FY '12 Capital Template Instructions
Oregon Health & Science University
FY '12 Capital ROI Template Instructions
The following document is to assist in the completion of the OHSU Capital ROI Template for the FY '12 Capital Budgeting Cycle.
There are FIVE sections within this workbook. They are as follows:
1) Instructions
2) ROI Worksheet
3) Detail Cost Estimate
4) Capital Request Form
5) Total Year 0 Capital Expenditures (or Total Project cost)
Depending on the nature of your request, there may be certain sections which could be excluded from your capital request. Please
see the FY '12 Capital Budget Guidelines, for further reference, on the CFS Budgeting website
(http://ozone.ohsu.edu/financial/budget/index.shtml).
Reminder: All capital requests (regardless of dollar value) must be entered into KBace.
Instructions on how to use template:
To begin, please review the FY '12 Capital Budget Guidelines and these Instructions.
Once your review complete, identify which template and which sections will be required for your FY '12 capital request.
Additional Instructions - ROI worksheet:
A. Fill in all required input fields. These cells are shaded in green.
Enter in the title of your request - "Sample Project."
Enter in all implementation costs and ongoing costs/benefits for departments involved.
Enter in the name of the department that will be impacted as a result of this request.
Ensure to reflect all capital and operating costs in their respected sections.
Adjust / enter in any factors needed on ongoing costs/benefits.
Ensure to reflect all ongoing costs/benefits by respective area impacted.
B. After entering in all implementation costs and ongoing costs/benefits for departments involved, you can adjust
the outgoing years, if necessary, to accurately reflect the cash flow impact of activity.
C. All other data will be populated automatically. No other input on this form is necessary.
Note: Financial calculations are set for only University projects. If Hospital is also impacted, rate may need to be adjusted upon review.
Additional Instructions - Detail Cost Estimate
A. Name / Phone #, Department, and Date is linked to fields on the capital request form. No need to enter
on this form.
B. Prior Year Capital Expenditures and FY 2012 Requested Capital will be populated by linked cells. (These should be
reviewed for reasonableness)
C. Enter in any expected requested capital for FY 2012 through FY 2016. This will be used to update and
be coordinated within the Five-Year plan.
D. Enter the anticipated Funding Source and amount in total. If more than one, please list all impacted.
E. Enter in the anticipated start and completion date of request.
F. Indicate whether a return on capital investment is required. List specifically any details qualifying the exclusion.
G. Obtain appropriate signatures. Approvals can be obtained by including those individuals on the email submitting
the request. If they are visible on the email, it will be assumed they are aware and approve of the capital request.
Additional Instructions - Capital Request Form
A. Enter in the Name / Phone #, Department, and Date of request. These fields are linked to other forms.
Enter in the Strategic Initiative Tactic #, if applicable.
B. Enter a detailed description for each of the sections listed. They are as follows:
Project / Capital Request Description
Justification for Project / Capital Request - Potential Risks / Alternatives
Does this request fulfill a commitment?
Is this request legally required? (Cite regulation/specifics)
How does this request advance key strategies?
Other Factors / Assumptions
Indicate the reason for Project / Capital Request. Select boxes that apply.
Keep in mind, this form will be included will all other details provided. This is the section for you to provide
the basis for your request. This form will be reviewed and considered heavily in the process.
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FY '12 Capital Template Instructions
Oregon Health & Science University
FY '12 Capital ROI Template Instructions
Additional Instructions - Total Year 0, if applicable
A. If your project will take multiple years to complete, this is where you will enter in all costs associated with
your project in the specific fiscal year it is anticipated.
These totals will link to the ROI worksheet as total "Year 0" capital expenditures which as defined as all
costs required and expected to be needed in order to compete request capital activity.
While working on this workbook, please save often! This may help reduce rework of schedules.
Also, you may attach any support you feel necessary to this workbook. Please send this file to Gene Whiteley-Ross,
(whiteleg@ohsu.edu) as soon as complete and approved.
Once sent, please print out a copy of all schedules for your records. Once received, all files will be accumulated and
submitted to the CAC for review.
As always, if you have any questions or comments, please call Gene @ ext. #47158. He will work to
resolve your concerns or issues in order to complete this required documentation.
Thanks in advance for all your hard work and consideration of these matters.
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OHSU CAPITAL ROI FORM - Economic Life: 10 Years
Sample Project
NOTE: Please review the FY 11 Capital Budgeting Guidelines, once available. This form may not be necessary for certain requests over $50k, exceptions will be listed within Guidelines. Requests under $50k do not require a workbook.
- Year 0 ** FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021
Implementation Costs
ITG Input Implementation Financial Impact - Automatically Updated
Capital Expenses CK
Salaries - Capitalized Labor - - - - - - - - - - -
Contract Labor - - - - - - - - - - -
Professional Services - - - - - - - - - - -
Capital Equipment - - - - - - - - - - -
Building Improvements - - - - - - - - - - -
Software - - - - - - - - - - -
Hardware - - - - - - - - - - -
Freight - - - - - - - - - - -
Operating Expenses
Salaries & Wages - Operating (under $100k) -
Minor Equipment -
Maintenance -
Training -
Other Expenses -
Other Department: _____________________
Capital Expenses CK
Salaries - Capitalized Labor - - - - - - - - - - -
Contract Labor - - - - - - - - - - -
Professional Services - - - - - - - - - - -
Capital Equipment - - - - - - - - - - -
Building Improvements - - - - - - - - - - -
Software - - - - - - - - - - -
Hardware - - - - - - - - - - -
Freight - - - - - - - - - - -
Operating Expenses
Salaries & Wages - Operating (under $100k) -
Minor Equipment -
Maintenance -
Training -
Other Expenses -
Total Project Outlay -
Total Expected Depreciation - - - - - - - - - -
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021
Operating Costs - Benefits/Ongoing Input Factor Input Benefit Impact - Automatically updated. (If needed, can override with additional/expected benefites in future years)
ITG Benefits
Additional Revenue 0% 0 % growth - - - - - - - - - -
"Real Wage" Savings (Include OPE) 3% 3 % inc. assumed - - - - - - - - - -
Contractor savings - Assume 1 time -
Cost Avoidance (Labor, Supps, etc.) - Assume 1 time -
Supply savings 0% 0 % growth - - - - - - - - - -
Rent\Lease (assumes no step increases) 0% 0 % growth - - - - - - - - - -
Other Savings - Assume 1 time -
Productivity/Efficiency Savings 0% 0 % growth - - - - - - - - - -
Departmental Benefits
Additional Revenue 0% 0 % growth - - - - - - - - - -
"Real Wage" Savings (Include OPE) 3% 3 % inc. assumed - - - - - - - - - -
Contractor savings - Assume 1 time -
Cost Avoidance (Labor, Supps, etc.) - Assume 1 time -
Supply savings 0% 0 % growth - - - - - - - - - -
Rent\Lease (assumes no step increases) 0% 0 % growth - - - - - - - - - -
Other Savings - Assume 1 time -
Productivity/Efficiency savings 0% 0 % growth - - - - - - - - - -
Total Incremental Savings - - - - - - - - - -
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OHSU CAPITAL ROI FORM - Economic Life: 10 Years
Sample Project
NOTE: Please review the FY 11 Capital Budgeting Guidelines, once available. This form may not be necessary for certain requests over $50k, exceptions will be listed within Guidelines. Requests under $50k do not require a workbook.
- Year 0 ** FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021
Input Factor Input Cost Impact - Automatically updated
ITG Costs
Wages (Include OPE) 3% 3 % inc. assumed - - - - - - - - - -
Software Licensing/Maintenance 0% 0 % growth - - - - - - - - - -
Other expenses 0% 0 % growth - - - - - - - - - -
Maintenance 0% 0 % growth - - - - - - - - - -
Rent\Lease (assumes no step increases) 0% 0 % growth - - - - - - - - - -
Departmental Costs
Wages (Include OPE) 3% 3 % inc. assumed - - - - - - - - - -
Software Licensing/Maintenance 0% 0 % growth - - - - - - - - - -
Other expenses 0% 0 % growth - - - - - - - - - -
Maintenance 0% 0 % growth - - - - - - - - - -
Rent\Lease (assumes no step increases) 0% 0 % growth - - - - - - - - - -
Total Incremental Costs - - - - - - - - - -
Net Benefit/Expense Impact 0 - - - - - - - - - -
Net Benefit/Expense Impact w/o productivity savings 0 - - - - - - - - - -
ITG Costs/Benefits - - - - - - - - - -
Dept. Costs/Benefits - - - - - - - - - -
Total Cost/Benefit - - - - - - - - - -
chk - - - - - - - - - -
** Year 0 represents the total anticipated costs for all fiscal years.
Includes Productivity Increases (Soft Savings) If project exceeds multiple years, combine all costs into Year 0.
OHSU Please see the tab at the end of workbook for Year 0 schedule.
Net Present Value @ OHSU - Combined Hurdle Rate ** 0 Hurdle Rate
Depreciable Lives - Legend
Internal Rate of Return 0.00% 6.97% OHSU - Combined Type Years
Payback Period: Sum of Years / Average years ITG Salaries & Wages 3.0
Contract Labor 5.0
** Rate may need to be adjusted upon review Professional Services 3.0
Capital Equipment 7.0
Without Productivity Increases (Soft Savings) Building Improvements 10.0
OHSU Software 3.0
Net Present Value @ OHSU - Combined Hurdle Rate ** 0 Hurdle Rate Hardware 5.0
Freight 7.0
Internal Rate of Return 0.00% 6.97% OHSU - Combined
If another depreciable life is deemed necessary, please contact
Payback Period: Sum of Years / Average years CFS - Budgets and changes can be made to workbook.
** Rate may need to be adjusted upon review
=============================================================================================================================================================================================
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OHSU CAPITAL DETAIL COST ESTIMATE
Name, Phone #: Department: Date:
A completed ROI is required on all capital requests over $50,000. The details supplied below will assist the Capital Allocation Committee in its allocation of
capital budget. Please complete and return to Gene Whiteley-Ross, CFS - Capital Budget Manager, as soon as completed.
Total Capital Request - University Only Funding Sources
Prior Year Total Anticipated
Request Title Capital FY2012 FY2013 FY2014 FY2015 FY2016 Capital Funding Source $ Amount
Expenditures Expenditures
Sample Project - - - - - - - Unrestricted -
Anticipated Start Date: Expected Completion Date:
Detailed Cost Estimate - Total Project
Quantity Item Description Total Cost Summary of Implementation Exps Total Cost
Capital Expenditures
1 Salaries - Capitalized Labor 0 Total Capital Cost 0
1 Contract Labor 0 minus Hospital Capital Cost 0
1 Professional Services 0 Total University Capital Cost 0
1 Capital Equipment 0
1 Building Improvements 0
1 Software 0 Operating Expenses 0
1 Hardware 0 minus Hospital Operating Expenses 0
1 Freight 0 Total University Operating Expenses 0
Operating Expenditures
1 Salaries & Wages - Operating (under $100k) 0
1 Minor Equipment 0
1 Maintenance 0 Previously Authorized and Expected Spent -
1 Training 0
1 Other Expenses 0 TOTAL HOSPITAL PROJECT COST 0
TOTAL UNIVERSITY PROJECT COST 0
TOTAL PROJECT APPROVAL AMOUNT 0 TOTAL OHSU PROJECT COST 0
Return on Capital Investment
Return Required (Please check one) Yes No
If no, list category (safety, regulatory, etc.):
FINANCIAL RETURN
First Year Savings/Earnings: $ - Second Year Savings/Earnings: $ -
Estimated Economic Life 10.0 Years
IRR (without productivity savings) 0.00%
By signing, you agree that to the best of your knowledge: 1) The financial information is accurate. 2) The ROI is calculated correctly. 3) I understand my
unit will receive the expense, capital and benefits noted. 4) You are committing to funding all capital within your capital allocation for the specified year(s). 5)
You are committing OHSU to accomplish the benefits noted.
APPROVALS
Name Signature Title Date
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OHSU CAPITAL REQUEST FORM
Name, Phone #: Department: Date:
Request Title: Sample Project
Strategic Initiative Tactic #: (if applicable)
Project / Capital Request Description
Justification for Project / Capital Request - Potential Risks / Alternatives
Does this request fulfill a commitment? Is this request legally required? (Cite regulation/specifics) How does this request advance key strategies?
Other Factors / Assumptions
Reason for Project / Capital Request
PRIMARY BENEFIT OF PROJECT (Please check boxes that apply)
Cost Savings Regulation (Be specific, cite reg):
Profit generating Mission supported
Quality/Maintenance Customer service
Safety Other:
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OHSU CAPITAL ROI FORM - Total Year 0
Sample Project
** NOTE: This form is only to be used if you have multiple years contributing expenditures to Year 0.
FY 2011 FY 2016 Total Year 0
and Prior FY 2012 FY 2013 FY 2014 FY 2015 and After Expenditures
Implementation Costs
ITG Input
Capital Expenses
Salaries (w/ Contract Lab./Prof. Svcs, over $100k) - - - - - - -
Contract Labor - - - - - - -
Professional Services - - - - - - -
Capital Equipment - - - - - - -
Building Improvements - - - - - - -
Software - - - - - - -
Hardware - - - - - - -
Freight - - - - - - -
Operating Expenses
Salaries & Wages - Operating (under $100k) - - - - - - -
Minor Equipment - - - - - - -
Maintenance - - - - - - -
Training - - - - - - -
Other Expenses (Contingency) - - - - - - -
Other Department: _____________________
Capital Expenses
Salaries (w/ Contract Lab./Prof. Svcs, over $100k) - - - - - - -
Contract Labor - - - - - - -
Professional Services - - - - - - -
Capital Equipment - - - - - - -
Building Improvements - - - - - - -
Software - - - - - - -
Hardware - - - - - - -
Freight - - - - - - -
Operating Expenses
Salaries & Wages - Operating (under $100k) - - - - - - -
Minor Equipment - - - - - - -
Maintenance - - - - - - -
Training - - - - - - -
Other Expenses (Contingency) - - - - - - -
Total Project Outlay - Year 0 Total Expenditures - - - - - - -
(*) Total "FY 2011 and Prior" should reflect those expected spent expenditures which were previously authorized.
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