Economic contributions of hospitals in Florida

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Title:
Economic contributions of hospitals in Florida
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Hodges, Alan W.
Rahmani, Mohammad
Publisher:
Food & Resource Economics Department, University of Florida
Place of Publication:
Gainesville, Fla.
Publication Date:
Copyright Date:
2010

Notes

General Note:
Sponsored project final report to the Florida Hospital Association, Orlando, FL

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University of Florida Institutional Repository
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University of Florida
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Economic Contributions of Hospitals in Florida

Sponsored Project Final Report to the Florida Hospital Association, Orlando, FL
By Alan W. Hodges* and Mohammad Rahmani
University of Florida, Food & Resource Economics Department
PO Box 110240, Gainesville, FL
*Corresponding author contact: email awhodgesi@ufl.edu; telephone 352-392-1881 x312

April 2, 2009
Revised June 3, 2010
Executive Summary

This study evaluated the broad economic contributions of hospitals in the state of Florida in 2007, using
data on hospital beds, revenues, expenditures, and employment from the Florida Hospital Uniform Reporting
System, together with regional economic models developed with the IMPLAN Professional software to estimate
multiplier effects arising in other sectors of the local economy from input purchases and spending by employees
and governments.
Characteristics of 280 non-federal licensed hospitals operating in Florida in 2007 included:
61,323 beds,
233,586 fulltime equivalent employees,
$31.87 billion in operating expenses,
$14.64 billion paid in employee salaries and benefits,
$32.31 billion in net revenues,
$30.14 billion in non-local sources such as health insurance, Medicaid and Medicare.
Estimated total statewide economic contributions of Florida hospitals in 2007 included:
659,240 fulltime and part-time jobs,
$79.9 billion in industry output or sales revenues,
$45.8 billion in value added, representing personal and business income, and property income,
2.48 percent share of Gross Domestic Product of Florida from direct value added of $17.29 billion,
$32.1 billion in labor income to employees and business owners,
$9.3 billion in property income, such as rents, dividends and interest payments,
$2.6 billion in indirect business taxes paid to local and state governments
Regionally, total employment contributions of Florida hospitals were greatest in the Miami-Ft.
Lauderdale area (227,516 jobs), followed by the Orlando area (155,598), Tampa-St. Petersburg (102,016),
Sarasota-Bradenton (52,863), Jacksonville (51,721), Gainesville (26,188), Pensacola (21,649), Tallahassee
(12,738), and Panama City (8,950). The largest individual Florida counties in terms of employment impacts were
Miami-Dade (110,373 jobs), Broward (60,743) Orange (54,283), Hillsborough (49,378), Duval (42,536),
Pinellas (40,488), Palm Beach (39,088), Alachua (23,380), Polk (18,490), Brevard (18,460), Lee (17,452),
Volusia (17,177) and Escambia (15,147).








Given the significant role of hospitals in the local economy, reductions in hospital funding would have

far reaching impacts on the state and its communities. For example, a hypothetical $100 million reduction in

Medicaid funding to Florida hospitals by the State of Florida is estimated to result in the elimination of 2,187

jobs, reduce output by $258 million, and reduce value added by $157 million.



Introduction

Healthcare is a major driver of economic activity in the United States, valued at $2.2 trillion in 2007,

representing approximately 16.2 percent of Gross Domestic Product. The healthcare industry experienced

average annual growth of 8.8 percent over the past 10 years, which was well above the U.S. average over the

same time. Activity in the healthcare sector has also been relatively stable compared to many other sectors of the

economy. Hospitals are an important component of the healthcare industry, providing acute care, emergency,

trauma, psychiatric and rehabilitation services valued at $697 billion annually, or 31 percent of total U.S.

healthcare expenditures. Hospitals in the U.S. directly employ nearly 5.3 million people and account for 14.8

million jobs, including multiplier effects, according to a recent study by Avalere Health sponsored by the

American Hospital Association (AHA, 2009).

Healthcare services are important in the state of Florida due to its rapidly growing and aging population.

The healthcare industry serves as a source of economic development, to attract new residents and businesses to

the state. Total employment in the healthcare sector in Florida has grown from about 724,000 in 2001 to nearly

843,000 in 2007, representing average annual growth of 2.7 percent (Figure 1).


Figure 1. Trend in Florida healthcare industry employment, 2001-07.
o00
Thousand -*-Offic es of phy sicians
Fulltime & Part- dentists, and other
2 time Jobs health practitioners

-- Hospitals
200


150 Nursing and
residential care
facilities
100
--Medical and
____ diagnostic labs,
outpatient and
50 ambulatory care
Home health care
0 services
2001 2002 2003 2004 2005 2006 2007
Source: Implan data for Florida (MIG, Inc., 2008)



Hospitals are the second largest segment of the healthcare industry in Florida, behind offices of

physicians, dentists and other health practitioners. Florida currently has 296 hospitals, with a total of 65,816








beds, and 225,000 fulltime equivalent employees, according to data from the Florida Hospital Association (FHA,
Oct. 2008). Among Florida's full-service community hospitals, 84 were investor owned, 95 were not-for-profit,
and 31 were public institutions, plus 12 federal facilities. Florida hospitals offering specialized services included
psychiatric treatment (33), rehabilitation (15), long-term treatment (22), children's care (12), rural patient care
(26), and teaching (7). In 2007 these facilities provided care to 2.3 million patients over 10.8 million patient-
days, and performed nearly 1.9 million surgeries. Florida hospitals provide high skill, high wage jobs, with
annual earnings averaging $52,661 in 2006.
The purpose of this project is to estimate the annual economic contributions of hospital operations in the
state of Florida and its regions and counties, including values generated indirectly in other sectors of the
economy via multiplier effects. This report updates a previous study for 1999 (Anderson, Wieand and Colie,
1999).


Methods

Data on revenues, expenditures, fulltime equivalent employment and number of beds for all Florida
hospitals in 2007 were obtained from the Florida Hospital Uniform Reporting System (FHURS) maintained by
the Florida Agency for Healthcare Administration. Reporting to the FHURS is required for non-federal licensed
hospitals under Florida law. Procedures for reporting through an online system are described in a user manual,
and data largely conform to Generally Accepted Accounting Principles (GAAP), with minor exceptions.
Expenditure information reported includes total operating expenses, employee salaries, and non-operating
expenses for amortization and depreciation. Revenues are reported for payments received from health insurance,
health maintenance organizations (HMO), Medicaid, Medicare, local government, and self paying individuals.
Discounts to employees, bad debts, and unpaid services rendered to indigent patients are reported as negative
revenue amounts. Non-local sources of revenues, such as health insurance, Medicaid and Medicare, net of
administrative and employee discounts and local matching contributions to Medicaid, represent new monies to
the state or region that give rise to multiplier effects through re-spending in other sectors of the economy.
Information was available for a total of 280 Florida hospitals in 2007. Seven new facilities that opened in 2008
were excluded from this analysis, as well as some federal hospitals that are not required to report information. In
some cases where consolidated data were reported for a number of hospital facilities owned by a parent
company, values were disaggregated based on the number of beds, in order to provide an accurate accounting by
location. A complete listing of Florida hospitals operating in 2007 is provided in Appendix B.
The broad economic contributions of hospitals in Florida were evaluated with regional economic models
constructed with the IMPLAN Professional software and associated Florida state and county datasets for 2007
(MIG, Inc. 2008). This type of model for input-output analysis augmented with social accounting matrices
enables estimation of the secondary impacts of industry activities in the local economy arising through input
purchases from vendors, and through spending by employee households and governments, known as indirect and
induced multiplier effects, respectively (Miller and Blair). A glossary of economic impact analysis terminology








is provided in Appendix A. Models were constructed for the state of Florida and for each of the state's 67
counties, using default parameters and trade flow assumptions, and all social accounts internalized. This means
that the multiplier effects captured expenditures by households, local, state and federal governments, and capital
investment generated by new resources garnered by the hospital industry. Estimated economic contributions at
the county level were normalized to match with total values at the state level. Spending by hospitals that occurs
within the state or county was accounted for by regional purchase coefficients in IMPLANthat represent the
average share of goods and services provided from local sources. A summary of input purchase coefficients for
hospitals used in the IMPLAN model for Florida is provided in Appendix C.
Financial data and estimates of economic contribution for Florida hospitals were summarized by county
and regions. The functional economic regions of Florida, indicated in Figure 2, represent metropolitan areas and
surrounding non-metro counties that are economically linked, as defined by the U.S. Department of Commerce-
Bureau of Economic Analysis, based on employee commuting patterns reported in the 2000 Census and other
data such as newspaper readership (Johnson and Kort, 2004). Economic contribution estimates for hospitals were
also summarized by maj or industry groups defined according to the North American Industry Classification
System (NAICS).


Figure 2. Economic regions of Florida.

Tallahassee

Pensacola Jacksonville

Panama City
Gainesville Orlando


Tampa,
St.Petersburg



Sarasota, Miami,
Bradenton Fort
Lauderdale


Source: US Department of Commerce, Bureau of Economic Analysis.








Results


Hospital Employment, Expenditures and Revenues

Available information on Florida hospital operations employment, expenditures and revenues in 2007
are summarized in Table 1. For the 280 non-federal licensed hospital facilities operating in Florida, there were a
total of 61,323 beds, and 233,586 fulltime equivalent employees. Total operating expenses amounted to $31.87
billion (Bn), including employee salaries of $11.94 Bn, and employee benefits of $2.70 Bn. Non-operating
expenses included depreciation and amortization ($1.76 Bn) and interest on borrowed capital ($625 million).
Total revenues amounted to $32.31 Bn, including insurance payments ($17.11 Bn), Medicare ($13.15 Bn),
Medicaid ($3.36 Bn), other local government revenue ($1.66 Bn). Matching contributions to Medicaid from
local governments in Florida amounted to $722 million (Mn). Charity, bad debt and self-pay revenue was a
negative total (-$304 Mn), but it was not possible to disaggregate these values because they were reported as a
lump sum. Funds restricted for indigent care were $1.2 Mn. Administrative, employee and policy discounts to
revenues amounted to -$2.70 Bn. Total revenues from non-local sources were estimated at $30.14 Bn, including
payments from health insurance, Medicaid and Medicare, net of discounts and local matching Medicaid
contributions.
Table 1. Summary of Florida hospital operations, employment, expenditures and revenues, 2007

Number Hospitals 280
Number Beds 61,323
Fulltime Equivalent Employees 233,586
Total Operating Expenses (Mn$) 31,871.2
Employee Salaries (Mn$) 11,939.5
Employee Benefits (Mn$) 2,696.6
Total Non-Operating Expenses (Mn$) 2,381.5
Interest Expense (Mn$) 624.5
Depreciation and Amortization Expenses (Mn$) 1,757.0
Total Revenues (Mn$) 32,312.7
Insurance Based Revenue (Mn$) 17,111.0
Medicare / HMO Revenue (Mn$) 13,153.0
Medicaid / HMO Revenue (Mn$) 3,357.5
Other (Local) Government Revenue (Mn$) 1,656.4
Charity, Bad Debt, Self-Pay Revenue (Mn$) -304.3
Administrative, Employee and Policy Discounts (Mn$) -2,759.7
Restricted Funds for Indigent Care (Mn$) 1.2
Total Non-Local Revenues Net of Discounts and Local 30,
Matching* (Mn$)
*Note: non-local revenues include health insurance, Medicaid and Medicare payments received, net of
administrative, employee and policy discounts and local matching Medicaid funds.








Operating expenditures that occurred within Florida were estimated at $26.6 Bn or 83.5 percent of total
operating expenses, while the remaining amount (16.5%) is purchased from outside the state, based on regional
purchase coefficients developed with the IMPLANmodel for Florida. For example the share of purchases of"In-
vitro diagnostic substance manufacturing" within Florida is 19.5 percent (Appendix C). Expenditures for items
purchased from outside the region are known as a "leakage" which has no economic impact on local economy.


Statewide Economic Contributions

Total statewide economic contributions of Florida hospitals in 2007, including multiplier effects for all
other sectors of the economy, are summarized in Table 2. Employment impacts were estimated at 659,240
fulltime and part-time jobs. Total output or revenue impacts were estimated at $79.88 Bn. Impacts on value
added, or personal and business net income, amounted to $45.84 Bn. Value added includes all wages, salaries
and benefits paid to workers, business profits, property income, capital consumption (depreciation) and indirect
business taxes. The sum of direct value added across all industry sectors is equivalent to Gross Domestic
Product (GDP), the broadest measure of aggregate economic activity. Direct value added by hospitals ($17.29
Bn) represented 2.48 percent of GDP of Florida in 2007 ($698.26 Bn). Labor income impacts to employee and
business owner compensation were $32.08 Bn. Impacts on other property income, such as rents, dividends and
interest, were $9.26 Bn. Impacts on indirect business taxes paid to local and state governments were estimated at
$2.60 Bn including taxes for ad valorem property, sales, excise, and motor fuels, but excluding income taxes.


Table 2. Summary of statewide economic contributions of Florida hospitals in 2007.
Total
Direct Indirect Induced Total Tot
Impact Measure Multiplier
Impact Measure Impact Impact Impact Impact Multip
Effect
Employment (fulltime & part-time jobs) 249,107 93,637 316,495 659,240 2.65

Output or Revenue (million) $32,313 $12,041 $35,529 $79,882 2.47

Total Value Added (million) $17,292 $7,047 $21,498 $45,836 2.65

Labor Income (million) $14,391 $3,966 $13,725 $32,082 2.23

Other Property Income (million) $801 $2,481 $5,973 $9,256 11.56

Indirect Business Taxes (million) $202 $600 $1,800 $2,602 12.88
Note: Direct impacts represent values for hospitals. Indirect impacts represent activity generated in other sectors
that furnish inputs to the hospital industry. Induced impacts reflect economic activity due to spending by
employee households and governments, and capital investment.

The direct component of economic contributions represents activity with the hospital sector, while
indirect effects are for input purchases through the vendor supply chain, and induced effects represent employee
household and government spending arising from non-revenues to the hospital sector. The indirect and induced
effects represented approximately 62 percent of the total employment impact, 60 percent of the total output








impact and 62 percent of the total value added impact, implying an overall multiplier effect of 2.65, 2.47 and
2.65, respectively (Table 2).
Given the significant role of hospitals in the local economy, reductions in hospital funding would have
far reaching effects on the state and its communities. For example, a hypothetical $100 million reduction in
Medicaid funding to Florida hospitals by the State of Florida is estimated to result in the elimination of 2,187
jobs, reduce output by $258 million, and reduce value added by $157 million.


Financial Characteristics and Economic Contributions in Florida Regions and Counties

Hospitals operated in 58 of Florida's 67 counties in 2007. Financial and operating characteristics of
Florida hospitals are summarized by region and county in Table 3. The largest regions for hospital employment
(FTE) were Miami-Ft. Lauderdale (77,253), Orlando (56,821) and Tampa-St. Petersburg (34,159), followed by
Jacksonville (19,675), Sarasota-Bradenton (18,905), Gainesville (9,264), Pensacola (7,638), Tallahassee (6,321)
and Panama City (3,550). The largest Florida counties for hospital employment were Miami-Dade (36,134),
Broward (21,060) Orange (18,930), Hillsborough (16,562), Duval (15,335), Palm Beach (13,293) and Pinellas
(12,602). In addition, six other counties had at least 5,000 fulltime equivalent employees (Alachua, Brevard,
Escambia, Lee, Polk, Volusia).
Economic contributions of Florida hospitals are summarized by region and county in Table 4. Total
employment impacts (fulltime and part-time jobs) were 227,516 in the Miami-Ft. Lauderdale region, 155,598 in
the Orlando area, 102,016 in Tampa-St. Petersburg, 52,863 in Sarasota-Bradenton, 51,721 in Jacksonville,
26,188 in Gainesville, 21,649 in Pensacola, 12,738 in Tallahassee, and 8,950 in the Panama City area. The
largest individual Florida counties in terms of employment impacts were Miami-Dade (110,373 jobs), Broward
(60,743) Orange (54,283), Hillsborough (49,378), Duval (42,536), Pinellas (40,488), Palm Beach (39,088),
Alachua (23,380), Polk (18,490), Brevard (18,460), Lee (17,452), Volusia (17,177) and Escambia (15,147).
Total output, value added, labor income and indirect business tax impacts across regions and counties were
roughly proportional to these employment impacts.








Table 3. Hospital employment, expenses and revenues in Florida regions and counties in 2007.

Non-Local
Revenues
Net of
Discounts &
Fulltime Operating Employee Net Local
Number Number Equivalent Expenses Salaries Revenues Matching*
Region / County Hospitals of Beds Employees (million $) (million $) (million $) (million $)


Miami-Fort Lauderdale
Broward
Hendry
Indian River
Martin
Miami-Dade
Monroe
Okeechobee
Palm Beach
St. Lucie
Orlando
Brevard
Citrus
Flagler
Hardee
Highlands
Lake
Marion
Orange
Osceola
Polk
Seminole
Sumter
Volusia
Tampa-St. Petersburg
Hernando
Hillsborough
Pasco
Pinellas
Sarasota-Bradenton
Charlotte
Collier
DeSoto
Lee
Manatee
Sarasota
Jacksonville
Baker
Clay
Duval
Nassau


21,725
6,449
25
554
424
9,457
267
100
3,839
610
11,831
1,582
326
99
25
335
657
779
3,308
514
1,746
773
192
1,495
9,458
584
3,699
1,075
4,100
5,665
665
906
49
1,694
849
1,502
4,989
1,163
310
3,005
54


77,253
21,060
152
1,857
2,031
36,134
726
326
13,293
1,674
56,821
7,301
1,517
490
110
1,245
3,340
3,215
18,930
2,514
7,152
4,028
409
6,572
34,159
1,827
16,562
3,169
12,602
18,905
2,114
3,544
225
5,939
2,295
4,788
19,675
1,193
1,064
15,335
310


11,240.2
2,927.6
18.0
233.8
249.5
5,263.6
118.9
45.8
2,105.8
277.2
7,033.3
911.6
203.1
65.0
13.6
164.7
451.9
442.3
2,229.4
340.7
816.7
514.0
53.6
826.5
4,995.1
248.0
2,405.9
481.6
1,859.5
2,686.7
301.5
516.4
23.4
802.0
358.1
685.3
2,609.4
68.3
163.4
2,134.7
33.6


5,228.3
1,439.5
8.6
113.3
132.0
2,485.6
49.4
20.8
871.1
108.1
3,354.1
448.8
83.6
27.9
6.1
69.4
200.2
189.6
1,100.1
153.8
408.2
240.4
25.4
400.6
2,108.3
105.3
1,029.1
204.8
769.0
1,214.4
126.3
235.3
13.4
391.1
151.9
296.4
1,191.3
49.1
67.6
953.9
19.9


10,603.6
2,772.3
13.1
223.7
241.7
4,857.6
117.2
51.5
2,013.7
312.9
8,268.2
873.8
186.5
81.5
14.7
160.4
445.4
436.3
3,173.4
479.0
846.7
726.9
54.0
789.6
5,057.8
279.0
2,439.7
482.3
1,856.9
2,652.5
299.5
491.0
22.7
841.2
358.6
639.5
2,461.8
18.6
178.1
2,027.3
38.7


9,814.9
2,414.3
13.9
204.1
218.2
4,742.5
98.5
46.8
1,784.6
292.0
7,713.2
779.8
172.7
80.3
14.2
154.8
419.9
410.2
2,991.9
430.2
792.9
680.6
47.6
738.1
4,722.5
244.1
2,274.1
441.5
1,762.6
2,533.7
263.1
483.0
24.2
841.3
325.0
597.1
2,269.3
18.2
159.1
1,860.7
35.6








Non-Local
Revenues
Net of
Discounts &
Fulltime Operating Employee Net Local
Number Number Equivalent Expenses Salaries Revenues Matching*
Region / County Hospitals of Beds Employees (million $) (million $) (million $) (million $)
Putnam 1 141 448 54.9 25.4 49.6 49.8
St. Johns 1 316 1,325 154.6 75.5 149.5 145.8
Gainesville 12 1,897 9,264 1,212.9 567.3 1,206.9 1,145.3
Alachua 5 1,473 7,803 1,060.3 489.4 1,077.9 1,023.7
Bradford 1 25 203 21.0 13.7 20.6 20.7
Columbia 2 166 730 95.6 44.9 82.9 75.4
Levy 1 40 61 5.6 2.5 4.9 4.9
Suwannee 1 15 146 14.7 9.7 14.1 13.9
Union 2 178 321 15.6 7.2 6.5 6.8
Pensacola 14 2,410 7,638 1,071.8 430.9 1,131.9 1,040.3
Escambia 4 1,497 5,119 716.6 289.0 726.3 675.6
Okaloosa 4 456 1,519 231.7 88.8 277.6 252.2
Santa Rosa 4 349 540 67.7 28.8 64.9 50.2
Walton 2 108 460 55.8 24.3 63.1 62.3
Tallahassee 9 2,425 6,321 606.6 348.0 504.2 488.3
Franklin 1 25 85 6.7 3.3 4.5 4.4
Gadsden 1 1,230 2,283 114.0 115.8 1.5 1.3
Leon 5 1,097 3,646 459.6 214.3 477.1 457.5
Madison 1 25 81 6.8 3.6 6.2 6.9
Taylor 1 48 226 19.5 11.0 14.8 18.3
Panama City 10 923 3,550 415.2 193.6 425.9 411.7
Bay 5 694 2,776 345.1 153.7 360.7 343.8
Calhoun 1 25 58 5.7 2.5 4.8 5.0
Holmes 1 20 95 7.2 4.4 7.2 7.5
Jackson 2 125 478 42.6 25.3 39.8 42.3
Washington 1 59 144 14.6 7.7 13.5 13.2
Grand Total 280 61,323 233,586 31,871.2 14,636.1 32,312.7 30,139.3
Source: Agency for Healthcare Administration, Florida Hospital Uniform Reporting System.
*Non-local revenues include health insurance, Medicaid and Medicare payments received, net of administrative, employee
and policy discounts, and local government matching Medicaid funds.










Table 4. Total economic contributions of hospitals in Florida regions and counties in 2007.


Region / County


Miami-Fort Lauderdale
Broward
Hendry
Indian River
Martin
Miami-Dade
Monroe
Okeechobee
Palm Beach
St. Lucie
Orlando
Brevard
Citrus
Flagler
Hardee
Highlands
Lake
Marion
Orange
Osceola
Polk
Seminole
Sumter
Volusia
Tampa-St. Petersburg
Hernando
Hillsborough
Pasco
Pinellas
Sarasota-Bradenton
Charlotte
Collier
DeSoto
Lee
Manatee
Sarasota
Jacksonville
Baker
Clay


Employment
(fulltime &
part-timejobs)
227,516
60,743
285
4,420
5,009
110,373
1,819
761
39,088
5,018
155,598
18,460
3,374
1,251
233
3,086
8,303
8,776
54,283
7,389
18,490
13,925
852
17,177
102,016
4,562
49,378
7,588
40,488
52,863
5,315
9,545
422
17,452
6,726
13,403
51,721
1,610
2,953


Output
(Revenue)
(million $)
28,131
7,331
24
484
556
13,558
243
96
5,160
678
18,973
2,004
357
164
26
324
923
975
7,441
995
1,991
1,842
97
1,835
12,898
533
6,391
936
5,038
6,326
613
1,178
40
2,087
820
1,589
6,068
31
376


Value Added
(million $)

16,456
4,219
13
277
320
8,026
145
51
3,009
396
10,645
1,113
193
94
14
183
515
531
4,209
573
1,099
1,035
52
1,036
7,322
284
3,683
530
2,825
3,604
345
708
21
1,168
457
904
3,498
15
211


Indirect
Labor Income Indirect
(million $) Business Taxes
(million (million $)

11,743 974
3,132 254
13 1
209 16
247 19
5,774 469
96 7
37 2
2,001 183
234 22
7,143 591
876 59
143 10
56 5
10 1
127 9
369 28
374 30
2,610 230
330 31
819 62
611 65
42 2
775 59
4,915 421
191 14
2,474 211
364 26
1,886 170
2,535 212
237 18
487 40
20 1
844 73
313 27
634 53
2,562 188
60 1
133 12










Region / County

Duval
Nassau
Putnam
St. Johns
Gainesville
Alachua
Bradford
Columbia
Levy
Suwannee
Union
Pensacola
Escambia
Okaloosa
Santa Rosa
Walton
Tallahassee
Franklin
Gadsden
Leon
Madison
Taylor
Panama City
Bay
Calhoun
Holmes
Jackson
Washington
Grand Total


Employment
(fulltime &
art-timejobs)
42,536
629
937
3,057
26,188
23,380
402
1,594
108
273
431
21,649
15,147
4,326
1,048
1,128
12,738
142
2,895
9,172
142
387
8,950
7,514
115
170
884
266
659,240


Output
(Revenue)
(million $)
5,178
68
92
323
2,844
2,599
38
164
9
25
10
2,608
1,779
580
115
134
1,067
9
3
1,018
11
27
969
851
9
13
73
23
79,882


Value Added
(million $)

3,007
35
48
182
1,660
1,527
21
88
4
14
5
1,496
1,034
332
61
69
610
5
1
585
5
14
545
483
5
7
38
12
45,836


Indirect
Labor Income Indirect
(million $) Business Taxes
(million (million $)

2,157 161
31 2
42 2
139 11
1,223 83
1,098 77
21 1
77 4
4 0
14 1
9 0
977 75
685 53
199 15
46 3
47 4
588 30
5 0
135 0
427 29
5 0
16 1
396 29
335 26
4 0
7 0
39 2
12 0
32,082 2,602








Economic Contributions by Industry Group

Total economic impacts of Florida hospitals are summarized by major industry group in Table 5.

Naturally, the largest impacts occurred in the health and social services group in which the direct impacts of

hospitals occur, with total employment impacts of 298,183 jobs, total output impacts of $36.64 Bn, and total

value added impacts of $19.97 Bn. In addition, however, employment impacts in excess of 20,000 jobs also

occurred in Transportation and Warehousing (49,891 jobs), Government (49,146), Real Estate and Rental

(33,995), Professional, Scientific and Technical Services (33,755), Administrative and Waste Services (32,491),

Accommodation and Food Services (28,935), Other Services (25,846),Construction (25,068), and Finance and

Insurance (20,033).


Table 5. Summary of economic contributions of Florida hospitals, by major industry group in 2007.
Employment Value Labor Other Indirect
Value Labor
(fulltime & Output Property Business
Industry Group (NAICS*) full-timee & output Added Income Property Business
part-time (Mn$) (Mn$) (Mn$) Type Income Taxes
jobs) (Mn$) (Mn$)


Agriculture, Forestry, Fishing
Mining
Utilities
Construction
Manufacturing
Wholesale Trade
Transportation & Warehousing
Retail Trade
Information
Finance & Insurance
Real Estate & Rental
Professional, Scientific & Tech. Services
Management of Companies
Administrative & Waste Services
Educational Services
Health & Social Services
Arts, Entertainment & Recreation
Accommodation & Food Services
Other Services
Government
Total


2,528
267
1,391
25,068
10,022
13,831
49,891
10,011
5,875
20,033
33,995
33,755
5,166
32,491
6,423
298,183
6,385
28,935
25,846
49,146
659,240


187
98
850
3,533
3,410
2,417
3,321
1,127
1,643
3,974
7,501
3,769
1,126
1,932
381
36,641
460
1,815
1,619
4,078
79,882


98
25
585
1,474
990
1,569
2,307
544
762
1,864
5,525
2,239
638
1,171
217
19,971
292
955
859
3,751
45,836


38
13
176
1,215
673
924
1,441
403
390
1,253
737
1,893
514
973
197
16,590
182
654
628
3,186
32,082


56
11
314
233
277
299
354
112
304
526
3,929
300
114
173
17
1,248
74
192
158
565
9,256


4
2
95
25
40
346
512
28
67
85
859
46
10
25
3
236
37
108
73
0
2,602


*Industry groups classified according to the North American Industry Classification System.








Tax Impacts


The impacts of Florida hospitals on local, state and federal government tax revenues in 2007 are

summarized in Table 6. Total tax impacts in 2007 were estimated at $10.39 Bn, including $7.57 Bn to the

Federal government and $2.85 Bn to state and local governments. The largest individual tax items were federal

income taxes ($3.02 Bn), employer and employee contributions to federal social insurance tax or "Social

Security" ($1.81 Bn each, respectively), Florida sales taxes ($1.11 Bn), Florida property taxes ($863 Mn), and

federal corporate profits taxes ($687 Mn).


Table 6. Total tax impacts of Florida hospitals on government tax revenues, 2007
Amount
Government / Tax Item mn
(Mn$)
Federal Government (Non-Defense) 7,569.2
Corporate Profits Tax 687.3
Customs Duty 53.0
Excise Taxes 126.8
Indirect business Non-Taxes 63.5
Income Tax 3,021.5
Social Insurance Tax- Employee Contribution 1,805.6
Social Insurance Tax- Employer Contribution 1,811.6
State and Local Government (Non-Education) 2,849.8
Corporate Profits Tax 104.6
Dividends 173.4
Motor Vehicle Licenses 16.9
Other Indirect Business Taxes 276.7
Property Tax 863.0
Non-Taxes 90.7
Sales Tax 1,114.2
Severance Tax 2.0
Motor Vehicle License 35.6
Fines, Fees 111.9
Fishing, Hunting Licenses 2.2
Social Ins Tax- Employee Contribution 11.1
Social Ins Tax- Employer Contribution 47.6
Enterprises (Corporations) transfers -25.0
Total 10,394.0
Note: total tax impacts include direct, indirect and induced multiplier effects.








Literature and Information Sources Cited

Agency for Healthcare Administration. State of Florida Hospital Uniform Reporting System Manual (AHA-
FHURS), July, 2005; 196 pages. Available at
http://www.fdhc.state.fl.us/MCHQ/CON FA/fa data/index.shtml.

American Hospital Association (AHA). The economic contribution of hospitals. Jan. 2009.

Anderson, Robert, Kenneth Wieand and Dennis Colie. The Economic Impact of Florida's Hospitals. University
of South Florida, Center for Economic Development Research, Tampa, FL; 35 pages; May 1999.

Florida Hospital Association (FHA). Facts and statistics about Florida's health care system. Oct. 2008. Available
at http://www.fha.org/facts.html.

Johnson, K. and J. Kort. Redefinition of the BEA Economic Areas. Bureau of Economic Analysis, U.S.
Department of Commerce, Survey of Current Business, pp. 68-75, Nov. 2004. Available at
http://www.bea.gov/scb/pdf/2004/11November/l 104Econ-Areas .pdf

Miller, Roland E. and Peter D. Blair. Input-Output Analysis: Foundations and Extensions. Prentice-Hall,
Englewood Cliffs, NJ, 464 pp, 1985 (Revised 2nd edition to be published by Cambridge University Press,
May 2009).

Minnesota IMPLAN Group, Inc. (MIG). IMPLAN Professional economic impact analysis and social accounting
software and county data for Florida. Stillwater, MN. Web resources available at www.implan.com.








Appendix A: Glossary of Economic Impact Terms
Terms are presented in a logical order rather than alphabetical order

Region defines the geographic area for which impacts are estimated. Regions are generally an aggregation of one
or more counties. Economic regions identified in this paper were defined based on worker commuting patterns.

Sector is a grouping of industries that produce similar products or services, or production processes. Most
economic reporting and models in the U.S. are based on the Standard Industrial Classification system (SIC code)
or the North American Industrial Classification System (NAICS).

Impact analysis estimates the impact of a change in output or employment resulting from a change in final
demand to households, governments or exports.

Input-output (I-O) model. An input-output model is a representation of the flows of economic activity between
industry sectors within a region. The model captures what each business or sector must purchase from every
other sector in order to produce its output of goods or services. Using such a model, flows of economic activity
associated with any change in spending may be traced backwards (e.g., purchases of plants that leads growers to
purchase additional inputs -- fertilizers, containers, etc.). Multipliers for a region may be derived from an input-
output model of the region's economy.

IMPLANis a micro-computer-based input output modeling system and Social Accounting Matrix (SAM). With
IMPLAN, one can estimate I-O models of up to 440 sectors for any region consisting of one or more counties.
IMPLAN includes procedures for generating multipliers and estimating impacts by applying final demand
changes to the model. The current version of the software is IMPLANPro 2.

Direct effects are the changes in economic activity during the first round of spending. Secondary effects are the
changes in economic activity from subsequent rounds of re-spending. There are two types of secondary effects:
Indirect effects are the changes in sales, income or employment within the region in backward-linked industries
supplying goods and services to businesses. For example, the increased sales in input supply firms resulting from
more nursery industry sales is an indirect effect. Induced effects are the increased sales within the region from
household spending of the income earned in the direct and supporting industries. Employees in the direct and
supporting industries spend the income they earn on housing, utilities, groceries, and other consumer goods and
services. This generates sales, income and employment throughout the region's economy. Total effects are the
sum of direct, indirect and induced effects.

Multipliers capture the total effects, both direct and secondary, in a given region, generally as a ratio of the total
change in economic activity in the region relative to the direct change. Multipliers may be expressed as ratios of
sales, income or employment, or as ratios of total income or employment changes relative to direct sales.
Multipliers express the degree of interdependency between sectors in a region's economy and therefore vary
considerably across regions and sectors. Type I multipliers include only direct and indirect effects. Type II
multipliers also include induced effects. Type SAM multipliers used by IMPLAN additionally account for
capital investments and transfer payments such as welfare and retirement income. A sector-specific multiplier
gives the total changes to the economy associated with a unit change in output or employment in a given sector.

Purchaser prices are the prices paid by the final consumer of a good or service. Producer prices are the prices
of goods at the factory or production point. For manufactured goods the purchaser price equals the producer
price plus a retail margin, a wholesale margin, and a transportation margin. For services, the producer and
purchaser prices are equivalent.








Margins. The retail, wholesale and transportation margins are the portions of the purchaser price accruing to the
retailer, wholesaler, and grower, respectively. Only the retail margins of many goods purchased by consumers
accrue to the local region, as the wholesaler, shipper, and manufacturer often lie outside the local area.

Measures of economic activity. Sales or output is the dollar volume of a good or service produced or sold.
Final Demand is sales to final consumers, including households, governments, and exports. Intermediate sales
are sales to other industrial sectors. Income is the money earned within the region from production and sales.
Total income includes personal income (wage and salary income, including income of sole proprietor's profits
and rents). Jobs or employment is a measure of the number of jobs required to produce a given volume of
sales/production, usually expressed as full time equivalents, or as the total number including part time and
seasonal positions. Value Added is the sum of total income and indirect business taxes. Value added is the most
commonly used measure of the contribution of a region to the national economy, as it avoids double counting of
intermediate sales and captures only the "value added" by the region to final products.










Appendix B: Listing of Florida Hospitals, by County
Source: Florida Hospital Association


Number Fulltime
Number ae
Beds Equivalent
Employees


Alachua
Alachua
Alachua
Alachua
Alachua
Baker
Baker
Bay
Bay
Bay
Bay
Bay
Bradford
Brevard
Brevard
Brevard
Brevard
Brevard
Brevard
Brevard
Brevard
Brevard
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Broward
Calhoun
Charlotte
Charlotte
Charlotte
Citrus
Citrus
Clay
Clay
Collier


North Florida Regional Medical Center
Shands AGH
Shands at the University of Florida
Shands Rehab Hospital
Shands Vista
Ed Fraser Memorial Hospital
Northeast Florida State Hospital
Bay Medical Behavioral Health Center
Bay Medical Center
Gulf Coast Medical Center
HealthSouth Emerald Coast Rehab Hospital
Select Specialty Hospital-Panama City
Shands Starke
Cape Canaveral Hospital
Circles of Care, Inc.
Devereux Florida Treatment Network
HealthSouth Sea Pines Rehabilitation Hospital
Holmes Regional Medical Center
Palm Bay Community Hospital
Parrish Medical Center
Wuesthoff Medical Center-Melbourne
Wuesthoff Medical Center-Rockledge
Atlantic Shores Hospital
Broward Health-Broward General Medical Center
Broward Health-Coral Springs Medical Center
Broward Health-Imperial Point Medical Center
Broward Health-North Broward Medical Center
Cleveland Clinic Florida Weston
Florida Medical Center
Ft. Lauderdale Hospital
HealthSouth Sunrise Rehabilitation Hospital
Hollywood Pavilion
Holy Cross Hospital
Kindred Hospital South Florida-Ft. Lauderdale
Kindred Hospital South Florida-Hollywood
Memorial Hospital Miramar
Memorial Hospital Pembroke
Memorial Hospital West
Memorial Regional Hospital
Memorial Regional Hospital South
Northwest Medical Center
Plantation General Hospital
South Florida State Hospital
St. Anthony's Rehabilitation Hospital
University Hospital & Medical Center
University Pavilion Hospital
Westside Regional Medical Center
Calhoun-Liberty Hospital, Inc.
Charlotte Regional Medical Center
Fawcett Memorial Hospital, Inc.
Peace River Regional Medical Center
Citrus Memorial Health System
Seven Rivers Regional Medical Center
Kindred Hospital North Florida
Orange Park Medical Center
NCH Downtown Naples Hospital


Gainesville
Gainesville
Gainesville
Gainesville
Gainesville
Macclenny
Macclenny
Panama City
Panama City
Panama City
Panama City
Panama City
Starke
Cocoa Beach
Melbourne
Viera
Melbourne
Melbourne
Palm Bay
Titusville
Melbourne
Rockledge
Ft. Lauderdale
Ft. Lauderdale
Coral Springs
Ft. Lauderdale
Deerfield Beach
Weston
Ft. Lauderdale
Ft. Lauderdale
Sunrise
Hollywood
Ft. Lauderdale
Ft. Lauderdale
Hollywood
Miramar
Pembroke Pines
Pembroke Pines
Hollywood
Hollywood
Margate
Plantation
Pembroke Pines
Lauderdale Lakes
Tamarac
Tamarac
Plantation
Blountstown
Punta Gorda
Port Charlotte
Port Charlotte
Inverness
Crystal River
Green Cove Springs
Orange Park
Naples


County


Hospital Name


Acute Care
Acute Care
Acute Care
Rehabilitation
Psychiatric
Acute Care
Psychiatric
Psychiatric
Acute Care
Acute Care
Rehabilitation
Acute Care/LTC
Acute Care
Acute Care
Psychiatric
IRTF/Psychiatric
Rehabilitation
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Rehabilitation
Psychiatric
Acute Care
Acute Care/LTC
Acute Care/LTC
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Rehabilitation
Acute Care
Psychiatric/Dept.
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care/LTC
Acute Care
Acute Care


1,257.5


325
367
660
40
81
25
1,138
90
323
176
75
30
25
150
52
100
90
514
60
210
115
291
72
716
200
204
409
150
459
100
126
60
571
70
124
178
301
299
690
324
215
264
350
26
257
60
224
25
208
238
219
198
128
80
230
420


6,545.3



122.1
1,071.0

1,850.0
715.7
135.3
74.8
203.4
891.7
153.4
219.7
148.2
3,381.4

892.6
472.1
1,142.3
90.3
2,819.2
889.6
648.4
1,287.3
804.6
808.0
160.4
262.4
68.0
1,785.7
150
260.7
602.5
823.8
2,058.5
4,531.8

661.0
553.3
412.0
45.0
618.9

717.7
58.0
771.6
629.3
713.2
1,076.3
440.5
172
891.7
2,815.7










Number Fulltime
Number
Beds Equivalent
Employees


Collier
Collier
Collier
Collier
Columbia
Columbia
DeSoto
Duval
Duval
Duval
Duval
Duval
Duval
Duval
Duval
Duval
Duval
Duval
Escambia
Escambia
Escambia
Escambia
Flagler
Franklin
Gadsden
Hardee
Hendry
Hernando
Hernando
Hernando
Hernando
Hernando
Highlands
Highlands
Highlands
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Hillsborough
Holmes
Indian River
Indian River
Indian River
Jackson
Jackson
Lake
Lake
Lake
Lake
Lee


NCH North Naples Hospital
Physicians Regional Medical Center-Collier Boulevard
Physicians Regional Medical Center-Pine Ridge
The Willough Healthcare System
Lake City Medical Center
Shands Lake Shore
DeSoto Memorial Hospital, Inc
Baptist Medical Center
Baptist Medical Center Beaches
Baptist Medical Center South
Brooks Rehabilitation Hospital
Mayo Clinic Hospital
Memorial Hospital Jacksonville
Shands Jacksonville
Specialty Hospital Memorial Health
St. Vincent's Medical Center
Ten Broeck Hospital Jacksonville
Wekiva Springs Center for Women
Baptist Hospital, Inc.
Lakeview Center, Inc.
Sacred Heart Hospital of Pensacola
West Florida Hospital
Florida Hospital Flagler
George E. Weems Memorial Hospital
Florida State Hospital
Florida Hospital Wauchula
Hendry Regional Medical Center
Brooksville Regional Hospital
HealthSouth Rehabilitation Hospital of Spring Hill
Oak Hill Hospital
Spring Hill Regional Hospital
Springbrook Hospital
Florida Hospital Heartland Med. Ctr.
Florida Hospital Lake Placid
Highlands Regional Medical Center
Brandon Regional Hospital
H. Lee Moffitt Cancer Ctr & Rsrch Inst
Kindred Hospital Bay Area-Tampa
Kindred Hospital Central Tampa
Memorial Hospital of Tampa
South Bay Hospital
South Florida Baptist Hospital
St. Joseph's Hospital, Inc.
St. Joseph's Women's Hospital
Tampa General Hospital
Town & Country Hospital
University Community Hospital-Carrollwood
University Community Hospital-Medical Center
Doctors Memorial Hospital
HealthSouth Treasure Coast Rehab. Hospital
Indian River Medical Center
Sebastian River Medical Center
Campbellton-Graceville Hospital
Jackson Hospital
Florida Hospital Waterman
Leesburg Regional Medical Center
LifeStream Behavioral Center
South Lake Hospital
Cape Coral Hospital


Naples
Naples
Naples
Naples
Lake City
Lake City
Arcadia
Jacksonville
Jacksonville Beach
Jacksonville
Jacksonville
Jacksonville
Jacksonville
Jacksonville
Jacksonville
Jacksonville
Jacksonville
Jacksonville
Pensacola
Pensacola
Pensacola
Pensacola
Palm Coast
Apalachicola
Chattahoochee
Wauchula
Clewiston
Brooksville
Brooksville
Brooksville
Spring Hill
Brooksville
Sebring
Lake Placid
Sebring
Brandon
Tampa
Tampa
Tampa
Tampa
Sun City Center
Plant City
Tampa
Tampa
Tampa
Tampa
Tampa
Tampa
Bonifay
Vero Beach
Vero Beach
Sebastian
Graceville
Marianna
Tavares
Leesburg
Leesburg
Clermont
Cape Coral


County


Hospital Name


Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Rehabilitation
Acute Care
Acute Care
Acute Care
Acute Care/LTC
Acute Care
Psychiatric
Psychiatric
Acute Care
IRTF/Psychiatric
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Acute Care
Rehabilitation
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care/LTC
Acute Care/LTC
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care/Dept.
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Rehabilitation
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care


261
100
83
42
67
99
49
579
146
120
143
214
353
696
107
528
99
20
492
16
458
531
99
25
1,230
25
25
120
70
204
124
66
159
50
126
367
162
73
102
180
112
147
649
234
877
201
120
475
20
90
335
129
25
100
204
309
40
104
291


706.6
21.7
331.0
399.1
224.6
4,402.9
755.2

490.1
1,608.9
1,410.2
3,362.3
230.6
2,832.3
158.6
84.0
1,972.6
25.8
2,099.1
1,021.1
489.8
85.1
2,283.0
109.7
152.2
823.5
173.4
714.9

114.9
867.6

376.9
1,344.9
2,122.1
129.2
195.9
453.8
394.9
598.4
3,682.6

4,949.3
348.3
427.1
1,915.3
95.0
156.7
1,283.4
416.9
75.2
402.3
1,034.3
1,507.6
85.5
712.8
1,150.8










Number Fulltime
Number
Beds Equivalent
Employees


Lee
Lee
Lee
Lee
Lee
Leon
Leon
Leon
Leon
Leon
Levy
Madison
Manatee
Manatee
Manatee
Manatee
Marion
Marion
Marion
Marion
Marion
Marion
Martin
Martin
Martin
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Miami-Dade
Monroe


Gulf Coast Hospital
HealthPark Medical Center
Lee Memorial Hospital
Lehigh Regional Medical Center
Southwest Florida Regional Medical Center
Capital Regional Medical Center
Eastside Psychiatric Hospital
HealthSouth Rehabilitation Hospital of Tallahassee
Select Specialty Hospital-Tallahassee
Tallahassee Memorial Hospital
Nature Coast Regional Health Network
Madison County Memorial Hospital
Blake Medical Center
Lakewood Ranch Medical Center
Manatee Glens Hospital
Manatee Memorial Hospital
Kindred Hospital Ocala
Marion-Citrus Mental Health Centers
Munroe Regional Medical Center
Ocala Regional Medical Center
Ten Broeck Hospital Ocala
West Marion Community Hospital
Martin Memorial Hospital South
Martin Memorial Medical Center
SandyPines Hospital
Aventura Hospital and Medical Center
Baptist Hospital of Miami, Inc.
Bascom Palmer Eye Inst/Anne Bates Leach Eye Hosp
Coral Gables Hospital
Doctors Hospital
HealthSouth Rehab Hospital of Miami
Hialeah Hospital
Homestead Hospital
Jackson Memorial Hospital
Jackson North Medical Center
Jackson North Specialty & Diagnostic Center
Jackson South Community Hospital
Kendall Regional Medical Center
Kindred Hospital South Florida-Coral Gables
Larkin Community Hospital
Mercy Hospital
Metropolitan Hospital of Miami
Miami Children's Hospital
Miami Jewish Home & Hospital for the Aged
Mount Sinai Medical Center
North Shore Medical Center
Palm Springs General Hospital
Palmetto General Hospital
Select Specialty Hospital-Miami
Sister Emmanuel Hospital
South Florida Evaluation and Treatment Center
South Miami Hospital
Southern Winds Hospital
St. Catherine's Rehabilitation Hospital
University of Miami Hospital
University of Miami Hospital/Clinics
West Gables Rehabilitation Hospital
Westchester General Hospital
DePoo Hospital


County


Hospital Name


Ft. Myers
Ft. Myers
Ft. Myers
Lehigh Acres
Ft. Myers
Tallahassee
Tallahassee
Tallahassee
Tallahassee
Tallahassee
Williston
Madison
Bradenton
Bradenton
Bradenton
Bradenton
Ocala
Ocala
Ocala
Ocala
Ocala
Ocala
Stuart
Stuart
Tequesta
Aventura
Miami
Miami
Coral Gables
Coral Gables
Miami
Hialeah
Homestead
Miami
North Miami Beach
Opalocka
Miami
Miami
Coral Gables
South Miami
Miami
Miami
Miami
Miami
Miami Beach
Miami
Hialeah
Hialeah
Miami
Miami
Miami
Miami
Hialeah
North Miami
Miami
Miami
Miami
Miami
Key West


Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Rehabilitation
Acute Care/LTC
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care/LTC
Psychiatric
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Rehabilitation
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care/LTC
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care/LTC
Acute Care/LTC
Psychiatric
Acute Care
Psychiatric
Rehabilitation
Acute Care
Acute Care
Rehabilitation
Acute Care
Acute Care


367.2


120
368
427
88
400
198
24
76
29
770
40
25
383
120
27
319
31
15
421
200
42
70
100
244
80
407
584
100
256
281
60
378
120
1,498
382
60
199
412
53
132
473
146
289
32
955
357
247
360
47
29
238
445
72
60
560
40
60
125
49


3,055.8
275.3
1,089.8
638.3
52.9
142.9
27.1
2,785.1
60.7
80.5
835.3
306.2
52.4
1,101.1
67.0
16.9
2,101.2
1,027.2
2.2



1,999.1
32.3
1,008.5
3,749.6
604.0
444.8
842.0
159.8
652.1
769.1
9,779.2




1,093.7
156.1
459.2
1,835.0
1,179.8
2,157.8
129.0
2,801.1
813.5
730.0
1,279.2
136.7
89.2
280
2,090.4

64.8
1,047.4
1,011.3
160.4
610.3










Hospital Name


Monroe
Monroe
Monroe
Nassau
Okaloosa
Okaloosa
Okaloosa
Okaloosa
Okeechobee
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Orange
Osceola
Osceola
Osceola
Osceola
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Palm Beach
Pasco
Pasco
Pasco
Pasco
Pasco
Pinellas
Pinellas
Pinellas
Pinellas
Pinellas
Pinellas
Pinellas
Pinellas
Pinellas
Pinellas


Fishermen's Hospital
Lower Keys Medical Center
Mariners Hospital
Baptist Medical Center Nassau
Fort Walton Beach Medical Center
Gulf Coast Treatment Center
North Okaloosa Medical Center
Twin Cities Hospital
Raulerson Hospital
Arnold Palmer Hospital for Children
Dr. P. Phillips Hospital
Florida Hospital Apopka
Florida Hospital East Orlando
Florida Hospital Orlando
Florida Hospital Winter Park
Health Central
La Amistad Residential Treatment Center
Lakeside Behavioral Healthcare, Inc.
Orlando Regional Lucerne Hospital
Orlando Regional Medical Center
Select Specialty Hospital Orlando-South
Select Specialty Hospital-Orlando
University Behavioral Center
Florida Hospital Celebration Health
Florida Hospital Kissimmee
Osceola Regional Medical Center
St. Cloud Regional Medical Center
A.G. Holley State Hospital
Bethesda Healthcare System
Boca Raton Community Hospital
Columbia Hospital
Delray Medical Center, Inc.
Fair Oaks Pavilion
Glades General Hospital
Good Samaritan Medical Center
JFK Medical Center
Jupiter Medical Center
Oakwood Center of the Palm Beaches, Inc.
Palm Beach Gardens Medical Ctr.
Palms West Hospital
Pinecrest Rehab. Hospital at Delray
St. Mary's Medical Center
Wellington Regional Medical Center
West Boca Medical Center, Inc.
Community Hospital
Florida Hospital Zephyrhills
Morton Plant North Bay Hospital
Pasco Regional Medical Center
Regional Medical Center Bayonet Point
All Children's Hospital
Bayfront Medical Center
Edward White Hospital
HealthSouth Rehabilitation Hospital
Helen Ellis Memorial Hospital
Kindred Hospital Bay Area-St. Petersburg
Largo Medical Center
Mease Hospital/Countryside
Mease Hospital/Dunedin
Morton Plant Hospital


Marathon
Key West
Tavernier
Fernandina Beach
Ft. Walton Beach
Ft. Walton Beach
Crestview
Niceville
Okeechobee
Orlando
Orlando
Apopka
Orlando
Orlando
Winter Park
Ocoee
Maitland
Orlando
Orlando
Orlando
Orlando
Orlando
Orlando
Celebration
Kissimmee
Kissimmee
St. Cloud
Lantana
Boynton Beach
Boca Raton
West Palm Beach
Delray Beach
Delray Beach
Belle Glade
West Palm Beach
Atlantis
Jupiter
West Palm Beach
Palm Beach Gardens
Loxahatchee
Delray Beach
West Palm Beach
Wellington
Boca Raton
New Port Richey
Zephyrhills
New Port Richey
Dade City
Hudson
St. Petersburg
St. Petersburg
St. Petersburg
Largo
Tarpon Springs
St. Petersburg
Largo
Safety Harbor
Dunedin
Clearwater


County


Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
IRTF/Psychiatric
Psychiatric
Acute Care
Acute Care
Acute Care/LTC
Acute Care/LTC
Psychiatric
Acute Care
Acute Care
Acute Care
Acute Care
Specialty
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric/Dept.
Acute Care
Acute Care
Acute Care
Acute Care
Psychiatric
Acute Care
Acute Care
Rehabilitation/Dept.
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Acute Care
Rehabilitation
Acute Care
Acute Care/LTC
Acute Care
Acute Care
Acute Care
Acute Care


Number Fulltime
Number ae
Beds Equivalent
Employees
58 142.9
118 388.0
42 195.0
54 310.1
257 825.4
24 30.6
110 464.6
65 198.5
100 325.8
443 2,919
161 1,061
50 288
225 1,295
896 5,155
297 1,709
171 983.0
40 75.7
56 60.8
209 1,377
581 3,829


130.2
47.0
644
478
1,043.7
348.8
175.9
1,623.0
2,065.4
522.4
1,186.7

266.3
667.7
1,582.4
997.5
63.5
666.4
646.4
45.0
1,404.0
694.9
685.7
883.3
650.5
456.4
333.3
845.1
1,844.2
1,775.5
257.6
173.7
447.0
176.5
706.6


1,755.4
2,130.9









Number Fulltime
County Hospital Name City Type Beds Equivalent
Employees
Pinellas Northside Hospital and Heart Institute St. Petersburg Acute Care 288 647.8
Pinellas Palms of Pasadena Hospital St. Petersburg Acute Care 307 545.1
Pinellas St. Anthony's Hospital St. Petersburg Acute Care 395 1,014.1
Pinellas St. Petersburg General Hospital St. Petersburg Acute Care 219 521.3
Pinellas Sun Coast Hospital Largo Acute Care/Dept. 200 450.2
Pinellas Windmoor Healthcare of Clearwater Clearwater Psychiatric 100 156.2
Polk Bartow Regional Medical Center Bartow Acute Care 72 321.6
Polk Heart of Florida Regional Medical Center Davenport Acute Care 142 692.3
Polk Lake Wales Medical Centers Lake Wales Acute Care 154 355.6
Polk Lakeland Regional Medical Center Lakeland Acute Care 851 3,661.7
Polk Regency Medical Center Winter Haven Acute Care 61
Polk Winter Haven Hospital Winter Haven Acute Care 466 2,120.4
Putnam Putnam Community Medical Center Palatka Acute Care 141 448.1
Santa Rosa Baptist Hospital, Inc. d/b/a/ Gulf Breeze Hospital Gulf Breeze Acute Care 65
Santa Rosa Jay Hospital Jay Acute Care 55 120.6
Santa Rosa Santa Rosa Medical Center Milton Acute Care 129 327.1
Santa Rosa West Florida Community Care Ctr. Milton Psychiatric 100 92.5
Sarasota Bayside Center for Behavioral Health Sarasota Psychiatric/Dept. 86
Sarasota Doctors Hospital of Sarasota Sarasota Acute Care 168 429.2
Sarasota Englewood Community Hospital, Inc. Englewood Acute Care 100 269.8
Sarasota HealthSouth Rehab Hospital of Sarasota Sarasota Rehabilitation 76 182.6
Sarasota HealthSouth RidgeLake Hospital Sarasota Acute Care/LTC 40 96.3
Sarasota Sarasota Memorial Hospital Sarasota Acute Care 720 3,069.1
Sarasota Venice Regional Medical Center Venice Acute Care 312 741.4
Seminole Central Florida Regional Hospital Sanford Acute Care 226 708.7
Seminole Florida Hospital Altamonte Altamonte Springs Acute Care 341 1,962
Seminole Orlando Regional South Seminole Hospital Longwood Acute Care 206 1,358
St. Johns Flagler Hospital, Inc. St. Augustine Acute Care 316 1,325.3
St. Lucie Lawnwood Regional Medical Ctr. & Heart Inst. Ft. Pierce Acute Care 341 931.4
St. Lucie Port St. Lucie Hospital Port St. Lucie Psychiatric 75 98.9
St. Lucie St. Lucie Medical Center Port St. Lucie Acute Care 194 643.4
Sumter The Villages Regional Hospital The Villages Acute Care 192 408.6
Suwannee Shands Live Oak Live Oak Acute Care 15 145.8
Taylor Doctors' Memorial Hospital, Inc. Perry Acute Care 48 226.1
Union Lake Butler Hospital/Hand Surgery Center Lake Butler Acute Care 25 70.7
Union Reception and Medical Center Lake Butler Specialty 153 250.0
Volusia Bert Fish Medical Center New Smyrna Beach Acute Care 112 621.8
Volusia Florida Hospital DeLand DeLand Acute Care 156 704.9
Volusia Florida Hospital Fish Memorial Orange City Acute Care 139 742.4
Volusia Florida Hospital Memorial Medical Center Ormond Beach Acute Care 205 1,030.4
Volusia Florida Hospital Oceanside Ormond Beach Acute Care 119
Volusia Halifax Behavioral Services Daytona Beach Psychiatric 30
Volusia Halifax Health Medical Center of Port Orange Port Orange Acute Care 80
Volusia Halifax Health Medical Center Daytona Beach Acute Care 654 3,472.0
Walton Healthmark Regional Medical Center DeFuniak Springs Acute Care 50 138.1
Walton Sacred Heart Hospital on the Emerald Coast Destin Acute Care 58 322.3
Washington Northwest Florida Community Hospital Chipley Acute Care 59 143.8
Note: some employment figures (shown in red type) were estimated in proportion to total number of beds for parent
company reporting unit, for purposes of county and regional analysis.








Appendix C: Florida Hospital Industry Purchases
Sectors shown represent at least 0.01 percent of total purchases

Share of Share of
Industry Sector / Institution Total Purchases
Purchases within State
Commodity Purchases
Real estate establishments 11.14% 70.00%
Management of companies and enterprises 2.60% 80.00%
Medical and diagnostic labs and outpatient and oth 2.44% 89.98%
Pharmaceutical preparation manufacturing 1.97% 17.70%
Insurance carriers 1.78% 66.08%
Veterinary services 1.74% 95.00%
In-vitro diagnostic substance manufacturing 1.71% 19.53%
Wholesale trade businesses 1.51% 90.81%
Electromedical and electrotherapeutic apparatus manuf. 1.26% 74.19%
Employment services 1.24% 80.00%
Electric power generation- transmission- and distribution 1.15% 71.63%
Sanitary paper product manufacturing 0.94% 0.06%
Surgical appliance and supplies manufacturing 0.91% 57.02%
Securities- commodity contracts- investments- and 0.88% 68.69%
Office administrative services 0.81% 80.00%
Animal (except poultry) slaughtering- rendering- a 0.72% 17.04%
US Postal Service 0.68% 69.66%
Other plastics product manufacturing 0.65% 25.72%
Surgical and medical instrument- laboratory and me 0.61% 76.20%
Management- scientific- and technical consulting s 0.60% 80.00%
Industrial gas manufacturing 0.54% 40.81%
Telecommunications 0.52% 56.80%
Services to buildings and dwellings 0.50% 80.00%
Legal services 0.42% 90.00%
Advertising and related services 0.40% 79.61%
Food services and drinking places 0.39% 90.00%
Commercial and industrial machinery and equipment 0.37% 80.00%
Accounting- tax preparation- bookkeeping- and payroll services 0.35% 90.00%
Automotive repair and maintenance- except car wash 0.35% 90.00%
Transport by truck 0.33% 76.26%
Ice cream and frozen dessert manufacturing 0.30% 42.84%
Seafood product preparation and packaging 0.26% 59.63%
Poultry processing 0.23% 15.95%
Other computer related services 0.22% 78.48%
Automotive equipment rental and leasing 0.22% 90.00%
Other basic organic chemical manufacturing 0.22% 42.65%
Maintenance & repair construct of nonresident structures 0.21% 100.00%
Cheese manufacturing 0.21% 6.07%
Fruit and vegetable canning- pickling- and drying 0.21% 4.26%
Soft drink and ice manufacturing 0.19% 16.83%








Share of Share of
Industry Sector / Institution Total Purchases
Purchases within State
Curtain and linen mills 0.19% 0.91%
Computer systems design services 0.18% 69.86%
Investigation and security services 0.16% 80.00%
Electronic and precision equipment repair and main 0.16% 90.00%
Private hospitals 0.15% 85.18%
Petroleum refineries 0.14% 3.04%
Environmental and other technical consulting services 0.13% 80.00%
Dry-cleaning and laundry services 0.13% 90.00%
Commercial and industrial machinery and equipment 0.13% 80.00%
Coffee and tea manufacturing 0.12% 67.91%
Other rubber product manufacturing 0.12% 0.05%
Monetary authorities and depository credit intermediaries 0.12% 65.27%
All other miscellaneous professional- scientific- 0.10% 80.00%
Business support services 0.10% 80.00%
Other pressed and blown glass and glassware manufacturing 0.10% 29.70%
Warehousing and storage 0.10% 76.26%
Personal and household goods repair and maintenance 0.10% 90.00%
Printing 0.09% 25.30%
All other basic inorganic chemical manufacturing 0.09% 34.13%
Scientific research and development services 0.09% 42.43%
Water- sewage and other treatment and delivery sys 0.08% 80.94%
Other support services 0.08% 80.00%
Fluid milk and butter manufacturing 0.07% 58.42%
Couriers and messengers 0.07% 70.01%
Paper mills 0.07% 0.02%
Coated and laminated paper- packaging paper and pl 0.06% 0.02%
Alkalies and chlorine manufacturing 0.06% 58.95%
Retail Stores Motor vehicle and parts 0.05% 95.00%
All other food manufacturing 0.05% 32.86%
Transport by rail 0.05% 91.62%
Paperboard container manufacturing 0.05% 0.03%
Seasoning and dressing manufacturing 0.05% 57.48%
Transit and ground passenger transportation 0.05% 79.47%
Frozen food manufacturing 0.04% 3.95%
Travel arrangement and reservation services 0.04% 70.01%
Waste management and remediation services 0.04% 80.00%
Soap and cleaning compound manufacturing 0.04% 28.94%
Petrochemical manufacturing 0.04% 26.37%
Facilities support services 0.04% 80.00%
Cable and other subscription programming 0.04% 56.52%
Civic- social- professional- and similar organizations 0.04% 66.90%
Retail Stores Food and beverage 0.04% 94.05%
Data processing- hosting- ISP- web search portals 0.04% 30.41%








Share of Share of
Industry Sector / Institution Total Purchases
Purchases within State
Retail Stores General merchandise 0.04% 95.00%
Private junior colleges, colleges and universities 0.03% 69.27%
All other chemical product and preparation manuf. 0.03% 33.55%
Transport by air 0.03% 46.17%
Semiconductor and related device manufacturing 0.03% 61.46%
Nondepository credit intermediation and related ac 0.03% 68.69%
Retail Stores Furniture and home furnishings 0.03% 95.00%
Scenic and sightseeing transportation and support 0.03% 70.01%
Natural gas distribution 0.03% 35.61%
Retail Nonstores Direct and electronic sales 0.02% 82.39%
Magnetic and optical recording media manufacturing 0.02% 0.62%
Synthetic rubber manufacturing 0.02% 0.07%
Retail Stores Building material and garden supply stores 0.02% 95.00%
Architectural- engineering- and related services 0.02% 90.00%
Internet publishing and broadcasting 0.02% 26.24%
Other fabricated metal manufacturing 0.02% 0.00%
Air conditioning- refrigeration- and warm air heat 0.02% 0.00%
Crown and closure manufacturing and metal stamping 0.02% 2.15%
Paperboard Mills 0.02% 0.02%
Showcase- partition- shelving- and locker manufacturing 0.02% 36.76%
All other textile product mills 0.02% 1.91%
Retail Stores Health and personal care 0.02% 95.00%
Independent artists- writers- and performers 0.02% 79.78%
General and consumer goods rental except video tap 0.02% 80.00%
Synthetic dye and pigment manufacturing 0.02% 15.36%
Urethane and other foam product (except polystyrene 0.02% 33.52%
Retail Stores Clothing and clothing accessories 0.02% 95.00%
Car washes 0.02% 90.00%
Retail Stores Electronics and appliances 0.02% 95.00%
Retail Stores Miscellaneous 0.01% 95.00%
Motor vehicle parts manufacturing 0.01% 9.06%
Lighting fixture manufacturing 0.01% 0.09%
Retail Stores Gasoline stations 0.01% 75.39%
Hotels and motels- including casino hotels 0.01% 80.00%
Stationery product manufacturing 0.01% 0.07%
Other concrete product manufacturing 0.01% 0.72%
Cutlery- utensil- pot- and pan manufacturing 0.01% 6.17%
Retail Stores Sporting goods- hobby- book and mu 0.01% 90.61%
Other state and local government enterprises 0.01% 77.39%
All other miscellaneous wood product manufacturing 0.01% 20.70%
Other electronic component manufacturing 0.01% 29.06%
Broadwoven fabric mills 0.01% 1.99%
Transport by water 0.01% 100.00%








Share of Share of
Industry Sector / Institution Total Purchases
Purchases within State
Womens and girls cut and sew apparel manufacturing 0.01% 9.78%
Office supplies (except paper) manufacturing 0.01% 7.24%
Other information services 0.01% 26.39%
Pottery- ceramics- and plumbing fixture manufacturing 0.01% 0.02%
Laminated plastics plate- sheet (except packaging) 0.01% 46.90%
Periodical publishers 0.01% 29.23%
Value Added
Employee Compensation 50.04% 100.00%
Proprietary Income 0.36% 100.00%
Other Property Income 2.48% 100.00%
Indirect Business Taxes 0.63% 100.00%
Total Value Added 53.51% 100.00%
Source: IMPLANProfessional data for Florida (MIG, Inc., 2008).




Full Text

PAGE 1

1 Economic Contributions of Hospitals in Florida Sponsored Project Final Report to the Florida Hospital Association Orlando, FL By Alan W. Hodges and Mohammad Rahmani University of Florida, Food & Resource Economics Department PO Box 110240, Gainesville, FL *Corresponding author contact: email awhodges@ufl.edu ; tel ephone 352 392 1881 x312 April 2 2009 R evised June 3, 2010 Executive Summary T his study evaluated the broad economic contribution s of hospital s in the state of Florida in 20 07, using d ata on hospital beds, revenues, expenditures, and employment from the Florida Hospital Uniform Reporting System together with regional economic models developed with the IMPLAN Pro fessional software to estimat e multiplier effects arising in oth er sectors of the local economy from input purchases and spending by employees and governments. Characteristics of 280 non federal licensed hospitals operating in Florida in 2007 included: 6 1 ,3 23 beds 2 33 586 ful l time equivalent employees $31.87 billio n in operating expenses $14.64 billion paid in employee salaries and benefits, $32.31 billion in net revenues $30. 14 billion in non local sources such as health insurance, Medicaid and Medicare. Estimated t otal statewide economic contributions of Flo ri da hospitals in 2007 included : 659,240 fulltime and part time jobs $79. 9 billion in industry output or sales revenue s $45.8 billion in value added, representing personal and business income and property income 2.48 percent share of Gross Domestic Pro duct of Florida from d irect value added of $17.29 billion $32. 1 billion in labor income to employees and business owners, $9. 3 billion in property income, such as rents, dividends and interest payments, $2.6 billion in indirect business taxes paid to loca l and state governments Regionally, total employment contributions of Florida hospitals were greatest in the Miami Ft. Lauderdale area ( 227,516 jobs ), followed by the Orlando area ( 155,598 ), Tampa St. Petersburg (102,016), Sarasota Bradenton ( 52,863 ) Jac ksonville ( 51,721 ), Gainesville ( 26,188 ), Pensacola ( 21,649 ), Tallahassee ( 12,738 ), and Panama City ( 8,950 ) The largest individual Florida counties in terms of employment impacts were Miami Dade (110,373 jobs) Broward ( 60 743 ) Orange ( 54 283 ), Hills borough ( 49 378 ), Duval ( 42 536 ), Pinellas ( 40 488 ) Palm Beach ( 39 088 ) Alachua (23,380) Polk (18,490) Brevard (18,460) Lee (17,452), Volusia (17,177) and Escambia (15,147).

PAGE 2

2 Given the significant role of hospitals i n the local economy reductions in hospital funding would have far reaching impacts on the state and its communities For example, a hypothetical $100 million re duction in Medicaid funding to Florida hospitals by the State of Florida is estimated to re sult in the elimination of 2 187 jobs reduce output by $258 million and reduce value added by $157 million Introduction H ealthcare is a major driver of economic activity in the United States, valued at $2.2 trillion in 2007 representing approximately 16 .2 percent of Gross Domestic Produc t. The healthcare industry experienced average annual growth of 8.8 percent over the past 10 years, which was well above the U.S average over the same time. Activity in the healthcare sector has also been relatively stable compared to many other sectors of the economy H ospitals are a n important component of the healthcare industry, providing acute care, emergency, trauma, psychiatric and rehabilitation services valued at $697 billion annually or 31 percent of total U.S. healthcare expenditures. Hospit als in the U.S. directly employ nearly 5.3 million people and account for 14.8 million jobs, including multiplier effects, according to a recent study by Avalere Health sponsored by the American Hospital Association (AHA, 2009). Healthcare services are i mportant in t he state of Florida due to its rapidly growing and aging population The healthcare industry serves as a source of economic development, to attract new residents and businesses to the state. Total employment in the healthcare sector in Florida has grown from about 724 ,000 in 2001 to nearly 843 ,000 in 2007, representing average annual growth of 2.7 percent (Figure 1). Figure 1 Trend in Florida healthcare industry employment, 2001 07 Hosp itals are the second larges t seg ment of the healthcare industry in Florida, behind offices of physicians dentists and other health practitioners. Florida currently ha s 2 96 hospitals with a total of 65,816

PAGE 3

3 beds, and 225,00 0 fulltime equivalent employees, according to data from the Florida Hospital Association (FHA Oct. 2008 ). service community hospitals, 84 were investor owned, 95 were not for profit and 31 were public institutions plus 12 federal facilities Florida hospitals offering specialized services i ncluded psychiatric treatment (33), rehabilitation (15) long (26), and teaching (7). In 2007 t hese facilities provided care to 2.3 million patients over 10.8 million patient days, and performe d nearly 1.9 million surgeries. Florida hospitals provide high skill, high wage jobs, with annual earnings averaging $52,661 in 2006 The purpose of this project is to estimate the annual economic contributions o f h ospital operations in the state of Flori da and its regions and c ounties including values generated indirectly in other sectors of the economy via multiplier effects This report updates a previous study for 1999 ( Anderson, Wieand and Colie 1999) Methods D ata on revenues, expenditures fullti me equivalent employment and number of beds for all Florida hospitals in 2007 were obtained from the Florida Hospital Uniform Reporting System ( FH URS) maintained by the Florida Agency for Healthcare Administration Reporting to the FHURS is required f or no n federal licensed hospitals under Florida law. Procedures for reporting through an online system are described in a user manual and data largely conform to Generally Accepted Accounting Principles (GAAP), with minor exceptions. Expenditure information re ported includes total operating expenses, employee salaries, and non operating expen ses for amortization and depreciation R evenues are reported for payments received from health insurance, health maintenance organizations (HMO), Medicaid, Medicare, local government, and self paying individuals. Discounts to employees, bad debts, and unpaid services rendered to indigent patients are reported as negative revenue amounts. N on local sources of revenues such as health i nsurance, Medicaid and Medicare net of a dministrative and employee discounts and local matching contributions to Medicaid represent new monies to the state or region that give rise to multiplier effects through re spending in other sectors of the economy Information was available for a total o f 280 Florida hospitals in 2007. Seven new facilities that opened in 2008 were excluded from this analysis as well as some federal hospitals that are not required to report information In some cases w here consolidated data were reported for a number of hospital facilities owned by a parent company, values were disaggregated based on the number of beds, in order to provide an accurate ac counting by location A complete listing of Florida hospitals operating in 2007 is provided in Appendix B The broad e conomic contributions of hospitals in Florida were evaluated with r egional economic models constructed with the IMPLAN Pro fessional software and associated Florida state and county datasets for 2007 (MIG, Inc. 2008). This type of model for input output ana lysis augmented with social accounting matrices enable s estimat ion of the secondary impacts of industry activities in the local economy arising through input purchases from vendors, and through spending by employee household s and governments known as indi rect and induced multiplier effects respectively (Miller and Blair ) A glossary of economic impact analysi s terminology

PAGE 4

4 is provided in Appendix A Models were c onstruct ed for the state of Florida and for each of the state counties using default par ameters and trade flow assumptions, and all social accounts internalized This means that the multiplier effects captured expenditures by h ouseholds, local, state and federal governments, and capital investment generated by new resources garnered by the h ospital industry Estimated economic contributions at the county level were normalized to match with total values at the state level. Spending by hospitals that occu rs within the state or county was accounted for by regional purchase coefficients in IMPLAN that represent the average share of goods and services provided from local sources. A summary of input purchase coefficients for hospitals used in the IMPLAN model for Florida is provided in Appendix C Financial data and estimates of economic contributi on for Florida hospitals were summarized by county and regio ns The functional economic regions of Florida, indicated in Figure 2, represent metropolitan areas and surrounding non metro counties that are economically linked as defined by the U.S. Departme nt of Commerce Bureau of Economic Analysis, based on employee commuting patterns reported in the 2000 Census and other data such as newspaper readership (Johnson and Kort, 2004) Economic contribution estimates for hospitals were also summarized by major i ndustry groups defined according to the North American Industry Classification System (NAICS). Figure 2 Economic regions of Florida. Source: US Department of Commerce, Bureau of Economic Analysis.

PAGE 5

5 Results Hospital Employmen t, Expenditures and Revenues Available i nformation on Florida hospital operations employment, expenditures and revenues in 2007 are summarized in Table 1. F or the 28 0 non federal licensed hospital facilities operating in Florida there were a total of 61 3 23 beds, and 2 33 586 fulltime equivalent employees. Total operating expenses amounted to $31.87 billion (Bn), including employee salaries o f $1 1 94 Bn and employee benefits of $2.70 Bn. N on operating expenses included depreciation and amortization ($1.76 Bn) and interest on borrowed capital ($625 million) T o tal revenues amounted to $32.31 Bn, including insurance payments ($17.11 Bn), Medicare ($13.15 Bn), Medicaid ($3.36 Bn), other local government revenue ($1.66 Bn). Matching contributions to Medicaid from local governments in Flo r i da amounted to $722 million (Mn) Charity, bad debt and self pay revenue was a negative total ( $304 Mn), but it was not possible to disaggregate these values because they were reported as a lump sum. Funds restricted for in digent care were $1.2 Mn. Administrative, employee and policy discounts to revenues amounted to $2.70 Bn. Total revenues from non local sources were estimated at $ 30. 14 Bn including payments from health insurance, Medicaid and Medicare, net of discounts and loca l matching Medicaid contributions Table 1. Summary of Florida hospital operations, employment, expenditures and revenues, 2007 Number Hospitals 280 Number Beds 61,323 Fulltime Equivalent Employees 233,586 Total Operating Expenses (Mn$) 31,871 .2 Employee Salaries (Mn$) 11,939.5 Employee Benefits (Mn$) 2,696.6 Total Non Operating Expenses (Mn$) 2,381.5 Interest Expense (Mn$) 624.5 Depreciation and Amortization Expenses (Mn$) 1,757.0 Total Revenues (Mn$) 32,312.7 Insurance Based Revenue (M n$) 17,111.0 Medicare / HMO Revenue (Mn$) 13,153.0 Medicaid / HMO Revenue (Mn$) 3,357.5 Other (Local) Government Revenue (Mn$) 1,656.4 Charity, Bad Debt, Self Pay Revenue (Mn$) 304.3 Administrative Employee and Policy Discounts (Mn$) 2,759.7 Restr icted Funds for Indigent Care (Mn$) 1.2 Total Non Local Revenues Net of Discounts and Local Matching (Mn$) 30, 139 3 *Note: non local revenues include health insurance, Medicaid and Medicare payments received, net of administrative, employee and policy d iscounts and local matching Medicaid funds.

PAGE 6

6 Operating e xpenditures that occurred within Florida were estimated at $26.6 Bn or 83.5 percent o f total operating expenses while the remaining amount (16.5%) is purchased from outside the state, based on regio nal purchase coefficients developed with the IMPLAN model for Florida xpen ditures for items purchased from outside the regi on are known as a has no economic impact on local economy. Statewide Economic Contributions Total statewide economic contributions of Florida hospitals in 2007, including multiplier effects for all other sectors of the economy, are summar ized in Table 2. Employment impacts were estimated at 659,240 fulltime and part time jobs. Total output or revenue impacts were estimated at $79.88 Bn. Impacts on value added, or personal and business net income, amounted to $45.84 Bn. Value added includ es all wages, salaries and benefits pa id to workers, business profits property income, capital consumption (depreciation) and indirect business taxes. The sum of d irect value added across all industry sectors is equivalent to Gross Domestic Product ( GDP ) the broadest measure of aggregate economic activity Direct value added by hospitals ($17.29 Bn) represented 2.48 percent of GDP of Florida in 2007 ($698.26 Bn) Labor income impacts to employee and business owner compensation were $32.08 Bn. Impacts o n other property income, such as rents, dividends and interest, were $9.26 Bn. Impacts on indirect business taxes paid to local and state governments were estimated at $2.60 Bn including taxes for ad valorem property, sales, excise, and motor fuels, but e xcluding income taxes. Table 2 Summary of statewide economic contributions of Florida hospital s in 2007. Impact Measure Direct Impact Indirect Impact Induced Impact Total Impact Total Multiplier Effect Employment (fulltime & part time jobs) 249,107 93 ,637 316,495 659,240 2.65 Output or Revenue (mil lion ) $32,313 $12,041 $35,529 $79,882 2.47 Total Value Added (million ) $17,292 $7,047 $21,498 $45,836 2.65 Labor Income (million ) $14,391 $3,966 $13,725 $32,082 2.23 Other Property Income (million ) $801 $ 2,481 $5,973 $9,256 11.56 In direct Business Taxes (million ) $202 $600 $1,800 $2,602 12.88 Note: Direct impacts represent values for hospitals Indirect impacts represent activity generated in other sectors that furnish input s to the hospital industry. I n duced impacts reflect economic activity due to spending by employee households and governments, and capital investment The direct component of economic contributions represents activity with the hospital sector, while indirect effects are for input pur chases through the vendor supply chain, and induced effects represent employee household and government spending arising from non revenues to the hospital sector The indirect and induced effects represented approximately 62 percent of the total employment impact, 60 percent of the total output

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7 impact and 62 percent of the total value added impact, implying an overall multiplier effect of 2.6 5, 2.47 and 2.65, respectively (Table 2) Given the significant role of hospitals i n the local economy reductions in hospital funding would have far reaching effects on the state and its communities For example, a hypothetical $100 million reduction in Medicaid funding to Florida hospitals by the State of Florida is estimated to re sult in the elimination of 2,187 jobs reduce output by $258 million, and reduce value added by $157 million. Financial Characteristics and Economic Contributions in Florida Region s and Count ies Financial and operating characteristic s of Florida hospitals are summarized by region and co unty in Table 3 The largest regions for hospital employment (FTE) were Miami Ft. Lauderdale (77,253), Orlando (56,821) and Tampa St. Petersburg (34,159), followed by Jacksonville (19,675), Sarasota Bra denton (18,905), Gainesville (9 264), Pensacola ( 7 638 ), Tallahassee (6,321) and Panama City (3,550) The largest Florida counties for hospital employment were Miami Dade (36,134), Broward (21,060) Orange (18,930), Hillsborough (16,562), Duval (15,335), Pa lm Beach (13,293) and Pinellas (12,602). In addition, six other counties had at least 5,000 fulltime equivalent employees (Alachua, Brevard, Escambia, Lee, Polk, Volusia). Economic contributions of Florida hospitals are summarized by region and county in Table 4. Total employment impacts (fulltime and part time jobs) were 227,516 in the Miami Ft. Lauderdale region, 155,598 in the Orlando area, 102,016 in Tampa St. Petersburg, 52,863 in Sarasota Bradenton, 51,721 in Jacksonville, 26,188 in Gainesville, 21,6 49 in Pensacola, 12,738 in Tallahassee, and 8,950 in the Panama City area. The largest individual Florida counties in terms of employment impacts were Miami Dade (110,373 jobs) Broward ( 60 743 ) Orange ( 54 283 ), Hillsborough ( 49 378 ), Duval ( 42 536 ), Pinel las ( 40 488 ) Palm Beach ( 39 088 ) Alachua (23,380) Polk (18,490) Brevard (18,460) Lee (17,452), Volusia (17,177) and Escambia (15,147). Total output, value added, labor income and indirect business tax impacts across regions and counties were roughly p roportional to these employment impacts.

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8 Table 3 H ospital employment, expenses and revenues in Florida region s and count ies in 2007. Region / County Number Hospitals Number of Beds Fulltime Equivalent Employees Operating Expenses (million $) Employe e Sal aries (million $) Net Revenues (million $) Non Local Revenues Net of Discounts & Local Matching (million $) Miami Fort Lauderdale 90 21,725 77,253 11,240.2 5,228.3 10,603.6 9,814.9 Broward 25 6,449 21,060 2,927.6 1,439.5 2,772.3 2,414.3 Hendry 1 25 152 18.0 8.6 13.1 13.9 Indian River 3 554 1,857 233.8 113.3 223.7 204.1 Martin 3 424 2,031 249.5 132.0 241.7 218.2 Miami Dade 33 9,457 36,134 5,263.6 2,485.6 4,857.6 4,742.5 Monroe 4 267 726 118.9 49.4 117.2 98.5 Okeechobee 1 100 326 45.8 20.8 51.5 46.8 Palm Beach 17 3,839 13,293 2,105.8 871.1 2,013.7 1,784.6 St. Lucie 3 610 1,674 277.2 108.1 312.9 292.0 Orlando 62 11,831 56,821 7,033.3 3,354.1 8,268.2 7,713.2 Brevard 9 1,582 7,301 911.6 448.8 873.8 779.8 Citrus 2 326 1,517 20 3.1 83.6 186.5 172.7 Flagler 1 99 490 65.0 27.9 81.5 80.3 Hardee 1 25 110 13.6 6.1 14.7 14.2 Highlands 3 335 1,245 164.7 69.4 160.4 154.8 Lake 4 657 3,340 451.9 200.2 445.4 419.9 Marion 6 779 3,215 442.3 189.6 436.3 410.2 Orange 14 3,308 18,930 2,229.4 1,100.1 3,173.4 2,991.9 Osceola 4 514 2,514 340.7 153.8 479.0 430.2 Polk 6 1,746 7,152 816.7 408.2 846.7 792.9 Seminole 3 773 4,028 514.0 240.4 726.9 680.6 Sumter 1 192 409 53.6 25.4 54.0 47.6 Volusia 8 1,495 6,572 826.5 400.6 789.6 738.1 Tampa St. Petersburg 39 9,458 34,159 4,995.1 2,108.3 5,057.8 4,722.5 Hernando 5 584 1,827 248.0 105.3 279.0 244.1 Hillsborough 13 3,699 16,562 2,405.9 1,029.1 2,439.7 2,274.1 Pasco 5 1,075 3,169 481.6 204.8 482.3 441.5 Pinellas 16 4,100 12,602 1,859.5 769.0 1,856.9 1,762.6 Sarasota Bradenton 26 5,665 18,905 2,686.7 1,214.4 2,652.5 2,533.7 Charlotte 3 665 2,114 301.5 126.3 299.5 263.1 Collier 5 906 3,544 516.4 235.3 491.0 483.0 DeSoto 1 49 225 23.4 13.4 22.7 24.2 Lee 6 1,694 5,939 802.0 391.1 841.2 841.3 Manatee 4 849 2,295 358.1 151.9 358.6 325.0 Sarasota 7 1,502 4,788 685.3 296.4 639.5 597.1 Jacksonville 18 4,989 19,675 2,609.4 1,191.3 2,461.8 2,269.3 Baker 2 1,163 1,193 68.3 49.1 18.6 18.2 Clay 2 310 1, 064 163.4 67.6 178.1 159.1 Duval 11 3,005 15,335 2,134.7 953.9 2,027.3 1,860.7 Nassau 1 54 310 33.6 19.9 38.7 35.6

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9 Region / County Number Hospitals Number of Beds Fulltime Equivalent Employees Operating Expenses (million $) Employe e Sal aries (million $) Net Revenues (million $) Non Local Revenues Net of Discounts & Local Matching (million $) Putnam 1 141 448 54.9 25.4 49.6 49.8 St. Johns 1 316 1,325 154.6 75.5 149.5 145.8 Gainesville 12 1,897 9,264 1,212.9 567.3 1, 206.9 1,145.3 Alachua 5 1,473 7,803 1,060.3 489.4 1,077.9 1,023.7 Bradford 1 25 203 21.0 13.7 20.6 20.7 Columbia 2 166 730 95.6 44.9 82.9 75.4 Levy 1 40 61 5.6 2.5 4.9 4.9 Suwannee 1 15 146 14.7 9.7 14.1 13.9 Union 2 178 321 15.6 7.2 6.5 6.8 Pensacola 14 2,410 7,638 1,071.8 430.9 1,131.9 1,040.3 Escambia 4 1,497 5,119 716.6 289.0 726.3 675.6 Okaloosa 4 456 1,519 231.7 88.8 277.6 252.2 Santa Rosa 4 349 540 67.7 28.8 64.9 50.2 Walton 2 108 460 55.8 24.3 63.1 62.3 Tallahassee 9 2,425 6,321 606.6 348.0 504.2 488.3 Franklin 1 25 85 6.7 3.3 4.5 4.4 Gadsden 1 1,230 2,283 114.0 115.8 1.5 1.3 Leon 5 1,097 3,646 459.6 214.3 477.1 457.5 Madison 1 25 81 6.8 3.6 6.2 6.9 Taylor 1 48 226 19.5 11.0 14.8 18.3 Panama City 10 923 3,550 415.2 193.6 425.9 411.7 Bay 5 694 2,776 345.1 153.7 360.7 343.8 Calhoun 1 25 58 5.7 2.5 4.8 5.0 Holmes 1 20 95 7.2 4.4 7.2 7.5 Jackson 2 125 478 42.6 25.3 39.8 42.3 Washington 1 59 144 14.6 7.7 13.5 13.2 Grand Total 280 61,323 233,586 31,871.2 14,636.1 32,312.7 30,139.3 Source: Agency for Healthcare Administration Florida Hospital Uniform Reporting System. *No n local revenues include health insurance, Medicaid and Medicare payments received net of administrative, employee and policy discounts and local government matching Medicaid funds

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10 Table 4 T otal economic contributions of hospital s in Florida regions and count ies in 2007. Region / County Employment (fulltime & part time jobs) Output (Revenue) (million $) Val ue Added (million $) Labor Income (million $) Indirect Business Tax es (million $) Miami Fort Lauderdale 227,516 28,131 16,456 11,743 974 Broward 60,743 7,331 4,219 3,132 254 Hendry 285 24 13 13 1 Indian River 4,420 484 277 209 16 Martin 5,009 556 320 247 19 Miami Dade 110,373 13,558 8,026 5,774 469 Monroe 1,819 243 145 96 7 Okeechobee 761 96 51 37 2 Palm Beach 39,088 5,160 3,009 2,001 183 St. Lucie 5,018 678 396 234 22 Orlando 155,598 18,973 10,645 7,143 591 Brevard 18,460 2,004 1,113 876 59 Ci trus 3,374 357 193 143 10 Flagler 1,251 164 94 56 5 Hardee 233 26 14 10 1 Highlands 3,086 324 183 127 9 Lake 8,303 923 515 369 28 Marion 8,776 975 531 374 30 Orange 54,283 7,441 4,209 2,610 230 Osceola 7,389 995 573 330 31 Polk 18,490 1,991 1,099 8 19 62 Seminole 13,925 1,842 1,035 611 65 Sumter 852 97 52 42 2 Volusia 17,177 1,835 1,036 775 59 Tampa St. Petersburg 102,016 12,898 7,322 4,915 421 Hernando 4,562 533 284 191 14 Hillsborough 49,378 6,391 3,683 2,474 211 Pasco 7,588 936 530 364 26 Pinellas 40,488 5,038 2,825 1,886 170 Sarasota Bradenton 52,863 6,326 3,604 2,535 212 Charlotte 5,315 613 345 237 18 Collier 9,545 1,178 708 487 40 DeSoto 422 40 21 20 1 Lee 17,452 2,087 1,168 844 73 Manatee 6,726 820 457 313 27 Sarasota 13,403 1, 589 904 634 53 Jacksonville 51,721 6,068 3,498 2,562 188 Baker 1,610 31 15 60 1 Clay 2,953 376 211 133 12

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11 Region / County Employment (fulltime & part time jobs) Output (Revenue) (million $) Val ue Added (million $) Labor Income (million $) Indirect Business Tax es (million $) Duval 42,536 5,178 3,007 2,157 161 Nassau 629 68 35 31 2 Putnam 937 92 48 42 2 St. Johns 3,057 323 182 139 11 Gainesville 26,188 2,844 1,66 0 1,223 83 Alachua 23,380 2,599 1,527 1,098 77 Bradford 402 38 21 21 1 Columbia 1,594 164 88 77 4 Levy 108 9 4 4 0 Suwannee 273 25 14 14 1 Union 431 10 5 9 0 Pensacola 21,649 2,608 1,496 977 75 Escambia 15,147 1,779 1,034 685 53 Okaloosa 4,326 580 332 199 15 Santa Rosa 1,048 115 61 46 3 Walton 1,128 134 69 47 4 Tallahassee 12,738 1,067 610 588 30 Franklin 142 9 5 5 0 Gadsden 2,895 3 1 135 0 Leon 9,172 1,018 585 427 29 Madison 142 11 5 5 0 Taylor 387 27 14 16 1 Panama City 8,950 969 5 45 396 29 Bay 7,514 851 483 335 26 Calhoun 115 9 5 4 0 Holmes 170 13 7 7 0 Jackson 884 73 38 39 2 Washington 266 23 12 12 0 Grand Total 659,240 79,882 45,836 32,082 2,602

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12 Economic Contributions by Industry Group Total economic impacts of Flo rida hospitals are summarized by major industry group in Table 5 Naturally, the largest impacts occurred in the health and social services group in which the direct impacts of hospitals occur, with total employment impacts of 29 8 183 jobs, total output i mpacts of $36. 64 Bn, and total value added impacts of $ 19 97 Bn. In addition, however, employment impacts in excess of 20,000 jobs also occurred in Transportation and Warehousing ( 49 891 jobs), Government ( 49 146 ), Real Estate and Rental ( 33 995 ), Professi onal, Scientific and Technical Services (3 3 755 ), Administrative and Waste Services (3 2 491 ), Ac c om m odation and Food Services (2 8 935 ), Other Services (2 5 84 6),Construction (25, 068 ), and Finance and Insurance (20, 03 3). Table 5 Summary of economic contrib utions of Florida hospitals by major industry group in 2007 Industry Group (NAICS ) Employment ( fulltime & part time jobs) Output (Mn$) Value Added (Mn$) Labor Income (Mn$) Other Property Type Income (Mn$) Indirect Business Taxes (Mn$) Agriculture, Fo restry, Fishing 2,528 187 98 38 56 4 Mining 267 98 25 13 11 2 Utilities 1,391 850 585 176 314 95 Construction 25,068 3,533 1,474 1,215 233 25 Manufacturing 10,022 3,410 990 673 277 40 Wholesale Trade 13,831 2,417 1,569 924 299 346 Transportation & Wa rehousing 49,891 3,321 2,307 1,441 354 512 Retail Trade 10,011 1,127 544 403 112 28 Information 5,875 1,643 762 390 304 67 Finance & Insurance 20,033 3,974 1,864 1,253 526 85 Real Estate & Rental 33,995 7,501 5,525 737 3,929 859 Prof essional S cientif ic & T ech. S ervices 33,755 3,769 2,239 1,893 300 46 Management o f Companies 5,166 1,126 638 514 114 10 Administrative & Waste Services 32,491 1,932 1,171 973 173 25 Educational Services 6,423 381 217 197 17 3 Health & Social Services 298,183 36,641 19, 971 16,590 1,248 236 Arts, Entertainment & Recreation 6,385 460 292 182 74 37 Accom m odation & Food Services 28,935 1,815 955 654 192 108 Other Services 25,846 1,619 859 628 158 73 Government 49,146 4,078 3,751 3,186 565 0 Total 659,240 79,882 45,836 3 2,082 9,256 2,602 *Industry groups classified according to the North American Industry Classification System.

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13 Tax Impacts The impacts of Florida hospitals on local, state and federal government tax revenues in 2007 are summarized in Table 6 Total tax im pacts in 2007 were estimated at $10.39 Bn, including $7.57 Bn to the Federal government and $2.85 Bn to state and local governments. The largest individual tax items were federal income tax es ($3.02 Bn), employer and employee contributions to federal socia l insurance tax or ($1.81 Bn each, respectively), Florida sales tax es ($1.11 Bn), Florida property tax es ($863 Mn), and federal corporate profits tax es ($687 Mn). Table 6 Total tax i mpacts of Florida hospitals on government tax revenu es, 2007 Government / Tax Item Amount (Mn$) Federal Government (Non Defense ) 7,569.2 Corporate Profits Tax 687.3 Custom s Duty 53.0 Excise T axes 126.8 Indirect business Non T axes 63.5 Income Tax 3,021.5 Social Ins urance Tax Employee Contributi on 1,805.6 Social Ins urance Tax Employer Contribution 1,811.6 State and Local Gov ernmen t ( Non Education ) 2,849.8 Corporate Profits Tax 104.6 Dividends 173.4 Motor Vehicle Lic enses 16.9 Other Indirect Bus iness Taxes 276.7 Property Tax 8 63 0 Non Taxes 90.7 Sales Tax 1,114.2 Severance Tax 2.0 Motor Vehicle License 35.6 Fines Fees 111.9 Fish ing, Hunt ing Licenses 2.2 Social Ins Tax Employee Contribution 11.1 Social Ins Tax Employer Contribution 47.6 Enterprises (Corporations) tr ansfers 25.0 Total 10,394.0 Note: t otal tax impacts include dire ct, indirect and induced multiplier effects

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14 Literature and Information Sources Cited Agency for Healthcare Administration State of Florida Hospital Uniform Reporting System Manual (AHA F HURS) July, 2005; 196 pages. Available at http://www.fdhc.state.fl.us/MCHQ/CON_FA/fa_data/index.shtml American Hospital Association (AHA). The economic contribution of hospitals Jan. 2009. Anderson, Robert, Kenneth Wieand and Dennis Colie University of South Florida, Center for Economic Development Research, Tampa, FL; 35 pages ; May 1999. Florida Hospital Association (FHA). Facts and at http://www.fha.org/facts.html Johnson, K. and J. Kort. Redefinition of the BEA Economic Areas Bureau of Economic Analysis, U.S. Departmen t of Commerce, Survey of Current Business pp. 68 75, Nov. 2004. Available at http://www.bea.gov/scb/pdf/2004/11November/1104Econ Areas.pdf Miller, R oland E. and Peter D. Blair. Input Output Analysis: Foundations and Extensions. Prentice Hall Englewood Cliffs, NJ, 464 pp, 1985 ( Revised 2 nd edition to be published by Cambridge University Press, May 2009) Minnesota IMPLAN Group, Inc. (MIG). IMPLAN Professional economic impact ana lysis and social accounting software and county data for Florida. Stillwater, MN Web resources available at www.implan.com

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15 Appendix A : Glossary of Economic Impact Terms Terms are presented in a logical order rather than alphabetical order Region defines the geographic area for which impacts are estimated. Regions are generally an aggregation of one or more counties. Economic regions identified in this paper were defined based on worker commuting patterns. Sector is a grouping of industries that produce similar products or services, or production processes. Most economic reporting and models in the U.S. are based on the Standard Industrial Classification system (SI C code) or the North American Industrial Classification System (NAICS). Impact analysis estimates the impact of a change in output or employment resulting from a change in final demand to households, governments or exports. Input output (I O) model An in put output model is a representation of the flows of economic activity between industry sectors within a region. The model captures what each business or sector must purchase from every other sector in order to produce its output of goods or services. Usin g such a model, flows of economic activity associated with any change in spending may be traced backwards (e.g., purchases of plants that leads growers to purchase additional inputs -fertilizers, containers, etc.). Multipliers for a region may be derived from an input output model of the region's economy. IMPLAN is a micro computer based input output modeling system and Social Accounting Matrix (SAM). With IMPLAN, one can estimate I O models of up to 440 sectors for any region consisting of one or more co unties. IMPLAN includes procedures for generating multipliers and estimating impacts by applying final demand changes to the model. The current version of the software is IMPLAN Pro 2. Direct effects are the changes in economic activity during the first ro und of spending. Secondary effects are the changes in economic activity from subsequent rounds of re spending. There are two types of secondary effects: Indirect effects are the changes in sales, income or employment within the region in backward linked in dustries supplying goods and services to businesses. For example, the increased sales in input supply firms resulting from more nursery industry sales is an indirect effect. Induced effects are the increased sales within the region from household spending of the income earned in the direct and supporting industries. Employees in the direct and supporting industries spend the income they earn on housing, utilities, groceries, and other consumer goods and services. This generates sales, income and employment Total effects are the sum of direct, indirect and induced effects. Multipliers capture the total effects, both direct and secondary, in a given region, generally as a ratio of the total change in economic activity in the r egion relative to the direct change Multipliers may be expressed as ratios of sales, income or employment, or as ratios of total income or employment changes relative to direct sales. Multipliers express the degree of interdependency between sectors in a considerably across regions and sectors. Type I multipliers include only direct and indirect effects. Type II multipliers also include induced effects. Type SAM multipliers used by IMPLAN additionally account for capital investments and transfer payments such as welfare and retirement income. A sector specific multiplier gives the total changes to the economy associated with a unit change in output or employment in a given sector Purchaser prices are the prices paid by the final consumer of a good or service. Producer prices are the prices of goods at the factory or production point. For manufactured goods the purchaser price equals the producer price plus a retail margin, a wholesale margin, and a transportation margin. For services, the producer and purchaser prices are equivalent.

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16 Margins. The retail, wholesale and transportation margins are the portions of the purchaser price accruing to the retailer, wholesaler, and grower, respectively. Only the retail margins of m any goods purchased by consumers accrue to the local region, as the wholesaler, shipper, and manufacturer often lie outside the local area. Measures of economic activity. Sales or output is the dollar volume of a good or service produced or sold. Final Dem and is sales to final consumers, including households, governments, and exports. Intermediate sales are sales to other industrial sectors. Income is the money earned within the region from production and sales. Total income includes personal income (wage a and rents). Jobs or employment is a measure of the number of jobs required to produce a given volume of sales/production, usually expressed as full time equivalents, or as the total number inc luding part time and seasonal positions. Value Added is the sum of total income and indirect business taxes. Value added is the most commonly used measure of the contribution of a region to the national economy, as it avoids double counting of intermediate

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17 Appendix B : Listing of Florida Hospitals by County Source: Florida Hospital Association County Hospital Name City Type Number Beds Fulltime Equivalent Employees Alachua North Florida Regional Medical Center Gainesville Acute Care 325 1,257.5 Alachua Shands AGH Gainesville Acute Care 367 Alachua Shands at the University of Florida Gainesville Acute Care 660 6,545.3 Alachua Shands Rehab Hospital Gainesville Rehabilitation 40 Alachua Shands Vista Gainesville Psychiatric 81 Baker Ed Fraser Memorial Hospital Macclenny Acute Care 25 122.1 Baker Northeast Florida State Hospital Macclenny Psychiatric 1,138 1,071.0 Bay Bay Medical Behavioral Health Center Panama City Psychiatri c 90 Bay Bay Medical Center Panama City Acute Care 323 1,850.0 Bay Gulf Coast Medical Center Panama City Acute Care 176 715.7 Bay HealthSouth Emerald Coast Rehab Hospital Panama City Rehabilitation 75 135.3 Bay Select Specialty Hospital Panama City Pa nama City Acute Care/LTC 30 74.8 Bradford Shands Starke Starke Acute Care 25 203.4 Brevard Cape Canaveral Hospital Cocoa Beach Acute Care 150 891.7 Brevard Circles of Care, Inc. Melbourne Psychiatric 52 153.4 Brevard Devereux Florida Treatment Network Viera IRTF/Psychiatric 100 219.7 Brevard HealthSouth Sea Pines Rehabilitation Hospital Melbourne Rehabilitation 90 148.2 Brevard Holmes Regional Medical Center Melbourne Acute Care 514 3,381.4 Brevard Palm Bay Community Hospital Palm Bay Acute Care 60 Brevard Parrish Medical Center Titusville Acute Care 210 892.6 Brevard Wuesthoff Medical Center Melbourne Melbourne Acute Care 115 472.1 Brevard Wuesthoff Medical Center Rockledge Rockledge Acute Care 291 1,142.3 Broward Atlantic Shores Hospital Ft. La uderdale Psychiatric 72 90.3 Broward Broward Health Broward General Medical Center Ft. Lauderdale Acute Care 716 2,819.2 Broward Broward Health Coral Springs Medical Center Coral Springs Acute Care 200 889.6 Broward Broward Health Imperial Point Medical Center Ft. Lauderdale Acute Care 204 648.4 Broward Broward Health North Broward Medical Center Deerfield Beach Acute Care 409 1,287.3 Broward Cleveland Clinic Florida Weston Weston Acute Care 150 804.6 Broward Florida Medical Center Ft. Lauderdale Acut e Care 459 808.0 Broward Ft. Lauderdale Hospital Ft. Lauderdale Psychiatric 100 160.4 Broward HealthSouth Sunrise Rehabilitation Hospital Sunrise Rehabilitation 126 262.4 Broward Hollywood Pavilion Hollywood Psychiatric 60 68.0 Broward Holy Cross Hospi tal Ft. Lauderdale Acute Care 571 1,785.7 Broward Kindred Hospital South Florida Ft. Lauderdale Ft. Lauderdale Acute Care/LTC 70 150 Broward Kindred Hospital South Florida Hollywood Hollywood Acute Care/LTC 124 260.7 Broward Memorial Hospital Miramar Mi ramar Acute Care 178 602.5 Broward Memorial Hospital Pembroke Pembroke Pines Acute Care 301 823.8 Broward Memorial Hospital West Pembroke Pines Acute Care 299 2,058.5 Broward Memorial Regional Hospital Hollywood Acute Care 690 4,531.8 Broward Memorial Regional Hospital South Hollywood Acute Care 324 Broward Northwest Medical Center Margate Acute Care 215 661.0 Broward Plantation General Hospital Plantation Acute Care 264 553.3 Broward South Florida State Hospital Pembroke Pines Psychiatric 350 412.0 Broward St. Anthony's Rehabilitation Hospital Lauderdale Lakes Rehabilitation 26 45.0 Broward University Hospital & Medical Center Tamarac Acute Care 257 618.9 Broward University Pavilion Hospital Tamarac Psychiatric/Dept. 60 Broward Westside Regiona l Medical Center Plantation Acute Care 224 717.7 Calhoun Calhoun Liberty Hospital, Inc. Blountstown Acute Care 25 58.0 Charlotte Charlotte Regional Medical Center Punta Gorda Acute Care 208 771.6 Charlotte Fawcett Memorial Hospital, Inc. Port Charlotte Acute Care 238 629.3 Charlotte Peace River Regional Medical Center Port Charlotte Acute Care 219 713.2 Citrus Citrus Memorial Health System Inverness Acute Care 198 1,076.3 Citrus Seven Rivers Regional Medical Center Crystal River Acute Care 128 440.5 Clay Kindred Hospital North Florida Green Cove Springs Acute Care/LTC 80 172 Clay Orange Park Medical Center Orange Park Acute Care 230 891.7 Collier NCH Downtown Naples Hospital Naples Acute Care 420 2,815.7

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18 County Hospital Name City Type Number Beds Fulltime Equivalent Employees Collier NCH North Naples Hospital Naples Acu te Care 261 Collier Physicians Regional Medical Center Collier Boulevard Naples Acute Care 100 Collier Physicians Regional Medical Center Pine Ridge Naples Acute Care 83 706.6 Collier The Willough Healthcare System Naples Psychiatric 42 21.7 Columbia Lake City Medical Center Lake City Acute Care 67 331.0 Columbia Shands Lake Shore Lake City Acute Care 99 399.1 DeSoto DeSoto Memorial Hospital, Inc Arcadia Acute Care 49 224.6 Duval Baptist Medical Center Jacksonville Acute Care 579 4,402.9 Duval Bap tist Medical Center Beaches Jacksonville Beach Acute Care 146 755.2 Duval Baptist Medical Center South Jacksonville Acute Care 120 Duval Brooks Rehabilitation Hospital Jacksonville Rehabilitation 143 490.1 Duval Mayo Clinic Hospital Jacksonville Acute Care 214 1,608.9 Duval Memorial Hospital Jacksonville Jacksonville Acute Care 353 1,410.2 Duval Shands Jacksonville Jacksonville Acute Care 696 3,362.3 Duval Specialty Hospital Memorial Health Jacksonville Acute Care/LTC 107 230.6 Duval St. Vincent's Medical Center Jacksonville Acute Care 528 2,832.3 Duval Ten Broeck Hospital Jacksonville Jacksonville Psychiatric 99 158.6 Duval Wekiva Springs Center for Women Jacksonville Psychiatric 20 84.0 Escambia Baptist Hospital, Inc. Pensacola Acute Care 492 1,972.6 Escambia Lakeview Center, Inc. Pensacola IRTF/Psychiatric 16 25.8 Escambia Sacred Heart Hospital of Pensacola Pensacola Acute Care 458 2,099.1 Escambia West Florida Hospital Pensacola Acute Care 531 1,021.1 Flagler Florida Hospital Flagler Palm Coast Acute Care 99 489.8 Franklin George E. Weems Memorial Hospital Apalachicola Acute Care 25 85.1 Gadsden Florida State Hospital Chattahoochee Psychiatric 1,230 2,283.0 Hardee Florida Hospital Wauchula Wauchula Acute Care 25 109.7 Hendry Hendry Reg ional Medical Center Clewiston Acute Care 25 152.2 Hernando Brooksville Regional Hospital Brooksville Acute Care 120 823.5 Hernando HealthSouth Rehabilitation Hospital of Spring Hill Brooksville Rehabilitation 70 173.4 Hernando Oak Hill Hospital Brooksv ille Acute Care 204 714.9 Hernando Spring Hill Regional Hospital Spring Hill Acute Care 124 Hernando Springbrook Hospital Brooksville Psychiatric 66 114.9 Highlands Florida Hospital Heartland Med. Ctr. Sebring Acute Care 159 867.6 Highlands Florida Ho spital Lake Placid Lake Placid Acute Care 50 Highlands Highlands Regional Medical Center Sebring Acute Care 126 376.9 Hillsborough Brandon Regional Hospital Brandon Acute Care 367 1,344.9 Hillsborough H. Lee Moffitt Cancer Ctr & Rsrch Inst Tampa Acute Care 162 2,122.1 Hillsborough Kindred Hospital Bay Area Tampa Tampa Acute Care/LTC 73 129.2 Hillsborough Kindred Hospital Central Tampa Tampa Acute Care/LTC 102 195.9 Hillsborough Memorial Hospital of Tampa Tampa Acute Care 180 453.8 Hillsborough South Bay Hospital Sun City Center Acute Care 112 394.9 Hillsborough South Florida Baptist Hospital Plant City Acute Care 147 598.4 Hillsborough St. Joseph's Hospital, Inc. Tampa Acute Care 649 3,682.6 Hillsborough St. Joseph's Women's Hospital Tampa Acute C are/Dept. 234 Hillsborough Tampa General Hospital Tampa Acute Care 877 4,949.3 Hillsborough Town & Country Hospital Tampa Acute Care 201 348.3 Hillsborough University Community Hospital Carrollwood Tampa Acute Care 120 427.1 Hillsborough University Co mmunity Hospital Medical Center Tampa Acute Care 475 1,915.3 Holmes Doctors Memorial Hospital Bonifay Acute Care 20 95.0 Indian River HealthSouth Treasure Coast Rehab. Hospital Vero Beach Rehabilitation 90 156.7 Indian River Indian River Medical Center Vero Beach Acute Care 335 1,283.4 Indian River Sebastian River Medical Center Sebastian Acute Care 129 416.9 Jackson Campbellton Graceville Hospital Graceville Acute Care 25 75.2 Jackson Jackson Hospital Marianna Acute Care 100 402.3 Lake Florida Hospi tal Waterman Tavares Acute Care 204 1,034.3 Lake Leesburg Regional Medical Center Leesburg Acute Care 309 1,507.6 Lake LifeStream Behavioral Center Leesburg Psychiatric 40 85.5 Lake South Lake Hospital Clermont Acute Care 104 712.8 Lee Cape Coral Hospi tal Cape Coral Acute Care 291 1,150.8

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19 County Hospital Name City Type Number Beds Fulltime Equivalent Employees Lee Gulf Coast Hospital Ft. Myers Acute Care 120 367.2 Lee HealthPark Medical Center Ft. Myers Acute Care 368 Lee Lee Memorial Hospital Ft. Myers Acute Care 427 3,055.8 Lee Lehigh Regional Medical Center Lehigh Ac res Acute Care 88 275.3 Lee Southwest Florida Regional Medical Center Ft. Myers Acute Care 400 1,089.8 Leon Capital Regional Medical Center Tallahassee Acute Care 198 638.3 Leon Eastside Psychiatric Hospital Tallahassee Psychiatric 24 52.9 Leon HealthS outh Rehabilitation Hospital of Tallahassee Tallahassee Rehabilitation 76 142.9 Leon Select Specialty Hospital Tallahassee Tallahassee Acute Care/LTC 29 27.1 Leon Tallahassee Memorial Hospital Tallahassee Acute Care 770 2,785.1 Levy Nature Coast Regiona l Health Network Williston Acute Care 40 60.7 Madison Madison County Memorial Hospital Madison Acute Care 25 80.5 Manatee Blake Medical Center Bradenton Acute Care 383 835.3 Manatee Lakewood Ranch Medical Center Bradenton Acute Care 120 306.2 Manatee M anatee Glens Hospital Bradenton Psychiatric 27 52.4 Manatee Manatee Memorial Hospital Bradenton Acute Care 319 1,101.1 Marion Kindred Hospital Ocala Ocala Acute Care/LTC 31 67.0 Marion Marion Citrus Mental Health Centers Ocala Psychiatric 15 16.9 Mario n Munroe Regional Medical Center Ocala Acute Care 421 2,101.2 Marion Ocala Regional Medical Center Ocala Acute Care 200 1,027.2 Marion Ten Broeck Hospital Ocala Ocala Psychiatric 42 2.2 Marion West Marion Community Hospital Ocala Acute Care 70 Martin Martin Memorial Hospital South Stuart Acute Care 100 Martin Martin Memorial Medical Center Stuart Acute Care 244 1,999.1 Martin SandyPines Hospital Tequesta Psychiatric 80 32.3 Miami Dade Aventura Hospital and Medical Center Aventura Acute Care 407 1,0 08.5 Miami Dade Baptist Hospital of Miami, Inc. Miami Acute Care 584 3,749.6 Miami Dade Bascom Palmer Eye Inst/Anne Bates Leach Eye Hosp Miami Acute Care 100 604.0 Miami Dade Coral Gables Hospital Coral Gables Acute Care 256 444.8 Miami Dade Doctors Ho spital Coral Gables Acute Care 281 842.0 Miami Dade HealthSouth Rehab Hospital of Miami Miami Rehabilitation 60 159.8 Miami Dade Hialeah Hospital Hialeah Acute Care 378 652.1 Miami Dade Homestead Hospital Homestead Acute Care 120 769.1 Miami Dade Jacks on Memorial Hospital Miami Acute Care 1,498 9,779.2 Miami Dade Jackson North Medical Center North Miami Beach Acute Care 382 Miami Dade Jackson North Specialty & Diagnostic Center Opalocka Acute Care 60 Miami Dade Jackson South Community Hospital Miam i Acute Care 199 Miami Dade Kendall Regional Medical Center Miami Acute Care 412 1,093.7 Miami Dade Kindred Hospital South Florida Coral Gables Coral Gables Acute Care/LTC 53 156.1 Miami Dade Larkin Community Hospital South Miami Acute Care 132 459.2 Miami Dade Mercy Hospital Miami Acute Care 473 1,835.0 Miami Dade Metropolitan Hospital of Miami Miami Acute Care 146 1,179.8 Miami Dade Miami Children's Hospital Miami Acute Care 289 2,157.8 Miami Dade Miami Jewish Home & Hospital for the Aged Miami Ac ute Care 32 129.0 Miami Dade Mount Sinai Medical Center Miami Beach Acute Care 955 2,801.1 Miami Dade North Shore Medical Center Miami Acute Care 357 813.5 Miami Dade Palm Springs General Hospital Hialeah Acute Care 247 730.0 Miami Dade Palmetto Genera l Hospital Hialeah Acute Care 360 1,279.2 Miami Dade Select Specialty Hospital Miami Miami Acute Care/LTC 47 136.7 Miami Dade Sister Emmanuel Hospital Miami Acute Care/LTC 29 89.2 Miami Dade South Florida Evaluation and Treatment Center Miami Psychiatri c 238 280 Miami Dade South Miami Hospital Miami Acute Care 445 2,090.4 Miami Dade Southern Winds Hospital Hialeah Psychiatric 72 Miami Dade North Miami Rehabilitation 60 64.8 Miami Dade University of Miami Hospi tal Miami Acute Care 560 1,047.4 Miami Dade University of Miami Hospital/Clinics Miami Acute Care 40 1,011.3 Miami Dade West Gables Rehabilitation Hospital Miami Rehabilitation 60 160.4 Miami Dade Westchester General Hospital Miami Acute Care 125 610.3 Monroe DePoo Hospital Key West Acute Care 49

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20 County Hospital Name City Type Number Beds Fulltime Equivalent Employees Monroe Fishermen's Hospital Marathon Acute Care 58 142.9 Monroe Lower Keys Medical Center Key West Acute Care 118 388.0 Monroe Mariners Hospital Tavernier Acute Care 42 195.0 Nassau Baptist Medical Center Nassau Fernandina Beach Acute Care 54 310.1 Okaloosa Fort Walton Beach Medical Center Ft. Walton Beach Acute Care 257 825.4 Okaloosa Gulf Coast Treatment Center Ft. Walton Beach Psychiatric 24 30.6 Okaloosa North Okaloosa Medical Center Crestview Acute Care 110 464.6 Okaloosa Twin Cities Hospital Niceville Acute Care 65 198.5 Okeechobee Raulerson Hospital Okeechobee Acute Care 100 325.8 Orange Arnold Palmer Hospital for Children Orlando Acute Care 443 2,919 Orange Dr. P. Phillips Hospital Orlando Acu te Care 161 1,061 Orange Florida Hospital Apopka Apopka Acute Care 50 288 Orange Florida Hospital East Orlando Orlando Acute Care 225 1,295 Orange Florida Hospital Orlando Orlando Acute Care 896 5,155 Orange Florida Hospital Winter Park Winter Park Acu te Care 297 1,709 Orange Health Central Ocoee Acute Care 171 983.0 Orange La Amistad Residential Treatment Center Maitland IRTF/Psychiatric 40 75.7 Orange Lakeside Behavioral Healthcare, Inc. Orlando Psychiatric 56 60.8 Orange Orlando Regional Lucerne Hospital Orlando Acute Care 209 1,377 Orange Orlando Regional Medical Center Orlando Acute Care 581 3,829 Orange Select Specialty Hospital Orlando South Orlando Acute Care/LTC 40 Orange Select Specialty Hospital Orlando Orlando Acute Care/LTC 35 130.2 Orange University Behavioral Center Orlando Psychiatric 104 47.0 Osceola Florida Hospital Celebration Health Celebration Acute Care 112 644 Osceola Florida Hospital Kissimmee Kissimmee Acute Care 83 478 Osceola Osceola Regional Medical Center Kissimmee Acute Care 235 1,043.7 Osceola St. Cloud Regional Medical Center St. Cloud Acute Care 84 348.8 Palm Beach A.G. Holley State Hospital Lantana Specialty 100 175.9 Palm Beach Bethesda Healthcare System Boynton Beach Acute Care 401 1,623.0 Palm Beach Boca Raton Community Hospital Boca Raton Acute Care 400 2,065.4 Palm Beach Columbia Hospital West Palm Beach Acute Care 250 522.4 Palm Beach Delray Medical Center, Inc. Delray Beach Acute Care 350 1,186.7 Palm Beach Fair Oaks Pavilion Delray Beach Psychiatr ic/Dept. 53 Palm Beach Glades General Hospital Belle Glade Acute Care 73 266.3 Palm Beach Good Samaritan Medical Center West Palm Beach Acute Care 333 667.7 Palm Beach JFK Medical Center Atlantis Acute Care 424 1,582.4 Palm Beach Jupiter Medical Cente r Jupiter Acute Care 156 997.5 Palm Beach Oakwood Center of the Palm Beaches, Inc. West Palm Beach Psychiatric 44 63.5 Palm Beach Palm Beach Gardens Medical Ctr. Palm Beach Gardens Acute Care 199 666.4 Palm Beach Palms West Hospital Loxahatchee Acute Ca re 175 646.4 Palm Beach Pinecrest Rehab. Hospital at Delray Delray Beach Rehabilitation/Dept. 90 45.0 Palm Beach St. Mary's Medical Center West Palm Beach Acute Care 463 1,404.0 Palm Beach Wellington Regional Medical Center Wellington Acute Care 143 694 .9 Palm Beach West Boca Medical Center, Inc. Boca Raton Acute Care 185 685.7 Pasco Community Hospital New Port Richey Acute Care 389 883.3 Pasco Florida Hospital Zephyrhills Zephyrhills Acute Care 154 650.5 Pasco Morton Plant North Bay Hospital New Por t Richey Acute Care 122 456.4 Pasco Pasco Regional Medical Center Dade City Acute Care 120 333.3 Pasco Regional Medical Center Bayonet Point Hudson Acute Care 290 845.1 Pinellas All Children's Hospital St. Petersburg Acute Care 216 1,844.2 Pinellas Bay front Medical Center St. Petersburg Acute Care 502 1,775.5 Pinellas Edward White Hospital St. Petersburg Acute Care 167 257.6 Pinellas HealthSouth Rehabilitation Hospital Largo Rehabilitation 70 173.7 Pinellas Helen Ellis Memorial Hospital Tarpon Spring s Acute Care 168 447.0 Pinellas Kindred Hospital Bay Area St. Petersburg St. Petersburg Acute Care/LTC 82 176.5 Pinellas Largo Medical Center Largo Acute Care 256 706.6 Pinellas Mease Hospital/Countryside Safety Harbor Acute Care 300 Pinellas Mease Ho spital/Dunedin Dunedin Acute Care 143 1,755.4 Pinellas Morton Plant Hospital Clearwater Acute Care 687 2,130.9

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21 County Hospital Name City Type Number Beds Fulltime Equivalent Employees Pinellas Northside Hospital and Heart Institute St. Petersburg Acute Care 288 647.8 Pinellas Palms of Pasadena Hospital St. Petersburg Acute C are 307 545.1 Pinellas St. Anthony's Hospital St. Petersburg Acute Care 395 1,014.1 Pinellas St. Petersburg General Hospital St. Petersburg Acute Care 219 521.3 Pinellas Sun Coast Hospital Largo Acute Care/Dept. 200 450.2 Pinellas Windmoor Healthcare o f Clearwater Clearwater Psychiatric 100 156.2 Polk Bartow Regional Medical Center Bartow Acute Care 72 321.6 Polk Heart of Florida Regional Medical Center Davenport Acute Care 142 692.3 Polk Lake Wales Medical Centers Lake Wales Acute Care 154 355.6 Po lk Lakeland Regional Medical Center Lakeland Acute Care 851 3,661.7 Polk Regency Medical Center Winter Haven Acute Care 61 Polk Winter Haven Hospital Winter Haven Acute Care 466 2,120.4 Putnam Putnam Community Medical Center Palatka Acute Care 141 448. 1 Santa Rosa Baptist Hospital, Inc. d/b/a/ Gulf Breeze Hospital Gulf Breeze Acute Care 65 Santa Rosa Jay Hospital Jay Acute Care 55 120.6 Santa Rosa Santa Rosa Medical Center Milton Acute Care 129 327.1 Santa Rosa West Florida Community Care Ctr. Milt on Psychiatric 100 92.5 Sarasota Bayside Center for Behavioral Health Sarasota Psychiatric/Dept. 86 Sarasota Doctors Hospital of Sarasota Sarasota Acute Care 168 429.2 Sarasota Englewood Community Hospital, Inc. Englewood Acute Care 100 269.8 Sarasota HealthSouth Rehab Hospital of Sarasota Sarasota Rehabilitation 76 182.6 Sarasota HealthSouth RidgeLake Hospital Sarasota Acute Care/LTC 40 96.3 Sarasota Sarasota Memorial Hospital Sarasota Acute Care 720 3,069.1 Sarasota Venice Regional Medical Center Venice Acute Care 312 741.4 Seminole Central Florida Regional Hospital Sanford Acute Care 226 708.7 Seminole Florida Hospital Altamonte Altamonte Springs Acute Care 341 1,962 Seminole Orlando Regional South Seminole Hospital Longwood Acute Care 206 1,35 8 St. Johns Flagler Hospital, Inc. St. Augustine Acute Care 316 1,325.3 St. Lucie Lawnwood Regional Medical Ctr. & Heart Inst. Ft. Pierce Acute Care 341 931.4 St. Lucie Port St. Lucie Hospital Port St. Lucie Psychiatric 75 98.9 St. Lucie St. Lucie Medi cal Center Port St. Lucie Acute Care 194 643.4 Sumter The Villages Regional Hospital The Villages Acute Care 192 408.6 Suwannee Shands Live Oak Live Oak Acute Care 15 145.8 Taylor Doctors' Memorial Hospital, Inc. Perry Acute Care 48 226.1 Union Lake Bu tler Hospital/Hand Surgery Center Lake Butler Acute Care 25 70.7 Union Reception and Medical Center Lake Butler Specialty 153 250.0 Volusia Bert Fish Medical Center New Smyrna Beach Acute Care 112 621.8 Volusia Florida Hospital DeLand DeLand Acute Care 156 704.9 Volusia Florida Hospital Fish Memorial Orange City Acute Care 139 742.4 Volusia Florida Hospital Memorial Medical Center Ormond Beach Acute Care 205 1,030.4 Volusia Florida Hospital Oceanside Ormond Beach Acute Care 119 Volusia Halifax Behav ioral Services Daytona Beach Psychiatric 30 Volusia Halifax Health Medical Center of Port Orange Port Orange Acute Care 80 Volusia Halifax Health Medical Center Daytona Beach Acute Care 654 3,472.0 Walton Healthmark Regional Medical Center DeFuniak Springs Acute Care 50 138.1 Walton Sacred Heart Hospital on the Emerald Coast Destin Acute Care 58 322.3 Washington Northwest Florida Community Hospital Chipley Acute Care 59 143.8 Note: some employment figures (shown in red type) were estimated in prop ortion to total number of beds for parent company reporting unit for purposes of county and regional analysis.

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22 Appendix C : Florida Hospital Industry Purchases Sectors shown represent at least 0.01 percent of total purchases Industry Sector / Institut ion Share of Total Purchases Share of P urchase s within State Commodity Purchases Real estate establishments 11.14% 70.00% Management of companies and enterprises 2.60% 80.00% Medical and diagnostic labs and outpatient and oth 2.44% 89.98% Pharmaceut ical preparation manufacturing 1.97% 17.70% Insurance carriers 1.78% 66.08% Veterinary services 1.74% 95.00% In vitro diagnostic substance manufacturing 1.71% 19.53% Wholesale trade businesses 1.51% 90.81% Electromedical and electrotherapeutic apparat us ma nuf. 1.26% 74.19% Employment services 1.24% 80.00% Electric power generation transmission and distr ibution 1.15% 71.63% Sanitary paper product manufacturing 0.94% 0.06% Surgical appliance and supplies manufacturing 0.91% 57.02% Securities comm odity contracts investments and 0.88% 68.69% Office administrative services 0.81% 80.00% Animal (except poultry) slaughtering rendering a 0.72% 17.04% US Postal Service 0.68% 69.66% Other plastics product manufacturing 0.65% 25.72% Surgical and me dical instrument laboratory and me 0.61% 76.20% Management scientific and technical consulting s 0.60% 80.00% Industrial gas manufacturing 0.54% 40.81% Telecommunications 0.52% 56.80% Services to buildings and dwellings 0.50% 80.00% Legal services 0.42% 90.00% Advertising and related services 0.40% 79.61% Food services and drinking places 0.39% 90.00% Commercial and industrial machinery and equipment 0.37% 80.00% Accounting tax preparation bookkeeping and pay roll services 0.35% 90.00% Automo tive repair and maintenance except car wash 0.35% 90.00% Transport by truck 0.33% 76.26% Ice cream and frozen dessert manufacturing 0.30% 42.84% Seafood product preparation and packaging 0.26% 59.63% Poultry processing 0.23% 15.95% Other computer rel ated service s 0.22% 78.48% Automotive equipment rental and leasing 0.22% 90.00% Other basic organic chemical manufacturing 0.22% 42.65% Maint enance & repair construct of nonresident structures 0.21% 100.00% Cheese manufacturing 0.21% 6.07% Fruit and v egetable canning pickling and drying 0.21% 4.26% Soft drink and ice manufacturing 0.19% 16.83%

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23 Industry Sector / Institut ion Share of Total Purchases Share of P urchase s within State Curtain and linen mills 0.19% 0.91% Computer systems design services 0.18% 69.86% Investigation and security services 0.16% 80.00% Electronic and precisio n equipment repair and main 0.16% 90.00% Private hospitals 0.15% 85.18% Petroleum refineries 0.14% 3.04% Environmental and other technical consulting servi ces 0.13% 80.00% Dry cleaning and laundry services 0.13% 90.00% Commercial and industrial machin ery and equipment 0.13% 80.00% Coffee and tea manufacturing 0.12% 67.91% Other rubber product manufacturing 0.12% 0.05% Monetary authorities and depository credit interme diaries 0.12% 65.27% All other miscellaneous professional scientific 0.10% 80.00 % Business support services 0.10% 80.00% Other pressed and blown glass and glassware manufa cturing 0.10% 29.70% Warehousing and storage 0.10% 76.26% Personal and household goods repair and maintenance 0.10% 90.00% Printing 0.09% 25.30% All other basi c inorganic chemical manufacturing 0.09% 34.13% Scientific research and development services 0.09% 42.43% Water sewage and other treatment and delivery sys 0.08% 80.94% Other support services 0.08% 80.00% Fluid milk and butter manufacturing 0.07% 58.4 2% Couriers and messengers 0.07% 70.01% Paper mills 0.07% 0.02% Coated and laminated paper packaging paper and pl 0.06% 0.02% Alkalies and chlorine manufacturing 0.06% 58.95% Retail Stores Motor vehicle and parts 0.05% 95.00% All other food manufa cturing 0.05% 32.86% Transport by rail 0.05% 91.62% Paperboard container manufacturing 0.05% 0.03% Seasoning and dressing manufacturing 0.05% 57.48% Transit and ground passenger transportation 0.05% 79.47% Frozen food manufacturing 0.04% 3.95% Travel arrangement and reservation services 0.04% 70.01% Waste management and remediation services 0.04% 80.00% Soap and cleaning compound manufacturing 0.04% 28.94% Petrochemical manufacturing 0.04% 26.37% Facilities support services 0.04% 80.00% Cable and other subscription programming 0.04% 56.52% Civic social professional and similar organizat ions 0.04% 66.90% Retail Stores Food and beverage 0.04% 94.05% Data processing hosting ISP web search portals 0.04% 30.41%

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24 Industry Sector / Institut ion Share of Total Purchases Share of P urchase s within State Retail Stores General merch andise 0.04% 95.00% Private junior col leges, colleges and universities 0.03% 69.27% All other chemical product and preparation manuf 0.03% 33.55% Transport by air 0.03% 46.17% Semiconductor and related device manufacturing 0.03% 61.46% Nondepository credit intermediation and related ac 0.03% 68.69% Retail Stores Furniture and home furnishings 0.03% 95.00% Scenic and sightseeing transportation and support 0.03% 70.01% Natural gas distribution 0.03% 35.61% Retail Nonstores Direct and electronic sales 0.02% 82.39% Magnetic and optical recording media manufacturing 0.02% 0.62% Synthetic rubber manufacturing 0.02% 0.07% Retail Stores Building material and garden suppl y stores 0.02% 95.00% Architectural engineering and related services 0.02% 90.00% Internet publishing and broadcasting 0.02% 26.24% Other fabricated metal manufacturing 0.02% 0.00% Air conditioning refrigeration and warm air heat 0.02% 0.00% Crown and closure manufacturing and metal stamping 0.02% 2.15% Paperboard Mills 0. 02% 0.02% Showcase partition shelving and locker manufact uring 0.02% 36.76% All other textile product mills 0.02% 1.91% Retail Stores Health and personal care 0.02% 95.00% Independent artists writers and performers 0.02% 79.78% General and cons umer goods rental except video tap 0.02% 80.00% Synthetic dye and pigment manufacturing 0.02% 15.36% Urethane and other foam product (except polystyrene 0.02% 33.52% Retail Stores Clothing and clothing accessories 0.02% 95.00% Car washes 0.02% 90.00% Retail Stores Electronics and appliances 0.02% 95.00% Retail Stores Miscellaneous 0.01% 95.00% Motor vehicle parts manufacturing 0.01% 9.06% Lighting fixture manufacturing 0.01% 0.09% Retail Stores Gasoline stations 0.01% 75.39% Hotels and mot els including casino hotels 0.01% 80.00% Stationery product manufacturing 0.01% 0.07% Other concrete product manufacturing 0.01% 0.72% Cutlery utensil pot and pan manufacturing 0.01% 6.17% Retail Stores Sporting goods hobby book and mu 0.01% 90 .61% Other state and local government enterprises 0.01% 77.39% All other miscellaneous wood product manufacturing 0.01% 20.70% Other electronic component manufacturing 0.01% 29.06% Broadwoven fabric mills 0.01% 1.99% Transport by water 0.01% 100.00%

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25 Industry Sector / Institut ion Share of Total Purchases Share of P urchase s within State Womens and girls cut and sew apparel manufacturi ng 0.01% 9.78% Office supplies (except paper) manufacturing 0.01% 7.24% Other information services 0.01% 26.39% Pottery ceramics and plumbing fixture manufactur ing 0.01% 0.02% Laminated plastics plate sheet (except packaging) 0.01% 46.90% Periodical publishers 0.01% 29.23% Value Added Employee Compensation 50.04% 100.00% Proprietary Income 0.36% 100.00% Other Property Income 2.48% 100.00% Indirect Business Taxes 0.63% 100.00% Total Value Added 53.51% 100.00% Source: IMPLAN Pr ofessional data for Florida (MIG, Inc., 2008).