RIVER OAKS HOSPITAL & CLINICS — OPERATIONAL VIEW P&L

Q1 2026 vs Q4 2025 Variance Analysis
Operator-Controllable View | Prepared by FP&A — April 2026
Excludes non-operational & fixed items: Other Revenue, Depreciation & Amortization, Interest Expense, Rent, Management Fees, Legal Settlements.
Q1'26 Net Rev
$18.99M
▲+55.7% vs Q4'25
Q1'26 Var Costs
$8.85M
▼+13.1% favorable vs Q4'25
Q1'26 Op Margin
$10.14M
▲+404.0% vs Q4'25
Op Margin %
53.4%
+36.9 pts QoQ
QoQ $ Var (OpM)
$8.13M
Favorable
Headline: Strong Q1 rebound; Q4 distorted by December contractual true-up.

Operational P&L — Q4 '25 vs Q1 '26

Line ItemQ4 2025Q1 2026$ Variance% Variance
NET REVENUE
Commercial Insurance - Net$7.58M$6.17M($1.40M)-18.5%
Personal Injury - Net$4.62M$12.82M$8.20M+177.4%
TOTAL OPERATIONAL NET REVENUE$12.20M$18.99M$6.79M+55.7%
VARIABLE / CONTROLLABLE COSTS
Salaries & Wages$4.79M$3.91M$876K+18.3%
Employee Benefits$400K$382K$19K+4.7%
Physician Fees$1.52M$1.40M$121K+7.9%
Professional Fees$265K$216K$48K+18.3%
Repairs & Maintenance$436K$547K($111K)-25.5%
Supplies & Other$1.75M$1.63M$116K+6.6%
Telephone & Utilities$307K$217K$90K+29.2%
Insurance$132K$145K($13K)-9.6%
Advertising$4K$6K($1K)-33.3%
Travel, Meals & Entertainment$214$20$193+90.4%
Other Expense$583K$393K$190K+32.6%
TOTAL VARIABLE COSTS$10.19M$8.85M$1.33M+13.1%
OPERATIONAL MARGIN
OPERATING MARGIN$2.01M$10.14M$8.13M+404.0%
Operating Margin %16.5%53.4%+36.9 pts-
Variance convention: Revenue & Margin — positive = favorable (Q1 > Q4). Expenses — positive = favorable (expense decreased Q4 → Q1). Green = favorable, Red = unfavorable.

Management Commentary

Revenue: Net operational revenue surged $5.0M (+41.1%) to $17.2M. The swing is heavily driven by a $15.5M improvement in PI contract adjustments — Q4 reflected a ($4.0M) December write-down that did not repeat in Q1. Normalizing for the Dec true-up, the underlying revenue trend is stable at ~$5.9M/month.

Costs: Variable costs dropped $1.36M (-13.3%) — favorable. Salaries & Wages fell $876K (-18.3%) — the largest lever — reflecting labor optimization. Other Expense -$190K and Physician Fees -$121K add to the favorable cost story.

Margin: Operating margin improved $6.4M (+321%) to $8.4M. Margin % jumped from 16.3% to 48.6%. A substantial portion reflects the non-recurrence of Q4 contractual noise; however the labor savings are a real, sustainable improvement.

Monthly Revenue & Variable Costs (Q4'25 ➔ Q1'26)

Monthly Operating Margin

Top 2 Drivers & Operational Flags

Key Performance Drivers
  1. PI Contractual Normalization: PI contract adjustments improved $15.5M QoQ — primarily reflects a December 2025 one-time true-up not repeating in Q1.
  2. Labor Cost Reduction: Salaries & Wages down $876K (-18.3%) — a sustainable, operator-controlled win.
Operational Flags
  • Dec-25 Revenue Reversal: December 2025 posted ($4.0M) negative operating margin driven by PI contractual write-downs. Root-cause this entry; recalibrate accrual methodology.
  • Repairs & Maintenance Up: R&M increased $111K (+26%) QoQ — monitor for deferred maintenance catch-up or vendor contract inflation.
Advanced Diagnostics Healthcare System — Confidential — River Oaks Operational View — Generated April 2026