be a subdivision of "Sur- plus and Deficit Account" and the balance on the credit side of this account would represent a part of the surplus of the hospital. In case there is actual net loss or damage caused by sale, fire or by demolition, etc., not covered by insurance, to any of the subdivisions of Hospital Properties and Equipment, Schedule 4, and if it is desired to charge such part of this net loss or damage as may be covered by the "Reserve for Depreciation" to such Depre- ciation Account this may be done by Journal Entry 22. In case extraordinary repairs or renewals are made to any of the subdivisions of Hospital Properties and Equipment, Schedule 4, and if it is desired to charge such part of such expenditures as may be covered by the Reserve for Depreciation, to such Depreciation Account this may be done by Journal Entry 21. If a Fund for Depreciation of Hospital Properties and Equipment, as outlined above, is established, one-twelfth of the estimated amount of yearly depreciation TREASURER'S GENERAL LEDGER ACCOUNTS 75 of Hospital Properties and Equipment might very properly be added to the actual monthly Operating Expenses, Schedule 2, in order to ascertain the full cost of running the Hospital and to figure the full cost per patient per day (not including Corporation Expenses or Special Fund Expenses). 15. RESERVE FOR DEPRECIATION OF HOSPITAL PROPERTIES AND For actual net loss or dam- Balance Estimated Depre- age by sale, fire or demoli- ciation from previous year tion, etc., charged off Buildings Account Hospital Properties and Furniture and Fixtures Ac- Equipment referred to count during month, as per Jour- Machinery and Tools Ac- nal Entry 22 count Buildings Apparatus and Instruments Furniture and Fixtures Account Machinery and Tools Ambulances, Live Stock, Apparatus and Instruments etc., Account Ambulances, Live Stock, etc Total Total For extraordinary repairs or Estimated depreciation ac- renewals made during crued during year ending month charged to Depre- as per Journal En- ciation Account, as per try No. 20 Journal Entry No. 21 Buildings Account Buildings Furniture and Fixtures Ac- Furniture and Fixtures count Machinery and Tools Machinery and Tools Ac- Apparatus and Instruments count Ambulances, Live Stock, etc Apparatus and Instruments Total Account Ambulances, Live Stock, etc.. Account Total Total Total The above "Reserve for Depreciation" will cease to exist unless there remains a balance on the credit side, which represents the amount of this "Reserve for Depreciation of Hospital Properties and Equipment, " as shown on the Books and on the Balance Sheet. 16. ENDOWED BED FUND ACCOUNT Dr. Cr. Total from previous month .... § Total from previous month Amount charged off En- Cash received to fully En- dowed Bed Fund during dow Beds during month, month and credited to as per Treasurer's Cash Surplus and Deficit Ac- Book 76 TREASURER'S GENERAL LEDGER ACCOUNTS 16. ENDOWED BED FUND ACCOUNT-Continued Dr. count, liability of Hospital having ceased, as per Journal Entry 12 Cr. Amounts transferred from " Partly Endowed Bed .. Fund" during month, account completion of such endowments as per Journal Entry 11 Total. Total Difference in totals equals " Endowed Bed Fund," as shown on Books and on Balance Sheet. Note-When beds are endowed at the Presbyterian Hospital it is the practice to credit such endowments to "Endowed Bed Fund Account" and to keep the amounts received invested in income bearing securities, as long as any nominor has the right to name patients to occupy such beds. In case, however, the right to name patients to occupy a bed should lapse, either by expiry of the term of the endowment or by death of the nominor without having appointed in writing a successor, the liability of the hospital, as regards that particular endowment, is considered to have ceased and the endowment is there- after treated as unrestricted and is credited as per Journal Entry No. 12 to " Surplus and Deficit Account," if such action is approved by the Board of Managers. A Suitable entry is also made on the Treasurer's Endowed Bed Ledger Accounts as described on pages 92 and 93. Dr. Cr. Total from previous month § Total from previous month Amounts Transferred to Cash received account Part- Endowed Bed Fund, dur- ly Endowed Bed Fund ing month, account en- during month, as per dowments completed, as per Journal Entry 11 Amounts charged off partly Endowed Bed Fund dur- ing month, and credited to Surplus and Deficit Account account liability of Hospital having ceased, as per Journal Entry 12 Treasurer's Cash Book Total Total 17. PARTLY ENDOWED BED FUND ACCOUNT Difference in totals equals " Partly Endowed Bed Fund," as shown on Books and on Balance Sheet. Note-Instalments received to partly endow beds are subject at any time to transfer to "Endowed Bed Fund Account" upon completion of such endowments. There is usually no liability on the part of the Hospital to furnish free treatment on such beds until they are fully endowed. No investments are therefore assigned to offset amounts standing to credit of "Partly Endowed Bed Fund Account" and no income from this Account is therefore shown in Schedule 1. TREASURER'S GENERAL LEDGER ACCOUNTS 77 18. GENERAL ENDOWMENT FUND ACCOUNT State in detail purposes and conditions of this Fund, as for instance, "Principal to be invested and income only to be used for meeting Operating Expenses" (Schedule 2). Dr. Total from previous month .... Amount charged off this account during month and credited to Surplus and Deficit Account, lia- bility of Hospital having ceased, as per Journal En- try 12 Cr. .. § Total from previous month Cash received during month for this Account, as per Treasurer's Cash Book Value of Investments given k to Hospital during month, for this Account as per Journal Entry 9 Total Total Difference in totals equals "General Endowment Fund," as shown on Books and on Balance Sheet. 19. X. Y. Z. VISITING NURSING FUND ACCOUNT State in detail purposes and conditions of this Fund, as for instance, Principal to be used for all expenses in connection with work of Visiting Nurses. Dr. Cr. Total from previous month .... § Total from previous month Appropriation during Donations received during month, for expenses month, for this Fund, as chargeable to this Fund, as per Treasurer's Cash Book reported by Superintend- ent, as per Journal Entry 4 .... Total Total Difference in totals equals the amount of this Fund, as shown on Books and on Balance Sheet. 20. A. B. C. PATHOLOGICAL DEPARTMENT FUND ACCOUNT State in detail purposes and conditions of this Fund, as for instance, "Principal or Income may be used for subscriptions to Periodicals, or for Purchase of Apparatus or Instruments for the Pathological Department." Dr. Cr. Total from previous month .... Appropriation during month for expenses §Total from previous month .. Donations received during month for this Fund, as chargeable to this Fund, as reported by Superin- tendent, as per Journal Entry 4 per Treasurer's Cash Book .. Cash received during month, account Income from in- .. vestments held in this Fund, as per Treasurer's Cash Book Amount of Income from In- vestments held in this 78 TREASURER'S GENERAL LEDGER ACCOUNTS 20. A. B. C. PATHOLOGICAL DEPT. FUND ACCOUNT-Continued Dr. Cr. Total Account accrued and due during month and unpaid and transferred to "Ac- counts Receivable," as per Journal Entry 18 Value of Investments given to Hospital during month, for this Fund as per Jour- nal Entry 9 Total Difference in totals equals the amount of this Fund, as shown on Books and on Balance Sheet. Note-The general Ledger Accounts, "Endowed Bed Fund," "General En- dowment Fund" or other similar Funds, the income from investments held in which is to be used only to meet current expenses and is not to be added to the principal, are intended to show only the increase or decrease of the principal of such Capital Funds. The investments assigned to each of such Funds and monthly income from same is shown by an Income Ledger Account, as described on pages 88 and 89 and also in separate General Ledger Accounts referred to on page 68. There are other General Ledger Accounts such as "X. Y. Z. Visiting Nursing Fund," "A. B. C. Pathological Department Fund" or other similar Fund Accounts in which the income from investments held in these funds as it falls due, is to be added to and becomes a part of the principal. Donations towards the principal of such Funds and income from investments which may be held in such Funds, are therefore both credited to such General Led- ger Fund Accounts and it is not necessary in such cases to keep additional General Ledger Accounts to show the income only from such Funds. Income Ledger Accounts, however, as described on pages 88 and 89 are kept where necessary to show a list of investments assigned to such f unds and the monthly income from same. 21. LOANS AND NOTES PAYABLE ACCOUNT Dr. Cr. Total from previous month §Total from previous month Loans paid during month, as Cash received during month per Treasurer's Cash Book account Loans incurred, as Loans paid during month per Treasurer's Cash Book by renewal, by signing of Loans renewed during new notes, and cancella- month by signing of new tion of old notes, as per notes and cancellation of Journal Entry 13 old notes, as per Journal Entry 13 Total Total Difference in totals equals "Loans and Notes Payable," as shown on Books and on Balance Sheet. Note-"Mortgages Payable Account" may be treated in the same manner as " Loans and Notes Payable Account." TREASURER'S GENERAL LEDGER ACCOUNTS 79 22. SURPLUS AND DEFICIT ACCOUNT De. Ca. •(Total from previous month •(Total from previous month Grand Total Current Ex- Grand Total Current Revenue, penses. Schedule 2, during Schedule 1, during month. month, as per Voucher as per Journal Entry 4 Register, as reported by Profit on Bonds, Stocks or Superintendent, as per other Investments sold Journal Entry 3 during month, as per Total Capital Expenditures, Income Ledger, as per Schedule 3, during month. Journal Entry 8 as per Voucher Register, Profit on sale of "Sites and as reported by Superin- Grounds," " Buildings " or tendent, as per Journal other Hospital Properties Entry 3 and Equipment, as per Uncollectible Superintend- Journal Entry 6 ent's Accounts Receiv- Amount charged off En- able charged off during dowed Bed Fund, Partly month, as reported by Endowed Bed Fund, or Superintendent, as per Other Funds during Journal Entry 3 month, account liability Uncollectible Treasurer's of Hospital having ceased, Accounts Receivable as per Journal Entry 12 charged off during month, Surplus amount of General as per Journal Entry 16 Material found to be on Loss or Depreciation of hand during month as re- General Material charged ported by Superintendent, off during month, as re- as per Journal Entry 2 ported by Superintendent, Unclaimed Overpayments as per Journal Entry 3 by Patients, as per Jour- Loss or Depreciation nal Entry 2 charged off Investment Unclaimed Wages, as per Accounts or Current Asset Journal Entry 2 Accounts, Schedule 4, Book Value of "Sites during month, as per and Grounds," " Buildings," Journal Entry 10 " Furniture and Fixtures," "Machinery and Tools," "Apparatus and Instru- ments," "Ambulances, Live Stock, etc." or other "Hospital Properties and Equipment," Schedule 4, sold during the month or for amount collected during month from Insurance Com- panies for such properties damaged or destroyed by fire, as per Journal Entry 19 Total Total 80 TREASURER'S INCOME LEDGER ACCOUNTS Difference in totals equals "Surplus or Deficit" to date, as shown on Books and on Balance Sheet. "Deficit to date," if any, up to the amount of Reserve Fund Accounts will represent the amount Reserve Fund Accounts, if any, have been encroached upon. "Surplus to date," if any, will represent the amount of surplus, which the Hospital has to its credit, not including the value of any of its plant, which goes to make up "Hospital Properties and Equipment." *At the first of each fiscal year, under the headings in the Treasurer's General Ledger of any of the accounts referred to on the debit side of the Balance Sheet (Schedule 4), the balance shown on the debit side of each account at the end of the previous month should be shown on the debit side only as "Balance at first of year," instead of "Total from previous month." §At the first of each fiscal year under the headings in the Treasurer's General Ledger of "Treasurer's Account with Superintendent," and any of the accounts referred to on the credit side of the Balance Sheet (Schedule 4), the balance shown on the credit side of each account at the end of the previous month should be shown on the credit side only as "Balance at first of year" instead of "Total from previous month." t At the first of each fiscal year, under the heading in the Treasurer's General Ledger "Surplus and Deficit Account," the amount of the "Surplus" or "Deficit to date" at the end of the previous month is the amount which should be shown on the credit side of the account, if a Surplus, or on the debit side of the account if a Deficit, as "Balance at first of Year," instead of "Total from previous month." TREASURER'S TRIAL BALANCE The Treasurer's Trial Balance at the end of any month or year is simply a transcript of the Balance Sheet (Schedule 4), in which, opposite each of the headings shown is entered the balance as shown by each account on the Treasurer's General Ledger at the end of such month and in lieu of the balance shown by Treasurer's Account with Superintendent such additional information from the Superintendent's Trial Balance, as is needed to complete the Balance Sheet. Opposite the word "Deficit" on the debit side, or opposite the word "Surplus" on the credit side of the trial balance must be entered "Deficit to date" or "Surplus to date," as the case may be, as shown by the "Surplus and Deficit" ledger account. The final totals must then agree. TREASURER'S INCOME LEDGER ACCOUNTS In addition to the "General Ledger Accounts" referred to in the preceding pages, the Treasurer should also keep separate Income Ledger Accounts with each kind of Bonds, Stocks, other Investments owned or Loan or Mortgage Receivable or Payable, TREASURER'S INCOME LEDGER ACCOUNTS 81 so as to show plainly the amount of the principal and income or expenses on account of each. In order to show what securities or other investments are assigned to each Fund and the monthly income from same, sepa- rate Income Ledger Accounts should be kept for each of these Fund accounts. The income as it accrues is posted to such ac- counts from the Treasurer's Cash Book, if paid, or by Journal Entry, if not paid, as indicated in the sample of such an account on pages 88 and 89. These Income Ledger Accounts do not form any part of the Treasurer's Balance Sheet and should not be confused with the General Ledger Accounts. The following illustrations will show how entries are made to such accounts: 82 TREASURER'S INCOME LEDGER ACCOUNTS 1. The Income Ledger Account for a Mortgage Receivable owned should be shown in about the following form: First Mortgage Receivable on six story Apartment House at No. 1250 West 75th Street, New York, owned by John Doe, made January 2, 1896, to the Title Guarantee & Trust Co., from whom it was purchased by The Presbyterian Hospital. Principle $50,000 due October 1, 1906. Interest at 5% per annum, payable April 1st and October 1st. Interest paid by John Doe, 101 Broadway, New York. CASH CASH Dr. book 1903 BOOK CR. $50,000 7/15/03 Bought at par and interest 5 50,000 10/1 2| months interest @ 5% ... ... 6 520.82 par value 10/1/06 Mortgage paid in full 28 50,000 1904 4/1 6 " " @5% ... ... 10 1,250.00 10/1 6 " " @5% ... ... 14 1,250.00 1905 4/1 6 " " @5% ... ... 18 1,250.00 10/1 6 " " @5% ... ... 22 1,250.00 1906 4/1 6 " " @5% ... ... 24 1,250.00 10/1 6 " " @5% ... ... 28 1,250.00 TREASURER'S INCOME LEDGER ACCOUNTS 83 2. The Income Ledger Account for each different kind of Bonds owned should be shown in about the following form: Erie R. R. Pennsylvania Coal Collateral Trust Mortgage Sinking Fund 4% Registered Gold Bonds. Interest February 1 and August 1. Principal due February 1, 1951. $10,000 of these bonds assigned January 2, 1904 To General Endowment Fund, see Income Ledger, pages 88, 89. and $20,000 of these bonds assigned February 5, 1904 To General Endowment Fund, see Income Ledger, pages 88, 89. CASH CASH Dr. 810,000 1/2/04 Bought @ 82 7/8 & int. .. BOOK .... 9 8,300 1904 book Cr. 2/1 1 months interest @ 4% on $10,000 Bonds 8 33.33 $20,000 2/5/04 Bought @ 84 7/8 & int. .. $15,000 6/1/06 Sold @ 90 1/8 $15,000 8/1/06 Sold @ 92 1/8 .... 9 17,000 .... 19 13,500 .... 23 13,800 Jrnl. 8/1 6 months interest @ 4% on $10,000 Bonds 10 200.00 8/1 5 months & 23 days interest @ 4% on $20,000 Bonds 10 384.44 1905 ♦Profit on above sales 14 2,000 Difference between total of the black and red figures will at any time show the par value and book value of the bonds on hand. ♦See Journal Entry No. 8. 2/1 6 months interest @ 4% on $30,000 Bonds 12 600.00 8/1 6 months interest @ 4% on $30,000 Bonds 14 600.00 1906 2/1 6 months interest @ 4% on $30,000 Bonds 16 600.00 8/1 6 months interest @ 4% on $15,000 Bonds 18 300.00 TREASURER'S INCOME LEDGER ACCOUNTS 84 3. The Income Ledger Account for each different kind of Stocks owned should be shown in about the following form: CASH Dr. journal 1905 200 Shares 4/1/05 given to Hospital @ 95 .... 11 19,000 10/1 Dividend No. 15 - 2% book Cr. 16 400 100 " 11/15/05 " " " @ 94 .... 15 9,400 CASH BOOK 1906 100 " 10/10/06 Sold @ 90 1/8 24 9,000 4/1 Dividend No. 16 - 2% 20 600 200 " 12/2/07 Sold @88 1/8 34 17,600 10/1 Dividend No. 17 - 2% 24 600 Journal 1907 ♦ Loss on above sales 21 1,800 4/1 Dividend No. 18 - 2% 28 400 • 10/1 Dividend No. 19 - 2% 32 400 UNION PACIFIC PREFERRED STOCK Note - The difference between the totals of the black and red figures will at any time show the par value and book value of the stock on hand. * See Journal Entry No. 10. TREASURER'S INCOME LEDGER ACCOUNTS 4. In case an investment is in the form of Income producing Real Estate or Buildings the Income Ledger Account may be kept in about the following form: Four-story Dwelling House unfurnished, located at No. 1005 East 81st Street, New York City, rented to John Doe, 101 Broadway, New York City, for five years from May 1st, 1905 at $200 per month, payable quarterly in advance. CASH Dr. journal 1905 BOOK Cr. 4/5/05 Given to Hospital valued at 11 20,000 5/1 Rent to 8/1/05 14 600 8/1 Rent to 11/1/05 16 600 cash 9/1 Bill for Maintenance 17 25 book 10/2 1905 Taxes 17 175 6/1/06 Cost of addition to house 13 2,000 11/1 Rent to 2/1/06 18 600 11/1/06 This property sold ..... 26 24,000 1906 Journal 2/1 Rent to 5/1/06 20 600 ♦Profit on above sale 17 2,000 5/1 Rent to 8/1/06 22 600 ' 5/15 Bill for Maintenance 23 100 ♦'See Journal Entry No. 8. 8/1 Rent to 11/1/06 24 600 10/1 1906 Taxes 25 180 The difference between the black and red figures on the credit side of this account will at any time show the net income from this investment. 85 Taxes and other than petty current expenses on account of income producing Investments such as those indicated above should be charged against the Income of such Investments rather than to Corpora- tion Expenses (Schedule 2). 86 TREASURER'S INCOME LEDGER ACCOUNTS 5. In case an investment is in the form of non-income producing Real Estate or Buildings, the Income Ledger Account may be kept in about the following form: Three-story Dwelling House, unfurnished, located at 900 East 70th Street, New York City; unoccupied, not rented. Dr. 8/1/05 Given to Hospital, valued at ... . JOURNAL 12 15,000 Cr. 9/29/05 11/1/05 9/30/06 Taxes for 1905 Bill for maintenance Taxes for 1906 CASH BOOK 17 170 19 500 23 180 *9/30/06 Loss account fire JOURNAL 16 3,000 9/30/07 Taxes for 1907 CASH BOOK 27 150 *9/30/07 Depreciation charged off JOURNAL 19 2,000 11/1/07 *12/1/07 CASH BOOK Cash received from Insurance Company account loss by fire 28 1,500 Property Sold 28 9,000 * Loss on above sale 500 The difference between the black and red figures on the debit side of this account will at any time show the book value of this investment. Where no income is received, Taxes and current expenses on account of such investment, may be charged to this Account, as indicated above, so as to increase the book value of the property and such increase may, if desired, from time to time be charged off by Journal Entry showing amount of such depreciation as indicated. *See Journal Entry No. 10. TREASURER'S INCOME LEDGER ACCOUNTS 87 6. The Income Ledger Account for each "Loan or Note Payable Account" or "Mortgage Payable" should be shown in about the following form: Dr. CASH Cr. 1905 1905 BOOK May 1 1 mo. Interest on $10,000 @ 5%, as per Jan. 1 By demand loan @ 5% 15 10,000 Superintendent's Voucher Register 41.67 April 1 By demand loan @ 5% 17 10,000 June 30 6 mos. Interest on $10,000 @ 5%, as per May 1 To Loan of April 1 paid 19 10,000 Superintendent's Voucher Register 250.00 Oct. 1 By demand loan @ 5% 21 20,000 Dec. 31 Interest to Dec. 31, 1906 @ 5%, as per Super- intendent's Voucher Register 500.00 1906 1906 Jan. 1 By Time loan for six months @ 5% .. 30,000 June 30 6 mos. Interest on $60,000 @ 5%, as per Superintendent's Voucher Register 1,500.00 JRNL. Dec. 31 6 mos. Interest on $60,000 @ 5%, as per ♦July 1 To Time loan paid by renewal 11 30,000 Superintendent's Voucher Register 1,500.00 *July 1 By Time loan for six months @ 5% .. 11 30,000 CASH BOOK Dec. 31 To Loans paid 25 60,000 The difference between the total of the black figures and the total of the red figures as shown on the credit side of this account will show at any time the amount of this Loan Payable. LOANS PAYABLE TO BANK OF MANHATTAN COMPANY *See Journal Entry No. 13. TREASURER'S INCOME LEDGER ACCOUNTS 88 7. In order to show at any time what investments are assigned to any Reserve Funds and the monthly Income from Investments held in such Funds, an Income Ledger Account for each Fund may be kept in about the following form: (For conditions and amount of this Fund, see page , of General Ledger) Dr. Cr. Investments assigned to this Fund INCOME CASH LEDGER 1904 BOOK 1/2/04 10,000 Erie R.R. Pa. Coal Coll. 4% 2/1 1 mo. Interest @ 4% on $10,000 Erie Bonds @ 83. Interest February 1 R.R. Bonds 8 33.33 and August 1 45 8,300 8/1 6 mos. Interest @ 4% on $10,000 Erie 2/5/04 20,000 Erie R.R. Pa. Coal Coll. 4% R.R. Bonds 10 200.00 Bonds @ 85. Interest February 1 8/15 mos. 23 days Interest @ 4% on $20,000 and August 1 45 17,000 Erie R.R. Bonds 10 384.44 4/6/05 20,000 So. Pac. 1st Ref. 4% Reg. Bonds 1905 @92. Interest January 1 and July 1 56 18,400 2/1 6 mos. Interest @ 4% on $30,000 Erie 5/15/06 10,000 U. S. Steel Cor. Skg. Fund 5% R.R. Bonds 12 600.00 Bonds @ 85. Interest January 1 7/1 2 mos. 24 days Interest @ 4% on $20,000 and July 1 63 8,500 So. Pac. Bonds 186.65 6/1/06 15,000 Erie R.R. Pa. Coal Coll. 4% 8/1 6 mos. Interest @ 4% on $30,000 Erie Bonds withdrawn for sale 45 12,650 R.R. Bonds 14 600.00 6/1/06 30,000 U. S. Steel Corp. Sinking Fund 1906 5% Bonds @ 88. Interest January 1 1/16 mos. Interest @ 4% on $20,000 So. and July 1 63 26,400 Pac. Bonds 16 400.00 7/1/06 Adams Mortgage Receivable 5% In- 2/1 6 mos. interest @ 4% on $30,000 Erie terest January 1 and July 1 68 21,000 R.R. Bonds 16 600.00 GENERAL ENDOWMENT FUND TREASURER'S INCOME LEDGER ACCOUNTS Dr. Cr. INCOME CASH LEDGER 1904 BOOK 8/1/06 15,000 Erie R.R. Pa. Coal Coll. 4% 7/1 1 mo. 15 days Interest @ 5% on $10,000 Bonds withdrawn for sale 45 12,650 7/1 U. S. Steel Bonds 6 mos. Interest @ 4% on $20,000 So. 18 62.50 Note - The investments listed in black less the invest- Pac. Bonds 18 400.00 ments withdrawn listed in red should show the investments 7/1 1 mo. Interest @ 5% on $30,000 U. S. assigned to this Fund at any time and their book value, When Bonds 18 125.00 investments are withdrawn they should be entered in red at the 8/1 6 mos. Interest @ 4% on $15,000 Erie same valuation at which they have been debited to this account. 1907 R.R. Bonds 18 300.00 1/1 6 mos. Interest @ 5% on Adams Mort- gage Receivable for $21,000 24 525.00 1/1 6 mos. Interest @ 4% on $20,000 So. Pac. Bonds 24 400.00 1/1 6 mos. Interest @ 5% on $40,000 U. S. Steel Bonds 24 1,000.00 The monthly income of this Fund as shown by this Income Ledger Account is posted direct to this account from the Treas- urer's Cash Book and should agree with the total monthly In- come, as posted from the Cash Book to the Treasurer's General Ledger Account "Income from Investments held in General Endowment Fund Account." 89 GENERAL ENDOWMENT FUND - Continued PROVISION FOR AMORTIZATION OR ACCUMULATION ON BONDS In Hospital Accounting it will not often be thought worth while to go into what might be called the technical refinements of accounting and to consider such matter^ as amortization and accumulation on bonds for the reasons that comparatively few hospitals own enough bonds, the book value of which is so different from the par value, as to make worth while the extra accounting involved. There would not seem to be much practical necessity, therefore, for financial officers of the ordinary hospital to consider such matters and, to avoid what seems to be unnecessary complica- tions in hospital accounting, no reference has been made to any periodical allowances for amortization and accumulation in the entries referring to bonds or interest thereon on the books of the Treasurer referred to in this volume. As a matter of information, however, for those who may not understand what is meant by taking care of amortization and accumulation on bonds the following brief explanation is offered. AMORTIZATION Bonds which are well secured or which bear a high rate of interest command a better price than those issued on a less favorable basis and are usually sold at a premium where both features are present. As the amount payable to the bond-holder at the maturity of the bond is the par value it may be desired to adopt some method to write off the premium paid, when bonds of a market value much above par are purchased by or are given to the hospital. From published tables it is easy to ascertain the amount of amortization or accumulation on bonds bearing different rates of interest and having certain fixed dates of maturity. The method of writing off the premium would be to treat the interest received as being in part true interest and in part a return of capital invested and divide it accordingly, properly crediting that part of the cash received which is applicable to the principal. For instance, if the market rate of interest is 4^% a $1000 bond 90 ACCUMULATION 91 bearing 6% interest payable semi-annually, redeemable at par in four years, will command a premium of about $54.40. An investor on a 4^% basis would therefore pay $1054.40 for the bond and receive $60.00 a year nominal interest and $1000 prin- cipal at the end of four years. At the end of the first six months the investor will divide the $30.00 into two parts, $23.70 net income at say 4^% on the book value and $6.30 return of original investment. This amount representing return of original investment would be credited to "Bonds Account" on the Treasurer's General Ledger and would be credited to reduce the book value of the particular bond con- cerned on the Treasurer's Income Ledger. At the end of the six months the book value of the investment will be $1048.10. This would continue, making the proper allowance for amortization, until the bond was reduced to par at maturity. ACCUMULATION Bonds which do not bear a high rate of interest or are not well secured do not command as high a price as those issued on a more favorable basis and where both features are present the bonds are usually sold at a discount. As the amount payable to the bond- holder at maturity of the bond is the par value, it may be desired to adopt some method to periodically credit the accumulation. The accumulation or discount, therefore, is properly divided in proportion to the number of years the bond is to run. The annual proportion of the discount is added to the true interest and the total is considered net income on the bond. For instance, if a $1000 bond bearing 3% interest payable semi-annually, redeem- able at par in four years, sells on a 4^% interest basis it will sell at a discount of about $54.40, the investor paying $945.60 for the bond, receiving $30.00 a year nominal interest and $1000 principal at the end of four years. At the end of the first six months the investor will add to the $15.00 cash interest at 3%, $6.30 accumulation. This amount representing accumulation would be debited to Bonds Account on the Treasurer's General Ledger and would be debited to in- crease the book value of the particular bond concerned on the Treasurer's Income Ledger. The book value of the investment in the bond at the end of the first six months, therefore, will be $951.90. This practice will continue until the bond is increased to par at maturity. 92 TREASURER'S ENDOWED BED LEDGER ACCOUNTS The advantages claimed for Amortization and Accumulation are that if bonds are purchased at a premium or a discount the par value is shown on the books at maturity, thus making the book value more nearly represent actual value and obviating the necessity of showing the loss or profit on redeeming securities if handled otherwise and spreading the premium or discount over the number of years the bonds are held. TREASURER'S ENDOWED BED LEDGER ACCOUNTS At the Presbyterian Hospital the Treasurer keeps in a separate Ledger from those referred to heretofore an Endowed Bed Ledger Account with each organization which, or each individual who, fully endows a bed or makes payments on account toward such endowments. At the head of each account detailed information is given in regard to the name of the Organization or Individual endowing the bed, and whether in perpetuity or for one life, etc., the name the bed is to bear, if any and in whose memory the bed is endowed, its certificate number and any other information pertinent. This record also shows the name and address of the Officer of any Organization or the Individual having the right to nominate patients to use such bed. In case of transfer of the right to nomi- nate patients by death of the nominor, or otherwise, the name and address of his or her successor is recorded as long as any such nominor exists at whose request the Hospital is obligated to fur- nish free treatment to patients. If no nominor exists having the right to name patients to use an endowed bed the liability of the Hospital ceases and at the Presbyterian Hospital it is then customary, with approval of the Board of Managers, in each case, to charge off the amount of such endowment from Endowed Bed Fund Account at the end of the fiscal year, as per Journal Entry 12. The following illustration will show how entries are made: In Case a Bed is Fully Endowed Dr. Cr Cash received by Treasurer, as per his Cash Book, or amount transferred from Partly Endowed Bed Fund account completion of such endowment, as per Journal Entry 11 TREASURER'S ENDOWED BED LEDGER ACCOUNTS 93 In Case a Bed is Endowed in Part Payments Dr. Cr. Total from previous month Cash received by Treasurer during month, partial payment on account, as per his Cash Book In Case a Bed has been Endowed and Liability of Hospital has Ceased Dr. Cr. Amount charged off account liability of Hospital hav- ing ceased, as per Journal Entry 12 Total of such endowment This account will then balance. STATEMENT SHOWING METHOD OF FIGURING "COST PER PATIENT PER DAY" AT THE PRESBYTERIAN HOSPITAL For Year Ending September 30, 1907 (Not Including Corporation Expenses) - Total Ward Patients Cost per Ward Patient per Day Private Room Patients Cost Per Pri- vate Room Pa- tient per day Dispensary Emergency Ward Visiting and Home Nursing 100% 82% 10% 5% 3% Administration Expenses $18,113.56 $14,853.12 $ .20 $1,811.36 $ .284 $905.68 $543.40 Professional Care of Patients: Supt. of Nurses, Assistants and Instructors 100% 3,978.96 82% 3,262.75 .044 10% 397.89 .062 5% 198.95 3% 119.37 . wo% actual cost actual cost Nurses 6,879.05 4,782.10 .065 2,096.95 .329 100% actual cost actual cost Special Nurses 17,149.00 3,408.00 .046 13,741.00 2.153 100% actual cost actual cost Orderlies 5,465.70 4,238.87 .657 1,226.83 .192 100% actual cost actual cost Ward Employees 1,980.95 1,633.45 .022 347.50 .054 Equipment for Nurses 100% 2,347.11 87 2/10% 2,047.15 .028 5 6/10% 130.50 .02 2 8/10% 65.25 4 4/10% 104.21 Medical and Surgical Supplies 100% 18,712.93 92% 17,215.90 .233 8% 1,497.03 .234 Dispensary, Matron 100% 23% 2% 75% 600.00 138.00 .002 12.00 .002 450.00 Dispensary Emergency Ward 100% 100% 8,768.83 100% 3,865.58 8,768.83 100% 3,865.58 Visiting and Home Nursing 100% 9,461.42 100% 9,461.42 X Ray Service 100% 1,122.58 35% 392.90 .005 5% 56.13 .009 20% 224.52 40% 449.03 Ambulance 100% 22 5/10% 77 5/10% 6,135.99 1,380.60 .019 4,755,39 Pathological Department 100% 6,585.85 84% 5,532.11 .075 8% 526.87 .083 8% 526.87 Housekeeping 100% 88 5/10% 9% 1% 1% 5/10% 31,407.06 .27,795.25 .376 2,826.64 .443 314.07 314.07 157.03 Kitchen 100% 82% 15% 1% 1% 1% 8,473.82 6,948.53 .094 1,271.07 .199 84.74 84.74 84.74 Laundry 100% 85 5/10% 9% 2% 3% 5/10% 7,142.22 6,106.60 .082 642.80 .10 142.84 214.27 35.71 Steward's Department 100% 66,070.71 82% 54,177.98 .732 - 15% 9,910.60 1.552 1% 660.71 1% 660.71 1% 660.71 General House and Property Expenses 100% 29,045.27 88% 25,559.84 .345 5% 1,452.26 .229 5% 1,452.26 1 5/10% 435.68 5/10% 145.23 Total Operating Expenses $253,306.59 $179,473.15 37,947.43 $13,794.72 $11,546.45 $10,544.84 Total Patient Days' Treatment and visits Cost per Patient per Day 74,013 $2.42 5/10 6,383 $5.94 5/10 86,172 $0.16 29,305 $0.39 4/10 13,790 $0.76 5/10 The Salaries of Operating Room Nurses and Operating Room Orderlies are distributed in proportion to the numbers of Private Room Surgical Patients and Ward Surgical Patients treated. Method of Figuring Cost of Different Branches of the Service. The method in use at The Presbyterian Hospital of figuring the total cost of caring for Ward, Private Room, Dispensary, Emergency Ward Patients or Patients visited in their omes is to charge each branch of the service with salaries and wages of all persons employed exclusively in, and all supplies and repairs directly chargeable to, such service. Other opera ing expenses, which contribute to the cost of the different branches of service are prorated in such proportion as the Superintendent and his Assistants may' consider most fair a er cai e ul consideration of the local conditions, which are, of course, subject to change from time to time. In determining the relative proportion of Administration Expenses, Pro- essiona Uare of Patients, Housekeeping, Kitchen, and other expenses, not including the amounts directly chargeable to Dispensary, Emergency Ward and Visiting and Home Nursing, ne percentage charged to Ward Patients and to Private Room Patients is based upon the number of days' treatment furnished in each service, modified by well-known facts. For ms ance, the fact that a private room patient requires more professional care than necessary if he were located in a ward; also that his food and the preparation of it costs very much more than that of the ward patient. The distribution of the cost of General House and Property Expenses among the different branches of the service is based upon the relative cubic contents of those parts of the buildings occupied by each of the five services mentioned. JLPALL-1Sih 19DS IHCCftbeo Of THE PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK. EXHIBIT A XUE-HUNDREDXMNIT-SJXAND_48ZlDQXXUUiU^^ Dollars, £526-4.8 in full for the following account; ( Sign __, THE PRESBYTERIAN HOSPITAL in the C1TY_OF NEW YORK, New York City, N. I'.jA.PRLk-lSIB 190$ To MR... C H AR L E S ..T... DAW S, Dr. for the above account? Address _556.-DE A This voucher, when signed by the proper officials of the Hospital, is payable in current funds at the FIDELITY BANK, NEW YORK CITY, when receipted In accordance with the directions above, printed in red Ink. i-ta-M. PLEASE COLLECT THIS VOUCHER PROMPTLY SO THAT THE HOSPITAL MAY 3E ASSURED OF ITS RECEIPT. NOTE: The (advantage of having a voucher printed as indicated above is that it may be folded once and placed in' an outlook envelope so that the name and address of the party in whose favor the voucher is made, as shown on the voucher, serves as the mailing address, thereby avoiding additional labor. By the sample voucher it will be noted that provision has been made for approval by some member of the Board of Managers. The President or Executive Committee might from time to time designate the manager, whose duty it would be to approve vouchers, if found correct. Such rotation of responsibility might increase the interest of the managers and make them more familiar with the actual workings and expenditures of the Hospital. It also increases the likelihood of valuable suggestions as to improving the management. In case it is desired to have a member of some committee also approve such vouchers as concern his particular committee, additional endorsements may be made accordingly. It would, of course, be optional with the hospital authorities as to whether they instruct the bank to honor vouchers when signed only by the Superintendent or Assistant Superintendent and by the Chief Clerk or Assistant Chief Clerk or whether the voucher must also bear the signature of any other hospital official. " Voucher No. -370 J Amount, 3 526-»48 Favor of CHARLES.-T.,..Q.A.V-L&. Month of .MARCH 1908- DISTRIBUTION PAYABLE AT FIDELITY BANK, NEW YORK CITY. Pay NASSAU NATIONAL BANK, of Brooklyn, or order, CHARLES T. DAVIS. Exhibit »A" (Back of Voucher) THE PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK. Madiaon Avenue end 70th St, New York, N. Y. THE PRESBYTERIAN HOSPITAL . J , „ sr EXHIBIT B EXHIBIT B PAY ROLL DISTRIBUTION EXHIBIT C THE PRESBYTERIAN HOSPITAL in the City of New York EXHIBIT C Vouchers registered during month of L2z^£L EXHIBIT D EXHIBIT D The Presbyterian Hospital in the City of New York. BILL REGISTER. Summary of Accounts ^/Uunb. Pay Patients and Other Hospital Receipts, for Month endinoZ^/*^ ioz^ EXHIBIT E EXHIBIT F