Loan Guarantee Program Financial Performance Indicators

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OMB No.: 0915-0285. Expiration Date: 6/30/2029
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Health Resources and Services Administration

Loan Guarantee Program Financial Performance Indicators


PERFORMANCE MEASURES

FOR HRSA USE ONLY

Grant Number
Application Tracking
Number



Historical 
Financial Indicators
Input the #, $ or Ratio for Each of the Health Center's Last Four Fiscal Years
Explain anomalies in figures or any positive/negative figures/trends
Describe how the Health Center has been or will be addressing any anomalies or negative figures/
trends
Describe what role, if any, the proposed loan guarantee project will play in helping to address any anomalies or negative figures /
trends
Revenue Drivers/Liquidity
Days Receivable
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




Days Cash on Hand

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




Current Ratio 

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




Debt Capacity
Leverage Ratio

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




EBIDTA

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




Debt Service Coverage Ratio

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




Solvency
Net Assets & Net Assets Ratio

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




Operating Margin

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         




Days in Accounts Payable

CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         
CY ­­___ : _­­­­­___         






Revenue Drivers / Liquidity
Days Receivable 
$ Patient Receivables at FYE / Number of Days in the FY
Days Cash on Hand
((Cash + Liquid Investments) / Total Revenue) x Number Days in Year
Current Ratio

Current Assets / Current Liabilities
Debt Capacity
Leverage Ratio
Total Debt / Net Assets
EBIDTA
Net Operating Income + Interest + Depreciation + Taxes + Amortization
Debt Service Coverage Ratio
EBITDA / Annual Debt Service Payments of Principal and Interest on All Debt
Solvency
Net Assets & Net Assets Ratio
Net Asset Ratio = Net Assets  / Total Assets
Operating Margin
Operating Income / Revenue
Days in Accounts Payable
(Accounts Payable / (Total Expenses - Interest Expense - Depreciation -  Change in Loan Loss Reserve)) x Number Days in Year
Questions
Explain anomalies in figures or any positive/negative figures/trends
Provide a detailed explanation of both positive and negative occurring anomalies, figures, and trends to further understand the data.  
Describe how the Health Center has been or will be addressing any anomalies or negative figures/
trends
Provide a description of how any identified anomalies, negative figures, or trends have been or will be addressed.
Describe what role, if any, the proposed loan guarantee project will play in helping to address any anomalies or negative figures /
trends
Provide a description of how the proposed loan guarantee project would assist in addressing any identified anomalies, negative figures, or trends. 

Health centers (section 330 grant funded and Federally Qualified Health Center look-alikes) are patient-directed organizations that deliver affordable, accessible, quality, and cost-effective primary health care services to patients and adjust fees based on income and family size. The Health Center Program application forms provide essential information to HRSA staff and objective review committee panels for application evaluation; funding recommendation and approval; designation; and monitoring. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0285 and it is valid until 06/30/2029. This information collection is mandatory under the Health Center Program authorized by section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b). Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 13N82, Rockville, Maryland, 20857 or [email protected].  Please see https://www.hrsa.gov/about/508-resources for the HRSA digital accessibility statement.