STATE OF CALIFORNIA CONTRACT SCH 4B Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 Provider No: HSC 30660G SPECIAL CARE UNITS REPORTED AUDITED 1. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 2. Total Inpatient Days (Adj ) 0 0 3. Average Per Diem Cost $ 0.00 $ 0.00 4. Medi-Cal Inpatient Days (Adj ) 0 0 5. Cost Applicable to Medi-Cal $ 0 $ 0 6. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 7. Total Inpatient Days (Adj ) 0 0 8. Average Per Diem Cost $ 0.00 $ 0.00 9. Medi-Cal Inpatient Days (Adj ) 0 0 10. Cost Applicable to Medi-Cal $ 0 $ 0 11. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 12. Total Inpatient Days (Adj ) 0 0 13. Average Per Diem Cost $ 0.00 $ 0.00 14. Medi-Cal Inpatient Days (Adj ) 0 0 15. Cost Applicable to Medi-Cal $ 0 $ 0 16. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 17. Total Inpatient Days (Adj ) 0 0 18. Average Per Diem Cost $ 0.00 $ 0.00 19. Medi-Cal Inpatient Days (Adj ) 0 0 20. Cost Applicable to Medi-Cal $ 0 $ 0 21. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 22. Total Inpatient Days (Adj ) 0 0 23. Average Per Diem Cost $ 0.00 $ 0.00 24. Medi-Cal Inpatient Days (Adj ) 0 0 25. Cost Applicable to Medi-Cal $ 0 $ 0 26. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 27. Total Inpatient Days (Adj ) 0 0 28. Average Per Diem Cost $ 0.00 $ 0.00 29. Medi-Cal Inpatient Days (Adj ) 0 0 30. Cost Applicable to Medi-Cal $ 0 $ 0 31. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ 0 $ 0 (To Contract Sch 4) COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 5 Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 Provider No: HSC 30660G RATIO COST TO CHARGES ANCILLARY COST CENTERS 37.00 Operating Room $ 5,222,093 $ 17,127,243 0.304900 $ 178,331 $ 54,373 38.00 Recovery Room 1,014,352 1,343,948 0.754756 6,458 4,874 39.00 Delivery Room and Labor Room 0 0 0.000000 0 0 41.00 Radiology - Diagnostic 4,823,241 9,416,051 0.512236 91,836 47,042 41.01 CT Scan 932,163 20,051,746 0.046488 68,491 3,184 41.02 Ultrasound 448,066 2,043,502 0.219264 3,228 708 41.03 Endoscopy 272,997 1,826,267 0.149484 534 80 42.00 Radiology - Therapeutic 6,118,075 23,386,129 0.261611 4,146 1,085 43.00 Radioisotope 551,454 1,471,178 0.374839 9,673 3,626 44.00 Laboratory 9,222,600 33,793,550 0.272910 363,841 99,296 44.01 Pathological Lab 0 0 0.000000 0 0 46.00 Whole Blood 0 0 0.000000 0 0 47.00 Blood Storing, Processing & Transfusion 3,484,612 3,346,946 1.041132 69,180 72,025 48.00 Intravenous Therapy 0 0 0.000000 0 0 49.00 Respiratory Therapy 1,182,676 3,703,274 0.319360 56,371 18,003 50.00 Physical Therapy 160,142 808,248 0.198135 14,066 2,787 51.00 Occupational Therapy 0 0 0.000000 0 0 52.00 Speech Pathology 0 0 0.000000 0 0 53.00 Electrocardiology 116,782 586,182 0.199225 10,132 2,019 54.00 Electroencephalography 0 0 0.000000 0 0 55.00 Medical Supplies Charged to Patients 6,512,926 14,325,190 0.454649 222,332 101,083 56.00 Drugs Charged to Patients 35,718,461 142,260,796 0.251077 583,610 146,531 57.00 Renal Dialysis 270,958 643,413 0.421125 25,482 10,731 58.00 ASC (Non-Distinct Part) 0 0 0.000000 0 0 59.00 0 0 0.000000 0 0 59.01 0 0 0.000000 0 0 59.02 0 0 0.000000 0 0 59.03 0 0 0.000000 0 0 60.00 Clinic 5,795,254 3,825,526 1.514891 0 0 60.01 Infusion Therapy Clinic 3,827,283 6,031,983 0.634498 0 0 60.02 Cancer Clinic 776,882 360,197 2.156826 0 0 62.00 Observation Beds 0 1,297 0.000000 0 0 65.00 Ambulance Services 85,605 0 0.000000 0 0 82.00 0 0 0.000000 0 0 83.00 0 0 0.000000 0 0 84.00 0 0 0.000000 0 0 85.00 0 0 0.000000 0 0 86.00 0 0 0.000000 0 0 TOTAL $ 86,536,624 $ 286,352,666 $ 1,707,711 $ 567,447 (To Contract Sch 3) * From Schedule 8, Column 27 COST (Contract Sch 6) CHARGES (Adj ) ANCILLARY COST* CHARGES TOTAL ANCILLARY MEDI-CALTOTAL MEDI-CAL SCHEDULE OF MEDI-CAL ANCILLARY COSTS This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 6 Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 Provider No: HSC 30660G ANCILLARY CHARGES 37.00 Operating Room $ 87,030 $ 91,301 $ 178,331 38.00 Recovery Room 6,779 (321) 6,458 39.00 Delivery Room and Labor Room 0 0 41.00 Radiology - Diagnostic 42,149 49,687 91,836 41.01 CT Scan 28,342 40,149 68,491 41.02 Ultrasound 7,364 (4,136) 3,228 41.03 Endoscopy 3,618 (3,084) 534 42.00 Radiology - Therapeutic 2,610 1,536 4,146 43.00 Radioisotope 3,218 6,455 9,673 44.00 Laboratory 182,708 181,133 363,841 44.01 Pathological Lab 0 0 46.00 Whole Blood 0 0 47.00 Blood Storing, Processing & Transfusion 33,045 36,135 69,180 48.00 Intravenous Therapy 0 0 49.00 Respiratory Therapy 71,290 (14,919) 56,371 50.00 Physical Therapy 7,118 6,948 14,066 51.00 Occupational Therapy 0 0 52.00 Speech Pathology 0 0 53.00 Electrocardiology 3,687 6,445 10,132 54.00 Electroencephalography 0 0 55.00 Medical Supplies Charged to Patients 82,045 140,287 222,332 56.00 Drugs Charged to Patients 287,504 296,106 583,610 57.00 Renal Dialysis 27,042 (1,560) 25,482 58.00 ASC (Non-Distinct Part) 0 0 59.00 0 0 59.01 0 0 59.02 0 0 59.03 0 0 60.00 Clinic 822 (822) 0 60.01 Infusion Therapy Clinic 2,325 (2,325) 0 60.02 Cancer Clinic 0 0 62.00 Observation Beds 0 0 65.00 Ambulance Services 0 0 82.00 0 0 83.00 0 0 84.00 0 0 85.00 0 0 86.00 0 0 TOTAL MEDI-CAL ANCILLARY CHARGES $ 878,696 $ 829,015 $ 1,707,711 (To Contract Sch 5) AUDITEDADJUSTMENTSREPORTED (Adj 3) ADJUSTMENTS TO MEDI-CAL CHARGES This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 7 Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 Provider No: HSC 30660G PROFESSIONAL SERVICE COST CENTERS 40.00 Anesthesiology $ 0 $ 0 0.000000 $ $ 0 41.00 Radiology - Diagnostic 0 0 0.000000 0 43.00 Radioisotope 0 0 0.000000 0 44.00 Laboratory 0 0 0.000000 0 53.00 Electrocardiology 0 0 0.000000 0 54.00 Electroencephalography 0 0 0.000000 0 61.00 Emergency 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 TOTAL $ 0 $ 0 $ 0 $ 0 (To Contract Sch 3) HBP TO ALL PATIENTS RATIO OF REMUNERATION TOTAL CHARGES COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED (Adj )(Adj ) (Adj ) PHYSICIAN'S REMUNERATION TO CHARGES MEDI-CAL CHARGES MEDI-CAL COSTREMUNERATION This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 8 Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 NET EXP FOR OLD CAPITAL OLD NEW CAPITAL NEW TRIAL BALANCE COST ALLOC BLDG & MOVABLE BLDG & MOVABLE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC EXPENSES (From Sch 10) FIXTURES EQUIP FIXTURES EQUIP COST COST COST COST COST COST COST 0.00 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 COMPUTATION OF COST ALLOCATION (W/S B) GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg & Fixtures 2,100,657 2.00 Old Cap Rel Costs-Movable Equipmen 3,155,027 0 3.00 New Cap Rel Costs-Bldg & Fixtures 1,666,012 0 0 4.00 New Cap Rel Costs-Movable Equipme 946,993 0 0 0 4.01 0 0 0 0 0 4.02 0 0 0 0 0 0 4.03 0 0 0 0 0 0 0 4.04 0 0 0 0 0 0 0 0 4.05 0 0 0 0 0 0 0 0 0 4.06 0 0 0 0 0 0 0 0 0 0 4.07 0 0 0 0 0 0 0 0 0 0 0 4.08 0 0 0 0 0 0 0 0 0 0 0 0 5.00 Employee Benefits 272,344 5,476 8,224 4,343 2,469 0 0 0 0 0 0 0 6.01 Non-Patient Telephones 0 0 0 0 0 0 0 0 0 0 0 0 6.02 Data Processing 0 0 0 0 0 0 0 0 0 0 0 0 6.03 Purchasing/Receiving 0 0 0 0 0 0 0 0 0 0 0 0 6.04 Patient Admitting 0 0 0 0 0 0 0 0 0 0 0 0 6.05 Patient Business Office 0 0 0 0 0 0 0 0 0 0 0 0 6.06 0 0 0 0 0 0 0 0 0 0 0 0 6.07 0 0 0 0 0 0 0 0 0 0 0 0 6.08 0 0 0 0 0 0 0 0 0 0 0 0 6.00 Administrative and General 22,344,383 293,350 440,590 232,654 132,245 0 0 0 0 0 0 0 7.00 Maintenance and Repairs 0 0 0 0 0 0 0 0 0 0 0 0 8.00 Operation of Plant 2,709,159 3,249 4,880 2,577 1,465 0 0 0 0 0 0 0 9.00 Laundry and Linen Service 223,273 12,815 19,248 10,164 5,777 0 0 0 0 0 0 0 10.00 Housekeeping 923,699 13,294 19,966 10,543 5,993 0 0 0 0 0 0 0 11.00 Dietary 1,200,886 68,167 102,382 54,063 30,730 0 0 0 0 0 0 0 12.00 Cafeteria 0 0 0 0 0 0 0 0 0 0 0 0 13.00 Maintenance of Personnel 0 0 0 0 0 0 0 0 0 0 0 0 14.00 Nursing Administration 1,445,400 2,853 4,286 2,263 1,286 0 0 0 0 0 0 0 15.00 Central Services & Supply 377,319 31,288 46,992 24,814 14,1050000000 16.00 Pharmacy 3,189,308 47,600 71,491 37,751 21,4580000000 17.00 Medical Records and Library 2,243,335 46,726 70,178 37,058 21,0640000000 18.00 Social Service 445,097 9,385 14,095 7,443 4,231 0 0 0 0 0 0 0 19.00 0 0 0 0 0 0 0 0 0 0 0 0 19.02 0 0 0 0 0 0 0 0 0 0 0 0 19.03 0 0 0 0 0 0 0 0 0 0 0 0 20.00 000000000000 21.00 Nursing School 000000000000 22.00 Intern & Res Service-Salary & Fringes 245 0 0 0 0 0 0 0 0 0 0 0 23.00 Intern & Res Other Program 1,625,79000000000000 24.00Paramedical Ed Program 000000000000 INPATIENT ROUTINE COST CENTERS 25.00 Adults & Pediatrics (Gen Routine) 8,435,787 299,618 450,003 237,624 135,070 0 0 0 0 0 0 0 26.00 Intensive Care Unit 4,448,758 59,920 89,996 47,522 27,0130000000 27.00 Coronary Care Unit 000000000000 28.00 Neonatal Intensive Care Unit 000000000000 29.00Surgical Intensive Care 000000000000 30.00 Subprovider I 000000000000 31.00 Subprovider II 000000000000 32.00 000000000000 33.00Nursery 000000000000 34.00 Medicare Certified Nursing Facility 0 0 0 0 0 0 0 0 0 0 0 0 35.00 Distinct Part Nursing Facility 0 0 0 0 0 0 0 0 0 0 0 0 36.00 Adult Subacute Care Unit 0 0 0 0 0 0 0 0 0 0 0 0 36.01 Subacute Care Unit II 0 0 0 0 0 0 0 0 0 0 0 0 36.02 Transitional Care Unit 000000000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 8 Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 NET EXP FOR OLD CAPITAL OLD NEW CAPITAL NEW TRIAL BALANCE COST ALLOC BLDG & MOVABLE BLDG & MOVABLE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC EXPENSES (From Sch 10) FIXTURES EQUIP FIXTURES EQUIP COST COST COST COST COST COST COST 0.00 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 COMPUTATION OF COST ALLOCATION (W/S B) ANCILLARY COST CENTERS 37.00 Operating Room 2,303,248 119,989 180,214 95,162 54,092 0 0 0 0 0 0 0 38.00 Recovery Room 533,183 21,656 32,525 17,175 9,763 0 0 0 0 0 0 0 39.00 Delivery Room and Labor Room 0 0 0 0 0 0 0 0 0 0 0 0 41.00 Radiology - Diagnostic 2,898,185 117,136 175,929 92,899 52,806 0 0 0 0 0 0 0 41.01 CT Scan 497,279 10,226 15,358 8,110 4,6100000000 41.02 Ultrasound 324,659 2,062 3,096 1,635 9290000000 41.03 Endoscopy 195,727 0 0 0 0 0 0 0 0 0 0 0 42.00 Radiology - Therapeutic 2,871,179 270,029 405,563 214,157 121,731 0 0 0 0 0 0 0 43.00 Radioisotope 341,294 8,741 13,129 6,933 3,9410000000 44.00 Laboratory 5,324,930 239,665 359,958 190,076 108,0430000000 44.01Pathological Lab 000000000000 46.00Whole Blood 000000000000 47.00 Blood Storing, Processing & Transfusio 2,653,772 10,292 15,458 8,162 4,6400000000 48.00 Intravenous Therapy 000000000000 49.00 Respiratory Therapy 700,464 29,737 44,663 23,585 13,4060000000 50.00 Physical Therapy 114,822 0 0 0 0 0 0 0 0 0 0 0 51.00 Occupational Therapy 0 0 0 0 0 0 0 0 0 0 0 0 52.00 Speech Pathology 000000000000 53.00Electrocardiology 75,1112,0623,0961,6359290000000 54.00 Electroencephalography 000000000000 55.00 Medical Supplies Charged to Patients 4,388,48500000000000 56.00 Drugs Charged to Patients 23,403,76100000000000 57.00 Renal Dialysis 208,227 0 0 0 0 0 0 0 0 0 0 0 58.00 ASC (Non-Distinct Part) 0 0 0 0 0 0 0 0 0 0 0 0 59.00 000000000000 59.01 000000000000 59.02 000000000000 59.03 000000000000 60.00 Clinic 3,142,964 206,909 310,761 164,098 93,2760000000 60.01 Infusion Therapy Clinic 1,910,887 119,049 178,802 94,417 53,668 0 0 0 0 0 0 0 60.02 Cancer Clinic 395,958 33,547 50,386 26,606 15,123 0 0 0 0 0 0 0 62.00Observation Beds 000000000000 65.00Ambulance Services 67,47300000000000 82.00 000000000000 83.00 000000000000 84.00 0 0 0 0 0 0 0 0 0 0 0 0 85.00 0 0 0 0 0 0 0 0 0 0 0 0 86.00 0 0 0 0 0 0 0 0 0 0 0 0 NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop & Canteen 185,440 14,267 21,428 11,315 6,4320000000 97.00Research 000000000000 98.00Physicians' Private Office 000000000000 99.00 Nonpaid Workers 000000000000 99.01 0 0 0 0 0 0 0 0 0 0 0 0 99.02 0 0 0 0 0 0 0 0 0 0 0 0 99.03 000000000000 99.04 000000000000 99.05 000000000000 100.00 Doctors Meals 000000000000 100.01 000000000000 100.02 000000000000 100.03 0 0 0 0 0 0 0 0 0 0 0 0 100.05 Public Relations 617,091 1,550 2,329 1,230 6990000000 TOTAL 110,907,611 2,100,657 3,155,027 1,666,012 946,993 0 0 0 0 0 0 0 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPIT TRIAL BALANCE EXPENSES GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipmen 3.00 New Cap Rel Costs-Bldg & Fixtures 4.00 New Cap Rel Costs-Movable Equipme 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 5.00 Employee Benefits 6.01 Non-Patient Telephones 6.02 Data Processing 6.03 Purchasing/Receiving 6.04 Patient Admitting 6.05 Patient Business Office 6.06 6.07 6.08 6.00 Administrative and General 7.00 Maintenance and Repairs 8.00 Operation of Plant 9.00 Laundry and Linen Service 10.00 Housekeeping 11.00 Dietary 12.00 Cafeteria 13.00 Maintenance of Personnel 14.00 Nursing Administration 15.00 Central Services & Supply 16.00 Pharmacy 17.00 Medical Records and Library 18.00 Social Service 19.00 19.02 19.03 20.00 21.00 Nursing School 22.00 Intern & Res Service-Salary & Fringes 23.00 Intern & Res Other Program 24.00 Paramedical Ed Program INPATIENT ROUTINE COST CENTER 25.00 Adults & Pediatrics (Gen Routine) 26.00 Intensive Care Unit 27.00 Coronary Care Unit 28.00 Neonatal Intensive Care Unit 29.00 Surgical Intensive Care 30.00 Subprovider I 31.00 Subprovider II 32.00 33.00 Nursery 34.00 Medicare Certified Nursing Facility 35.00 Distinct Part Nursing Facility 36.00 Adult Subacute Care Unit 36.01 Subacute Care Unit II 36.02 Transitional Care Unit SCHEDULE 8.1 Fiscal Period Ended: MAY 31, 2008 ADMINIS- ALLOC EMPLOYEE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ACCUMULATE TRATIVE & COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 48,012 0 0 0 0 0 0 0 0 23,491,233 0 0 0 0 0 0 0 0 0 0 0 0 0 324 0 0 0 0 0 0 0 0 2,721,654 731,385 0 0 0 0 0 0 0 0 0 0 271,277 72,900 0 0 0 0 0 0 0 0 0 0 973,495 261,605 0 4,496 0 0 0 0 0 0 0 0 1,460,724 392,537 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,906 0 0 0 0 0 0 0 0 1,467,994 394,491 01,40600000000495,924133,269 09,001000000003,376,609907,390 011,936000000002,430,297653,089 0 3,650 0 0 0 0 0 0 0 0 483,900 130,038 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000000000 00 0000000000 00 0 3 0 0 0 0 0 0 0 0 248 67 00000000001,625,790436,895 0000000000 00 0 58,891 0 0 0 0 0 0 0 0 9,616,994 2,584,356 024,488000000004,697,6971,262,403 0000000000 00 0000000000 00 0000000000 00 0000000000 00 0000000000 00 0000000000 00 0000000000 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000000000 00 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPIT TRIAL BALANCE EXPENSES ANCILLARY COST CENTERS 37.00 Operating Room 38.00 Recovery Room 39.00 Delivery Room and Labor Room 41.00 Radiology - Diagnostic 41.01 CT Scan 41.02 Ultrasound 41.03 Endoscopy 42.00 Radiology - Therapeutic 43.00 Radioisotope 44.00 Laboratory 44.01 Pathological Lab 46.00 Whole Blood 47.00 Blood Storing, Processing & Transfusio 48.00 Intravenous Therapy 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 58.00 ASC (Non-Distinct Part) 59.00 59.01 59.02 59.03 60.00 Clinic 60.01 Infusion Therapy Clinic 60.02 Cancer Clinic 62.00 Observation Beds 65.00 Ambulance Services 82.00 83.00 84.00 85.00 86.00 NONREIMBURSABLE COST CENTER 96.00 Gift, Flower, Coffee Shop & Canteen 97.00 Research 98.00 Physicians' Private Office 99.00 Nonpaid Workers 99.01 99.02 99.03 99.04 99.05 100.00 Doctors Meals 100.01 100.02 100.03 100.05 Public Relations TOTAL SCHEDULE 8.1 Fiscal Period Ended: MAY 31, 2008 ADMINIS- ALLOC EMPLOYEE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ACCUMULATE TRATIVE & COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 13,352 0 0 0 0 0 0 0 0 2,766,058 743,317 0 2,997 0 0 0 0 0 0 0 0 617,299 165,886 0 0 0 0 0 0 0 0 0 0 0 0 0 11,382 0 0 0 0 0 0 0 0 3,348,336 899,792 03,58400000000539,167144,889 0000000000332,38289,320 0 954 0 0 0 0 0 0 0 0 196,681 52,854 0 11,007 0 0 0 0 0 0 0 0 3,893,666 1,046,337 01,09300000000375,131100,808 022,690000000006,245,3621,678,304 0000000000 00 0000000000 00 01,365000000002,693,688723,870 0000000000 00 05,85600000000817,712219,742 0 1,081 0 0 0 0 0 0 0 0 115,903 31,146 0 0 0 0 0 0 0 0 0 0 0 0 0000000000 00 0730000000082,90722,279 0000000000 00 00000000004,388,4851,179,309 000000000023,403,7616,289,247 0 0 0 0 0 0 0 0 0 0 208,227 55,956 0 0 0 0 0 0 0 0 0 0 0 0 0000000000 00 0000000000 00 0000000000 00 0000000000 00 022,246000000003,940,2541,058,857 0 16,600 0 0 0 0 0 0 0 0 2,373,423 637,805 0 3,215 0 0 0 0 0 0 0 0 524,836 141,038 0000000000 00 000000000067,47318,132 0000000000 00 0000000000 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 049400000000239,37564,327 0000000000 00 0000000000 00 0000000000 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000000000 00 0000000000 00 0000000000 00 0000000000 00 0000000000 00 0000000000 00 0 0 0 0 0 0 0 0 0 0 0 0 075300000000623,651167,593 0 292,855 0 0 0 0 0 0 0 0 110,907,611 23,491,233 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPIT TRIAL BALANCE EXPENSES GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipmen 3.00 New Cap Rel Costs-Bldg & Fixtures 4.00 New Cap Rel Costs-Movable Equipme 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 5.00 Employee Benefits 6.01 Non-Patient Telephones 6.02 Data Processing 6.03 Purchasing/Receiving 6.04 Patient Admitting 6.05 Patient Business Office 6.06 6.07 6.08 6.00 Administrative and General 7.00 Maintenance and Repairs 8.00 Operation of Plant 9.00 Laundry and Linen Service 10.00 Housekeeping 11.00 Dietary 12.00 Cafeteria 13.00 Maintenance of Personnel 14.00 Nursing Administration 15.00 Central Services & Supply 16.00 Pharmacy 17.00 Medical Records and Library 18.00 Social Service 19.00 19.02 19.03 20.00 21.00 Nursing School 22.00 Intern & Res Service-Salary & Fringes 23.00 Intern & Res Other Program 24.00 Paramedical Ed Program INPATIENT ROUTINE COST CENTER 25.00 Adults & Pediatrics (Gen Routine) 26.00 Intensive Care Unit 27.00 Coronary Care Unit 28.00 Neonatal Intensive Care Unit 29.00 Surgical Intensive Care 30.00 Subprovider I 31.00 Subprovider II 32.00 33.00 Nursery 34.00 Medicare Certified Nursing Facility 35.00 Distinct Part Nursing Facility 36.00 Adult Subacute Care Unit 36.01 Subacute Care Unit II 36.02 Transitional Care Unit SCHEDULE 8.2 Fiscal Period Ended: MAY 31, 2008 CENTRAL MEDICAL MAINT & OPER LAUNDRY & MAINT OF NURSING SERVICE RECORDS SOCIAL REPAIRS PLANT LINEN HOUSEKEEP DIETARY CAFE PERSONNEL ADMIN & SUPPLY PHARMACY & LIBRARY SERVICE 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 0 24,604 0 25,522 0 0 130,872 0 48,482 0 0 0 0 1,496,998 0 0 0 0 0 0 0 5,478 0 2,029 0 47,373 0 0 60,069 0 22,253 0 9,475 0 0 091,385033,8540118,433000 089,707033,2320142,1200000 0 18,017 0 6,675 0 18,949 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000000000000 000000000000 0 0 0 0 0 0 0 0 0 0 0 0 000000000000 000000000000 0 575,227 154,888 213,095 301,703 355,300 0 773,132 0 0 180,385 211,365 0 115,039 36,878 42,617 59,089 151,595 0 664,893 0 0 99,408 164,395 000000000000 000000000000 000000000000 000000000000 000000000000 000000000000 000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000000000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPIT TRIAL BALANCE EXPENSES ANCILLARY COST CENTERS 37.00 Operating Room 38.00 Recovery Room 39.00 Delivery Room and Labor Room 41.00 Radiology - Diagnostic 41.01 CT Scan 41.02 Ultrasound 41.03 Endoscopy 42.00 Radiology - Therapeutic 43.00 Radioisotope 44.00 Laboratory 44.01 Pathological Lab 46.00 Whole Blood 47.00 Blood Storing, Processing & Transfusio 48.00 Intravenous Therapy 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 58.00 ASC (Non-Distinct Part) 59.00 59.01 59.02 59.03 60.00 Clinic 60.01 Infusion Therapy Clinic 60.02 Cancer Clinic 62.00 Observation Beds 65.00 Ambulance Services 82.00 83.00 84.00 85.00 86.00 NONREIMBURSABLE COST CENTER 96.00 Gift, Flower, Coffee Shop & Canteen 97.00 Research 98.00 Physicians' Private Office 99.00 Nonpaid Workers 99.01 99.02 99.03 99.04 99.05 100.00 Doctors Meals 100.01 100.02 100.03 100.05 Public Relations TOTAL SCHEDULE 8.2 Fiscal Period Ended: MAY 31, 2008 CENTRAL MEDICAL MAINT & OPER LAUNDRY & MAINT OF NURSING SERVICE RECORDS SOCIAL REPAIRS PLANT LINEN HOUSEKEEP DIETARY CAFE PERSONNEL ADMIN & SUPPLY PHARMACY & LIBRARY SERVICE 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 230,363 47,941 85,339 0 80,535 0 201,014 0 0 180,351 0 0 41,576 22,127 15,402 0 14,212 0 123,701 0 0 14,150 0 0 0 0 0 0 0 0 0 0 0 0 0 0 224,885 0 83,309 0 75,797 0 0 0 0 97,734 0 019,63207,273018,9490000202,2520 03,95801,46600000020,9400 0 0 0 0 0 4,737 0 0 0 0 18,726 0 0 518,420 25,815 192,051 0 71,060 0 0 0 0 246,219 58,712 016,78206,21704,737000014,8810 0 460,124 55,317 170,455 0 132,6450000348,8030 000000000000 000000000000 019,75907,32004,737000035,2380 000000000000 057,092021,150028,424000038,5560 0 0 0 0 0 4,737 0 0 0 0 8,356 0 0 0 0 0 0 0 0 0 0 0 0 0 000000000000 03,95801,4660000006,1720 000000000000 00000000720,9880224,1440 0000000004,527,6721,497,7810 0 0 0 0 0 0 0 0 0 0 6,774 0 0 0 0 0 0 0 0 0 0 0 0 0 000000000000 000000000000 000000000000 000000000000 0 397,238 25,815 147,158 35,956 123,171000040,2770 0 228,558 0 84,670 0 61,585 0 154,626 0 0 63,507 223,107 0 64,407 0 23,860 0 18,949 0 0 0 0 3,792 0 000000000000 000000000000 000000000000 000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 027,390010,14704,737000000 000000000000 000000000000 000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000000000000 000000000000 000000000000 0000138,8690000000 000000000000 000000000000 0 0 0 0 0 0 0 0 0 0 0 0 02,97701,10304,737000000 0 3,453,038 368,780 1,260,622 2,032,615 1,496,998 0 1,917,366 720,988 4,527,672 3,348,446 657,579 This is trial version www.adultpdf.com . EQUIP COST COST COST COST COST COST COST 0.00 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 COMPUTATION OF COST ALLOCATION (W/S B) GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg. ALLOC ACCUMULATE TRATIVE & COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 48,012 0 0 0 0 0 0 0 0 23,491,233 0 0 0 0 0 0 0 0 0 0 0 0 0 324 0 0 0 0 0 0 0 0 2,721,654 731,385 0 0 0 0 0 0 0 0 0 0 271,277 72,900 0 0 0 0 0 0 0 0 0 0 973,495 261,605 0 4,496 0 0 0 0 0 0 0 0 1,460,724 392,537 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,906 0 0 0 0 0 0 0 0 1,467,994 394,491 01,40600000000495,924133,269 09,001000000003,376,609907,390 011,936000000002,430,297653,089 0 3,650 0 0 0 0 0 0 0 0 483,900 130,038 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000000000. ALLOC ACCUMULATE TRATIVE & COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 13,352 0 0 0 0 0 0 0 0 2,766,058 743,317 0 2,997 0 0 0 0 0 0 0 0 617,299 165,886 0 0 0 0 0 0 0 0 0 0 0 0 0 11,382 0 0 0 0 0 0 0 0 3,348,336 899,792 03,58400000000539,167144,889 0000000000332,38289,320 0 954 0 0 0 0 0 0 0 0 196,681 52,854 0 11,007 0 0 0 0 0 0 0 0 3,893,666 1,046,337 01,09300000000375,131100,808 022,690000000006,245,3621,678,304 0000000000