Rural Ambulance Service Budget Model ii

Rural Ambulance Service

Budget Model 

 

U.S. Department of Health and Human Services 

Health Resources and Services Administration 

Office of Rural Health Policy 
Rural Ambulance Service Budget Model iii

This document was prepared under HRSA contract # 250-03-0022, U. S. Department of Health 

and Human Services, Health Resources and Services Administration, Office of Rural Health 

Policy.
Rural Ambulance Service Budget Model iv

Contents 

Foreword................................................................................................................................v 

Overview................................................................................................................................1 

Future Efforts.............................................................................................................5 

Introduction............................................................................................................................7 

Limitations .................................................................................................................7 

Notes about the Model...............................................................................................7 

Let’s get Started .........................................................................................................7 

Spreadsheets...........................................................................................................................8 

Demographics ............................................................................................................9 

Vehicles......................................................................................................................10 

Building......................................................................................................................12 

Other Capital..............................................................................................................13 

Staffing.......................................................................................................................14 

Training......................................................................................................................16 

Other Expenses ..........................................................................................................17 

Budget........................................................................................................................18 

Rate Study..................................................................................................................20 

QuickBooks Easy Step Interview ..........................................................................................23 

Contact REMSTTAC.................................................................................................29 

APPENDIX A: REMSTTAC Stakeholders’ Group ..............................................................33 
 
Rural Ambulance Service Budget Model iv

Foreword 

We are very pleased to offer you the 

Rural Ambulance Service Budget 

Model. This budgeting and financial 

management tool is an important part of 

the financial toolkit under development 

for rural ambulance services and rescue 

squads that do not have the resources to 

purchase such tools themselves. We 

recognize that rural ambulance services 

are an essential component of rural 

health care systems. Budgeting and 

financial management is but one of the 

many challenges facing rural Emergency 

Medical Services (EMS) agencies in the 

United States today. Rural EMS 

agencies also face such issues as 

recruitment and retention of qualified, 

trained human resources; increasing 

education and training requirements; 

increasing cost of equipment and 

increasing funding challenges, to name a 

few. 

With capital and operating costs 

increasing and reimbursement 

decreasing, management of limited 

financial resources is becoming a more 

important component of rural ambulance 

service management and governance. 

The Rural Ambulance Service Budget 

Model provides a management tool that 

enables a service to enter known 

financial information into a simple, yet 

elegant preprogrammed spreadsheet. 

Once information is entered into the 

model, a budget is automatically 

calculated that can be exported into off 

the shelf accounting software and 

monthly budget versus actual results can 

be used to better manage limited funds 

and plan for improved financial 

management of the service. 

This publication was developed by the 

Federal Office of Rural Health Policy, 

Health Resources and Services 

Administration in cooperation with the 

Rural Emergency Medical Services and 

Trauma Technical Assistance Center. It 

is hoped that this Rural Ambulance 

Service Budget Model will serve as a 

valuable tool for rural ambulance 

services and provide for better informed 

fiscal management in the challenging 

realm of out of hospital health care. 

Please see the special note on the 

following page concerning the ongoing 

availability of this document.

Marcia K. Brand, Ph.D. 

Associate Administrator for Rural Health, 

HRSA 

Nels D. Sanddal, Director 

Rural Emergency Medical Services and 

Trauma Technical Assistance Center
Rural Ambulance Service Budget Model vi

A special note to the reader: 

In FY 2000, Congress funded the Trauma and EMS Program within the Department of 

Health and Human Services, Health Resources and Services Administration (HRSA) to 

foster the development of appropriate, modern systems of such care. Ten percent of the 

funding provided for that program was earmarked for “rural” trauma and EMS and was 

administered by HRSA’s Office of Rural Health Policy (ORHP). In FY 03, ORHP 

established the Rural Emergency Medical Services and Trauma Technical Assistance 

Center (REMSTTAC). This product represents one of the deliverables identified in the 

REMSTTAC contract. Congress zeroed out the HRSA Trauma and EMS Program in FY 

05 and ORHP, therefore, lost the resources necessary to continue REMSTTAC. 

However, as part of ORHP’s ongoing commitment to rural EMS, this and other products 

will continue to be available from two sources. These include the Critical Illness & 

Trauma Foundation (www.citmt.org) [not a government Web site], the parent 

organization of the previously funded REMSTTAC, and the Rural Assistance Center 

(www.RAConline.org) [not a government Web site
Rural Ambulance Service Budget Model vi

OVERVIEW 

In the early stages of the development of the Rural EMS and Trauma Technical 

Assistance Center (REMSTTAC) a diverse group of stakeholders were brought together 

to provide input and direction regarding how the TA center might best meet the needs of 

its constituency groups. These three groups are broadly defined as: 

• Federal Agencies and national EMS, trauma, and rural health organizations with 

interest in or responsibility for rural EMS and trauma and their intersection with 

rural health. 

• State EMS lead agencies, State Offices of Rural Health, and similar State level 

organizations that relate to rural EMS, trauma, and overall rural health. 

• Local and regional EMS and trauma providers, including rural ambulance 

services, hospitals, rural health clinics, and other agencies and organizations 

involved in regional and local health planning and provision. 

In developing and prioritizing the REMSTTAC scope of work, the stakeholder group 

recommended the development of a financial tool kit that would provide specific 

financial and budgeting tools to rural EMS agencies and organizations that may be 

managed by volunteer EMS providers or others with limited experience or training in the 

financial and budgeting aspects of public, private or not-for-profit organizations. As 

cited in the Rural and Frontier EMS Agenda for the Future (2005), many rural and 

frontier EMS services “have no expertise or infrastructure for collecting fees or 

maintaining the business functions.” The need for this toolkit has been further validated 

through a series of “town hall” meetings conducted in the intermountain west and New 

England States with representation from local EMS leadership. 

In response to this direction, a task group was organized within REMSTTAC to develop 

tools for this financial tool kit. The task group, coordinated by a REMSTTAC staff 

person, includes a business/financial consultant and representatives of: the National 

Association of State EMS Officials, the Rural Health Resource Center and the National 

Association of Emergency Medical Technicians (EMTs). In addition to the considerable 

knowledge and expertise of these task group members, tasks and priorities are reviewed 

by the entire stakeholder group. Their input and direction guides the work of the task 

group. The task group and stakeholders identified the following priorities for toolkit 

development: 

• A financial Chart of Accounts that identifies common elements of assets, 

liabilities, revenues, and expenses applicable to a rural EMS agency or 

organization 

• A budget tool that assists rural EMS agencies and organizations in developing 

and tracking operating budgets and establishing fee schedules 

• Instructions for using a budgeting tool and interface with common “off the shelf” 

accounting software that is readily available at low cost to rural EMS agencies or 

organizations. 
Rural Ambulance Service Budget Model 1

The Sample Chart of Accounts represents the first drawer in the Financial Toolkit. It 

provides a bookkeeping and accounting framework for rural EMS services and is 

consistent with generally accepted accounting principles. It is organized as follows:

• Assets – These accounts represent both cash and non-cash assets and include 

bank accounts, accounts receivable, fixed assets such as property, plant and 

equipment with allowances for applicable depreciation of such assets. 

• Liabilities and Equity – These accounts represent accounts payable, loans and 

lines of credit as well as earnings and owners’ equity or fund balances, depending 

on the type and structure of the organization. 

• Revenue – These are income accounts such as revenues from patient billing, 

other revenue, subsidies, etc. and are applicable to either cash basis or accrual 

basis accounting rules. 

• Expense – These accounts represent the costs of doing business, such as payroll, 

fringe benefits, costs of occupancy, repairs, maintenance, and similar expense 

items. 

Some EMS services may not need all the items shown in the sample Chart of Accounts. 

Others may find the need to add accounts. Either way, the sample provides a model with 

the most commonly used accounts in the accounting structure of a rural EMS 

organization. 

Sample Chart of Accounts 

Assets Liabilities/Equities

 

1000 Cash 4001 Patient Revenue - Medicare 

1200 Accounts Receivable 4002 Patient Revenue - Medicaid 

1300 Prepaids 4003 Patient Revenue - Other 

1400 Inventory 

1500 Investments 4100 Grant / Subsidies Revenue 

1600 Property, Plant and Equipment 4200 Investment Income 

1700 Other Assets 4300 Other Income 

 

2000 Accounts Payable 5000 Contractual Adjustments - Medicare

2100 Short Term Debt 5001 Contractual Adjustments - Medicaid

2200 Accrued Salaries 5002 Contractual Adjustments - Other 

2300 Other Accrued Liabilities 

2400 Long-term debt 

 

3000 Net assets/Equity - Unrestricted 

3100 Net assets/Equity - Restricted 
Rural Ambulance Service Budget Model 2

Expenses 

6101 Salaries-Patient Care 6342 Legal Fees 

6102 Benefits-Patient Care 6343 Collection Agency Fees 

6103 Medical Supplies - Patient Care 6344 Software Maintenance Contracts

6104 Gases (oxygen) - Patient Care 6345 Consulting Fees 

6105 Drugs - Patient Care 6346 Service Contracts 

6106 Laundry & Linen - Patient Care 6347 Management Contract 

6107 Equipment Depreciation - Patient care 6348 Claim Processing Contract 

6108 Equipment Repair - Patient Care 6350 Dues & Memberships 

6109 Minor Equipment - Patient Care 6351 Licenses 

6110 Training - Patient Care 6352 Donations 

6111 Books & Periodicals - Patient Care 6353 Food 

6112 Travel & Entertainment - Patient Care 6360 Printing & Publication 

 

6201 Dispatch Salaries 6400 Interest Expense 

6202 Dispatch Benefits 

6203 Dispatch Supplies 6503 Facilities Supplies & Services 

6207 Dispatch Equipment Depreciation 6507 Building Depreciation 

6209 Dispatch Minor Equipment 6508 Building Maintenance 

6213 Telephone 6570 Building Rent 

6214 Radio Maintenance 6571 Property Taxes 

6215 Radio Antenna 6572 Utilities 

6216 Cell Phones 6573 Housekeeping 

6217 Pagers 6574 Laundry - Non Patient Care 

 6575 Uniforms 

6301 Administration Salaries 6576 Property Insurance 

6302 Administration Benefits 

6303 Office Supplies 6680 Vehicle Registration 

6307 Office Equipment Depreciation 6681 Vehicle Gas & Oil 

6308 Office Repair & Maintenance 6682 Vehicle Repairs 

6309 Office Minor Equipment 6683 Vehicle Depreciation 

6311 Books & Periodicals 6684 Vehicle Leases 

6312 Travel & Entertainment 6685 Auto Insurance 

6313 Administration Telephone 6400 Interest Expense 

6320 Worker's Comp 

6321 Unemployment Tax 6503 Facilities Supplies & Services 

6322 FICA Tax 6507 Building Depreciation 

6323 General Liability Insurance 6508 Building Maintenance 

6324 Professional Liability Insurance 6570 Building Rent 

6325 Umbrella Coverage 6571 Property Taxes 

6326 Health Insurance 6572 Utilities 

6327 Pension Plan 

6340 Physician Fees 

6341 Accounting Fees 
Rural Ambulance Service Budget Model 3

The Rural Ambulance Service Budget Model (RASBM) fills a very large drawer in the 

REMSTTAC Financial Toolkit. The Budget Model is a customized Microsoft Excel® 

spreadsheet. Part of the Microsoft Office® software family, Excel® is commonly 

available to most computer users and is often bundled on computers marketed in the U.S. 

Where Excel® is not already installed on a personal computer; the software can be 

purchased inexpensively from most office supply stores or on-line software vendors. If 

you have other spreadsheet software REMSTTAC will assist you in the conversion or 

importation of this template. 

This tool was developed to assist rural ambulance services in establishing an annual 

budget. It also helps calculate the value of services donated to the ambulance service by 

another entity and the value of donated services provided by the ambulance staff to the 

community. 

Why should you prepare and use a budget? A budget is a record and forecast of all cash 

sources and cash expenditures. Maintaining a budget allows you to estimate future needs 

and profits and to plan for managing any discrepancies. At minimum, your budget 

should track the expenses of running your service compared to the money generated. A 

detailed budget will allow you to do much more than simply track revenue and expenses; 

it will provide the framework for quantifying the overall value of your ambulance 

service. This becomes especially important when seeking community support, reporting 

to oversight boards or committees, and in applying for grants or loans. The Rural 

Ambulance Service Budget Model provides step-by-step instructions for organizing 

important data regarding your service. 

 

By simply opening this Excel® file the user can input known or easily obtainable 

information into the spreadsheet. The following tutorial provides a detailed, easy to 

follow procedure for obtaining and entering necessary data into the budget model. When 

the worksheet variables are filled, the model automatically calculates and displays 

information that provides the user with an operating budget and information for 

establishing a fee schedule (for those ambulance services that charge for their services). 

The Budget Model file consists of a series of spreadsheet “tabs”, all of which are 

interrelated for calculation purposes. The “tabs” are labeled as follows: 

• Introduction 

• Demographics 

• Vehicles 

• Building 

• Other Capital 

• Staffing 

• Training 

• Other Expenses 

• Budget 

• Rate Study 
Rural Ambulance Service Budget Model 4

The first step in using this REMSTTAC Budget Model is to copy the .xls file from the 

enclosed CD ROM onto your computer hard drive. This file should reside in the 

directory on your hard drive where other Excel® spreadsheet files are maintained. Do not 

attempt to fill in your service information on the file on the CD ROM. 

DISCLAIMER: 

The rural EMS industry is widely diverse and this budget model will not be appropriate 

for, nor was it intended to serve, all ambulance services. Ambulance services are 

encouraged to engage the services of a professional accountant as necessary. 

Future Efforts: 

The REMSTTAC Budget Model and its associated Chart of Accounts are the first of 

several drawers in the Financial Toolkit to be developed. Additional tools under 

consideration are: 

• Cash flow management tools 

• Accounts receivable management tools 

• Billing and third party payer tools 

• Others as identified by the Financial Toolkit task group and the REMSTTAC 

stakeholder group 

We welcome your feedback on the REMSTTAC Budget Model and associated Tutorial. 

You may contact us at: 

REMSTTAC 

300 North Willson Avenue 

Suite 802-H 

Bozeman, MT 59715 

Phone 406-587-6370 

Toll Free 866-587-6370 

Fax 406-585-2741 

info@remsttac.org 

http://www.remsttac.org 
Rural Ambulance Service Budget Model 5
Rural Ambulance Service Budget Model 6

Rural Ambulance Service Budget Model 

INTRODUCTION 

Congratulations! You’ve taken an important first step in deciding to use the budget model 

tool provided by the Department of Health and Human Services, Health Resources and 

Service Administration’s Office of Rural Health Policy (ORHP). This product was 

developed by the Rural Emergency Medical Services & Trauma Technical Assistance 

Center (REMSTTAC) under a previous contract with ORHP. 

This tool was developed to assist rural ambulance services in establishing an annual 

budget. It also provides some utility in demonstrating the value to a community for 

services donated to the ambulance service by another entity (such as dispatch functions 

provided free by the sheriff), and the value of donated services provided by the 

ambulance staff to the community (such as the value of volunteer labor contributions). 

The tool is one of a series of “EMS Management Tools” being produced. 

The model will also give you the ability to upload our national standard EMS Chart of 

Accounts and the budget you develop directly into the Intuit’s QuickBooks® program. 

QuickBooks® is a proprietary accounting program that can help you manage your 

finances, print reports, provide payroll functions, and more. We chose QuickBooks® 

to provide an interface because Intuit supports it fully on-line and provides 

comprehensive help and training. 

Limitations: 

The rural EMS industry is widely diverse and this budget model will not be appropriate 

for, nor was it intended to serve, all ambulance services. Ambulance services are 

encouraged to engage the services of a professional accountant as necessary. 

Notes about the Model: 

This model consists of a series of visible and hidden rows and columns. It is designed to 

be completed sequentially; however it is possible to start one section, skip part, and then 

return. Green areas of the worksheet are always fine to fill in. Yellow areas provide 

caution or an either/or Statement. Filling in red sections, or any section on the budget 

page will override formulas. Do so with caution and monitor the effect on the rest of the 

model. These areas should be changed only by those with strong expertise in spreadsheet 

design and use. 

Let’s Get Started: 

First, print the document included in this package called “Budget Model Worksheet.doc”. 

Keep it handy: we’ll be filling it in as you move along in this tutorial. Next, open the 

budget model by double clicking on the “Budget Model.xls” file. The first page you see 

is the Demographics page. 
Rural Ambulance Service Budget Model 7

SPREADSHEETS 

 

If you are familiar with spreadsheets, skip to the next page. If you’re not, here’s a little 

primer. 

Spreadsheets are organized into columns and rows. Columns are identified by 

letters (A to Z and then AA to ZZ, and so on). Look at the words “Test Ambulance 

Service” above, (they are at the top of the yellow area). The area those words appear 

in is called a cell. The reference for that cell is B6. That is because those words appear 

going across the top in column B and going down to row six. The cell reference for the 

words “I am preparing a budget for the year:” is A19. The words in cell C7 are “on all 

subsequent worksheets”. 

 Now look at the bottom of the graphic. Under the number for row 31 you see a 

group of four arrows pointing left or right and then seven words: QuickBooks, 

Demographics, Vehicles, Building, Other Capital, Staffing and Training. (Your 

spreadsheet program may display some, all, or all of these plus others.) These are tabs. 

We’re working on the Demographics tab right now. To switch to the Vehicles tab, click 

on the word Vehicles and that tab will be displayed. 

If you need more assistance in learning about spreadsheets, please refer to the Help 
Rural Ambulance Service Budget Model 8

function on your spreadsheet program. 

Demographics: 

What this tab does: The transport and miles information you enter on this page will 

become important as you get to the final steps of the model. You will use them to help 

determine what you will need to set your rates at in order to cover your costs. 

On this tab you will enter the name and other information about your ambulance 

service. In cell B15, enter the number of emergency ambulance runs your service 

performed last year that resulted in a bill being sent. Do not include responses that did 

not result in a bill. In cell B16, follow the same procedure to record the number of nonemergencies. In cell B17, enter the total number of miles billed. Try to be accurate with 

these numbers, they are important later. 

STOP – IT IS TIME TO SAVE YOUR WORK. 

 This is the first save of your work. To save your file to your hard drive, click on 

File and then Save-As. Choose a location on your computer to save your work. Rename 

the file if you would like. We’ll have you save your data frequently as you work through 

this tutorial, always to the same place. Also, if you take a break, when you come back to 

continue working, be sure to open the saved spreadsheet from your hard drive, not the 

template version you opened to begin this tutorial. 

Now it’s time to move to the Vehicles tab. 
Rural Ambulance Service Budget Model 9

Vehicles:

What this tab does: The information you enter on this page feeds necessary information 

to your final budget. For vehicles you lease, it will transfer the lease costs into your 

budget. For vehicles you purchase, it will set up depreciation. Depreciation is an 

important part of your final budget. By depreciating over time, you will be saving 

money in the bank to replace your vehicles when their useful life is exhausted. Since 

the cost of vehicles will increase over time, depreciation alone will not produce enough 

cash to meet the increased price when replacement is necessary. You will need to 

supplement depreciation with either cash reserves, or funds produced another way. 

 Let’s make this friendly for you first. Click on cell A16 and replace the words 

“Ambulance #1” with terminology that is familiar to you. Call it Unit 101, Squad 54, or 

whatever label will help you recognize this as your primary ambulance. If you have more 

than one ambulance, replace the text in A17 through A25 similarly. 

If you are LEASING any of these ambulances, enter the monthly lease amount in the 

yellow area on the same row as that vehicle. For leased vehicles, you will not 

complete columns C to G. 
Rural Ambulance Service Budget Model 10

 For all vehicles - LEASED AND OWNED - fill in columns K (Vehicle License), 

L (Vehicle Registration) and M (Insurance). In column K, fill in the amount paid in 

vehicle licensing fees from your State EMS agency, if any, for all vehicles. The amount 

should be an annual amount, so if the State charges you once every two years, divide the 

total by two and enter that amount. Column L is for vehicle registration and license 

plates from your State vehicle licensing bureau, if any, for all vehicles. Enter an annual 

amount. Column M is for one year of vehicle insurance. Fill in the annual amount for 

each of the ambulances. 

If you LEASE your vehicles follow the same process as above for any non-ambulances 

you might have, using rows 32-36. Then, you’re done with this tab, unless you also 

own some of your vehicles. 

 We’ll use columns C to G for vehicles you OWN (or are making loan payments). 

If you normally replace your vehicles based on a specific number of years, enter the 

number of years in cell G10. If you normally replace vehicles when their mileage hits a 

specific level, enter the target number of miles in G11. Do NOT put values in both cells, 

but also make sure you fill in one of them. If you don’t follow either of these 

replacement milestones, pick one and estimate a number for it. 

 For each owned ambulance enter the following information: Cell C16 (through 

C25) – the year the ambulance was acquired. Cell D16 (through D25) – the cost of the 

vehicle the year it was purchased. Cell E16 (through E25) – the cost of any capital 

equipment you purchased with the ambulance. 

 Many ambulance services will purchase new stretchers, mobile radios, 

defibrillators and other capital equipment each time they purchase an ambulance. If you 

follow this process, enter the total value of capital items that are purchased with the 

vehicle. Capital is commonly defined as those items that cost more than $500 and have a 

useful life exceeding one year. It is important to keep track of what equipment is 

represented in this figure. It will roll into the total vehicle depreciation calculation; 

therefore, it should not be listed again later with other capital equipment. 

Cells F16 and G16 (through F25 and G25) – if you entered a number of years in cell G10, 

you do not need to fill in these numbers; your depreciation will be calculated based on the 

number of years the vehicle is in service. If you entered a number of miles in G11, then 

you need to complete F16 and G16. In F16, enter the odometer reading of your vehicle at 

the beginning of the previous 12 month period and the odometer reading at the end of the 

12 month period. Since you replace your vehicles based on miles driven, depreciation 

will be calculated based on the total number of miles driven last year. 

Complete the same information on rows 32-36 for all non-ambulances you own or lease. 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Now it’s time to move to the Building tab. 
Rural Ambulance Service Budget Model 11

Building:

What this tab does: The Buildings tab will record rent and mortgage information. It sets 

up depreciation for buildings owned by the ambulance service. In addition, it estimates 

the value of space donated for your use. Pay attention to donated space for two reasons: 

first, it will help you understand the value of the donation, and secondly, you can publicly 

report the value of the donation. 

 

 Rows 7-12 are for donated space. For each category of space, enter the number of 

square feet in column B. Column C has some default square footage price estimates. If 

you know a specific value for your area, you can override these numbers with actual 

values. 

 Rows 14-20 are for lease payments made for space you occupy but don’t own. 

Enter your monthly lease payment for each building. 

 Rows 23-28 are for buildings you own. If you know the original cost, interest 

rate and mortgage term, enter those values and the annual payment amount will be 

automatically calculated. As an alternative, if you know the annual mortgage cost, you 

can just type it into the red area. NOTE: for owned buildings, enter ANNUAL 

information and for leased buildings, enter MONTHLY lease payments. 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Now it’s time to move to the Other Capital tab. 
Rural Ambulance Service Budget Model 12

Other Capital:

What this tab does: The Other Capital tab collects information to set up depreciation 

for capital items that are not included on the Vehicles tab. Capital items are those that 

cost over $500 and have a useful life that exceeds one year. 

 The Other Capital tab has 4 categories common capital equipment: 

communications, patient care, mechanic and office equipment. If you have equipment 

that doesn’t fit into one of these categories, you’ll have to make it fit somewhere. Use 

one of the “other” categories on rows 12, 17 or 25. Type over the word “other” to 

remember what equipment you placed there. 

 In each category, enter the purchase cost of the item(s) purchased. Feel free to 

change the number of years in the “Years Useful Life” columns. If you included your 

stretcher(s) or defibrillator(s) as equipment on the vehicle tab, do not enter them here. 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Now it’s time to move to the Staffing tab. 
Rural Ambulance Service Budget Model 13

Staffing:

What this tab does: The Staffing tab collects information about how you staff your 

ambulance service and will estimate your salary costs for next year. 

 Let’s make this friendly for you. If you have administrative staff, type over 

the label Administrative Position #1 in cell A8 with either the name or job 

classification for the person filling the role. If you have more than one administrative 

position (billing, secretary, etc.) do the same on A9 to A12. 

 

For administration, you will either enter the hours worked per week in column C and the 

rate per hour in column D, or you can type in an annual amount in column E. 

 

 Whether you staff full-time, volunteer or some combination of each, the 

ambulance staff section should work for you. This section is organized around your 

ambulance vehicles. If you have full-time staff or pay an on-call stipend to volunteers, 

you’ll use columns E and F. If you pay your staff a per-run stipend, you’ll use columns 

G and H. If you already know your annual salary costs, you can simply enter those in 

column J. 

Example: ABC ambulance service staffs one ambulance 24 hours a day with two fulltime staff. They have a second ambulance which uses on-call staff that are each paid $2 

per hour while on call, and $20 per run. On their 500 billable runs, the full-time staffed 

ambulance completes 450 and volunteers complete the other 50. 
Rural Ambulance Service Budget Model 14

 In cell D16 enter “2” to represent the two full time staff. In cell D17 enter “2” to 

represent the volunteers on call. In E16 and E17 enter 24, to represent around the clock 

staffing. 

 In cell F16 you will enter the average pay rate of the full-time staff. If your staff 

are paid different hourly rates depending on their longevity with the service, simply add 

up all of their pay rates and divide by the number of employees and this will give you the 

average hourly rate. The typical ambulance service will pay some overtime during the 

course of the year. Estimate the number of overtime hours and fill in the blocks below. 

Use that result as the Hourly Rate for cell F16. 

Calculation Result 

Number of hours per year 24 hours times 365 days 8,760 

Average hourly pay rate XXXXXXXXXXX 

Estimated annual number of 

hours of overtime pay 

XXXXXXXXXXX 

Average hourly pay rate at 

time and one-half 

Average hourly pay rate times 1.5 

Annual Regular Pay Number of hours per year (8,760) times average 

hourly pay rate 

Annual Overtime Pay Number of overtime hours per year times 

average hourly pay rate at time and one-half 

Total Pay Annual Regular Pay Plus Annual Overtime Pay 

Average hourly pay 

including overtime factor 

Total Pay divided by number of hours per year 

(8,760) 

 In cell D16 enter “2” for the volunteers that are on call. In cell E16 enter 24. In 

cell F16 enter “2” for the $2 per hour call time. In cell G16 enter 20 for the per-run 

stipend and in cell H16 enter 50 – the number of transports completed by the volunteers. 

Use a similar process to enter the information for communications and mechanic staff (if 

any). 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Now it’s time to move to the Training tab. 
Rural Ambulance Service Budget Model 15

Training:

What this tab does: The Training tab collects information about your ongoing education 

costs. 

The amounts entered into this tab should be ANNUAL amounts per person. 

Many States require certification/licensure renewal every two or three years. If your 

service pays these fees or reimburses staff for them, divide the fee paid by the number 

of years the certificate/licensure is valid. See an example on the Budget Model 

Worksheet for how to calculate this result. The example is based on a State 

certification/licensure fee of $40 for fours years and a National Registry fee of $25 for 

two years. 

Use a similar process to calculate the annual cost of refresher courses if your 

service pays for them. If your service pays for conference attendance, include the 

average cost of conference registration plus travel expenses in column G. 

If there is other training that you pay for (for example ACLS or PALS courses), report 

an average ANNUAL amount that includes reimbursed travel costs. For example, let’s 

say you pay a registration fee of $150 and reimburse on average $50 in travel related 

costs for ACLS. Since the refresher course is every two years, the cost per two year 

cycle per person is $200. However, you should report the ANNUAL cost per person 

($100). 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Now it’s time to move to the Other Expenses tab. 
Rural Ambulance Service Budget Model 16

Other Expenses:

What this tab does: This tab collects information about expenses that have not been 

recorded elsewhere on any tabs. 

This tab requires some detective work on your part. You will need to go through 

your records from last year to determine the total amounts paid for these various 

categories. The tab is organized into six different sections: patient care expenses, 

dispatch expenses, administrative expenses, interest expense, building expenses, and 

vehicle expenses. 

DO NOT CHANGE THE ACCOUNT NUMBERS OR DESCRIPTIONS ON 

THIS TAB. They are part of a national standard EMS Chart of Accounts. If you don’t 

see a category that matches they way you have previously recorded your expenses, you’ll 

need to find the best fit. If you use QuickBooks® or some other proprietary software, 

you can set-up sub-accounts to these categories later to match the way you keep track of 

expenses. 

On the Budget tab that follows this one, some benefit costs will be automatically 

calculated for you, using an average benefit rate of 30 percent of salary. If you don’t 

want to use this average rate and you know the actual costs of the red areas in column C, 

fill in the actual amount in the benefits cells under patient care, dispatch and 

administration in column C. Change the (0.3) in the formula to reflect your actual benefit 

percentage. 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Now it’s time to move to the Budget tab. 
Rural Ambulance Service Budget Model 17

Budget: 

What this tab does: This tab displays the calculations and amounts entered on all 

previous tabs. It also demonstrates the value of contributed items, either by other 

agencies to yours, or by your volunteer staff. It uses an inflation factor to increase your 

budget amounts from last year to the current year. 

About the patient care section: If you elected to fill in the red cells in the previous 

tab for benefits you should make the amount in cell C11 “0.” Otherwise, benefits will be 

reported twice. If your total employee salaries do not equate to at least $10 per hour for 

two people, cells F10 and F11 will report an amount that volunteers contribute. This 

number can be a powerful tool for you as you report the estimated dollar value you 

provided to the community through the volunteers’ service. Feel free to change the 

Percent Inflation on any or all of the rows in column D to match your particular 

circumstances. Column G is calculated by taking the actual or estimated information in 

column C times the inflation factor in column E for that row. 

About the dispatch section: Many ambulance services do not operate their own 

dispatch centers; the service is dispatched by the police or sheriff’s departments. If you 

haven’t reported an amount equivalent to $15 per hour, 24 hours a day in dispatch 

salaries, this sheet will estimate the value that your dispatch center provides to you. If 

you elected to fill in the red cells in the previous tab for benefits you should make the 

amount in cell C24 “0.” 
Rural Ambulance Service Budget Model 18

About the administrative section: Many ambulance services have part-time 

managers. If you have not reported at least $15 per hour for 40 hours per week in 

administrative payroll costs, this sheet will report the value of the contribution to the 

service by your management staff. If you elected to fill in the red cells in the previous 

tab for benefits you should make the amount in cell C36 zero. 

About the building section: Cell E24 will report the annual value given to the 

ambulance service for donated space that was reported on the building tab. 

Row 87 provides a total of your expenses from last year, the value added to the service by 

donated space or dispatch, the value provided to the community by volunteers, and 

budget amounts for next year that are based on this year’s budget plus an inflation factor. 

When you’re satisfied the amounts are correct, you should print this page. 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Now it’s time to move to the Rate Study tab. 
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Rate Study: 

What this tab does: This tab allows you to see the effect of varying base and mileage 

changes, based on the percentage of collections of your service. 

This tab is a tool for you to estimate what your charges will need to be in order to 

recoup your cost of providing service. The number of emergency calls, non-emergency 

calls, and billed miles reported on the demographics tab are displayed in cells B10, B20 

and B30. Note: in order to provide you with an example, we have used 500 emergency 

trips, 200 non-emergency trips and 9,000 billable miles. When you open this sheet, the 

numbers you entered on the demographics page will be displayed. 

In order to use this sheet, you will need to ask your billing clerk or billing 

company what your average percentage of collections are. If you bill $100,000 annually 

and collect $70,000, then your collection percentage is 70 percent. We’ll use this as an 

example. In this example, if you bill a $250 base rate for your 500 emergencies, you 

would collect roughly the amount in cell C14 ($87,500). For 200 non-emergencies 

charged at a $250 base rate you would collect the amount in cell C24 ($35,000). For 

9,000 billed miles at $9 per mile, you would collect the amount in cell C34 ($56,700). 

Your total collections for 500 emergencies, 200 non-emergencies and 9,000 billed miles 

would be $179,200. 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 
Rural Ambulance Service Budget Model 20

You can use this sheet to test various rates and collection percentages. We have 

provided space for you to add these three collections amounts on the Budget Model 

Worksheet. 

If you need to adjust the rates up or down for any or each of the categories, simply 

change the numbers in cells C10, C20 and C30. Each column D through M on row 10 

increases the base rate by $50. If you want to see what a base rate of $100 would collect, 

change C10 to $100. Then D10 will automatically convert to $150, E10 to $200 and so 

on. 

STOP – IT IS TIME TO SAVE YOUR WORK. Click on File and then Save. 

Congratulations! You have finished your own budget based on the Budget Model. We 

would appreciate hearing from you about your experience using this tool, what you did 

with it when you were finished, and ways we can enhance it in the future. To provide 

comments, please e-mail info@remsttac.org or telephone us at (866) 587-6370. 

Unless you plan to use QuickBooks® and want to import the Chart of Accounts and 

your budget, you’re finished with this tool. Importing into QuickBooks® will be 

covered in the next section. Printing costs for the QuickBooks® Pro Edition ranged from 

$199.95 to $399.95 at the time this document was printed. 

Whether or not you export your data to QuickBooks® you have taken a very important 

step in planning for the financial future of your Agency. By exporting your data to 

QuickBooks® or another off-the-shelf accounting software system, you will be able to 

follow the financial performance of your ambulance service on a monthly basis. 

Tracking expenditures and revenues monthly better enables you to anticipate future needs 

and plan for addressing them. Maintaining a detailed budget will also provide you with 

persuasive data to share with others when you need to demonstrate the value and needs of 

your ambulance service. 
Rural Ambulance Service Budget Model 21

QUICKBOOKS EASY STEP INTERVIEW 

There is one tab in the Budget Model that you haven’t used yet. This tab contains the and 

budget information you’ve just completed, which can be imported into QuickBooks®. 

This information is formatted for QuickBooks® Pro 2006. Whether it will import into 

other versions of QuickBooks® is unknown. 

We will provide you with a step by step example of importing this data that assumes 

you just purchased QuickBooks® and are starting from scratch. 

After installing QuickBooks®, start the program. Follow the prompts in the program. 

You will see the following screen. 

Fill in the appropriate information and click Next. 
Rural Ambulance Service Budget Model 22

Select “(No Type)” on the left side and click Next. 

Choose either the default place to save your file or another location on your hard drive 

and click save. 
Rural Ambulance Service Budget Model 23

Click “Begin Using QuickBooks” in the lower right corner. 

If some Alerts pop up, click “Mark As Done” or “Remind Me Again” if you want 

to be reminded. 

Now go back to your Budget Model spreadsheet. You’ll see this in the lower left 

corner of the sheet: 

Just above where it says “Ready” click the first arrow on the left side. 

 
Rural Ambulance Service Budget Model 24

Then you will see the first few tabs in the spreadsheet. 

Click on the QuickBooks tab, and you should see this: 

We need to save this tab in a format that QuickBooks can recognize. To do that, we’re 

going to save a duplicate of your budget model under a different name and format. 

Now change the “Save as type” in the center on the bottom to TEXT. Also, rename the 

file to QuickBooks.iif. 
Rural Ambulance Service Budget Model 25

Now click Save. You may now see two dialogue boxes, one informing you that only the 

current sheet can be saved and the other that some features of Excel may not be available 

in this format. Click YES to both dialogue boxes. 

Back to QuickBooks. 

Click on File, then Utilities, then Import, then IIF files. 
Rural Ambulance Service Budget Model 26

Now click on Desktop on the left and select the QuickBooks.iif file you previously saved. 

Click Open. After the budget is imported you will see the following: 
Rural Ambulance Service Budget Model 27

Contact REMSTTAC: 

Congratulations! You are finished with this tutorial. Please refer to the extensive 

in-product and on-line support for QuickBooks. 

Thank you for using the budget model. We’re interested in your feedback on the use and 

utility of this product. If you have comments or suggestions for improvement, please 

contact us at: 

REMSTTAC 

300 North Willson Avenue 

Suite 802-H 

Bozeman, MT 59715 

Phone 406-587-6370 

Toll Free 866-587-6370 

Fax 406-585-2741 

info@remsttac.org 

http://www.remsttac.org 

Health Resources and Services Administration, Office of Rural Health Policy 

5600 Fishers Lane, Room 9A-55 

Rockville, MD 20857 

Phone 301-443-0835 

Fax 301-443-2803 

http://ruralhealth.hrsa.gov/
Rural Ambulance Service Budget Model 28

APPENDIX A: REMSTTAC STAKEHOLDERS GROUP 

Jane Ball, Executive Director 

EMSC National Resource Center 

Trauma-EMS Technical Assistance 

Center 

Eli Briggs, Policy & State Affairs 

Manager 

National Rural Health Association 

Government Affairs Office 

Bethany Cummings 

Rural Affairs Ad Hoc Committee 

National Association of EMS Physicians 

Drew Dawson, Chief, EMS Division 

National Highway Traffic Safety 

Administration 

Tom Esposito, Medical Director 

Rural EMS and Trauma Technical 

Assistance Center 

Loyola University Medical Center 

Blanca Fuertes, Project Officer 

Department of Health and Human 

Services 

Health Resources and Services 

Administration 

Office of Rural Health Policy 

Grant Gray, Representative 

National Association of Emergency 

Medical Technicians 

Christian L. Hanna, Rural Site Director 

Children’s Safety Network 

National Children's Center for Rural 

Agricultural Health and Safety 

Bob Heath, EMS Education Coordinator 

Nevada State Health Division 

Marilyn Jarvis, Assistant Director for 

Continuing Education 

Burns Telecommunications Center 

Montana State University 

Doug Kupas 

Rural Affairs Ad Hoc Committee 

National Association of EMS Physicians 

Fergus Laughridge, Program Manager 

Nevada State Health Division 

EMS Bureau of Licensure & 

Certification 

Tami Lichtenberg, Program Manager 

Technical Assistance and Services 

Center 

Rural Health Resource Center 

Patrick Malone, Director 

Initiative for Rural Emergency Medical 

Services 

University of Vermont 

N. Clay Mann, Professor, Associate 

Director of Research 

Intermountain Injury Control Research 

Center 

University of Utah 

Evan Mayfield, CDC Public Health 

Advisor 

New York Department of Health 

Charity Moore, Research Assistant 

Cecil G. Sheps Center for Health 

Services Research 

University of North Carolina at Chapel 

Hill 

Carol Miller, Executive Director 

Frontier Education Center 

National Clearinghouse for Frontier 

Communities 

Daniel Patterson, AHRQ-NRSA PostDoctoral Research Fellow 

Cecil G. Sheps Center for Health 

Services Research 

University of North Carolina at Chapel 

Hill 
Rural Ambulance Service Budget Model 29

Davis Patterson, Research Associate 

WWAMI Center for Health Workforce 

Studies 

University of Washington 

Kristine Sande, Project Director 

Rural Assistance Center 

Dan Summers, Director of Education 

Center for Rural Emergency Medicine 

West Virginia University 

Chris Tilden, Interim Director 

Kansas Department of Health & 

Environment 

Office of Local & Rural Health 

Robert K. Waddell II, Secretary 

/Treasurer 

National Association of EMS Educators 

Bill White, President 

National Native American EMS 

Association 

Gary Wingrove, Program Development 

Technical Assistance and Services 

Center 

Rural Health Resource Center 

Jill Zabel, Healthcare Consulting 

Wipfli LLP