STATE OF CALIFORNIA COMPUTATION OF MEDICAL INPATIENT ROUTINE SERVICE COST_PART3 potx

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 8.3 Fiscal Period Ended: MAY 31, 2008 POST NON- INT & RES STEP-DOWN TOTAL ALLOC ALLOC ALLOC PHYSICIAN NURSING SALARY & INT & RES PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 0 0 000 0000 0 0 0 0 0 000000 0000000 0 0 0 0 0 126 825,499 0 15,792,068 15,792,068 000000007,294,013 7,294,013 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 000000000 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 000000000 0 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPITAL 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 & Transfusion 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 CENTERS 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 8.3 Fiscal Period Ended: MAY 31, 2008 POST NON- INT & RES STEP-DOWN TOTAL ALLOC ALLOC ALLOC PHYSICIAN NURSING SALARY & INT & RES PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) 00000135887,040 0 5,222,093 5,222,093 000000001,014,352 1,014,352 000000000 0 000001493,37304,823,241 4,823,241 00000000932,163 932,163 00000000448,066 448,066 00000000272,997 272,997 000001065,78506,118,075 6,118,075 00000532,8930551,454 551,454 0000020131,570 0 9,222,600 9,222,600 000000000 0 000000000 0 000000003,484,612 3,484,612 000000000 0 000000001,182,676 1,182,676 00000000160,142 160,142 000000000 0 000000000 0 00000000116,782 116,782 000000000 0 000000006,512,926 6,512,926 0000000035,718,461 35,718,461 00000000270,958 270,958 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 00000426,52605,795,254 5,795,254 000000003,827,283 3,827,283 00000000776,882 776,882 000000000 0 0000000085,605 85,605 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 00000000345,976 345,976 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 000000000 0 00000000138,869 138,869 000000000 0 000000000 0 000000000 0 00000000800,060 800,060 0 0 0 0 0 314 2,062,685 0 110,907,611 0 110,907,611 This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 9 Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 OLD BLDG OLD MOVBLE NEW BLDG NEW MOVBLE STAT STAT STAT STAT STAT STAT STAT STAT & FIXTURES EQUIP & FIXTURES EQUIP (SQ FT) (SQ FT) (SQ FT) (SQ FT) 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 4.00 New Cap Rel Costs-Movable Equipment 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 5.00 Employee Benefits 332 332 332 332 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 17,786 17,786 17,786 17,786 7.00 Maintenance and Repairs 8.00 Operation of Plant 197 197 197 197 9.00 Laundry and Linen Service 777 777 777 777 10.00 Housekeeping 806 806 806 806 11.00 Dietary 4,133 4,133 4,133 4,133 12.00 Cafeteria 13.00 Maintenance of Personnel 14.00 Nursing Administration 173 173 173 173 15.00 Central Services & Supply 1,897 1,897 1,897 1,897 16.00 Pharmacy 2,886 2,886 2,886 2,886 17.00 Medical Records and Library 2,833 2,833 2,833 2,833 18.00 Social Service 569 569 569 569 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 CENTERS 25.00 Adults & Pediatrics (Gen Routine) 18,166 18,166 18,166 18,166 26.00 Intensive Care Unit 3,633 3,633 3,633 3,633 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 STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 9 Provider Name: Fiscal Period Ended: USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008 OLD BLDG OLD MOVBLE NEW BLDG NEW MOVBLE STAT STAT STAT STAT STAT STAT STAT STAT & FIXTURES EQUIP & FIXTURES EQUIP (SQ FT) (SQ FT) (SQ FT) (SQ FT) 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) ANCILLARY COST CENTERS 37.00 Operating Room 7,275 7,275 7,275 7,275 38.00 Recovery Room 1,313 1,313 1,313 1,313 39.00 Delivery Room and Labor Room 41.00 Radiology - Diagnostic 7,102 7,102 7,102 7,102 41.01 CT Scan 620 620 620 620 41.02 Ultrasound 125 125 125 125 41.03 Endoscopy 42.00 Radiology - Therapeutic 16,372 16,372 16,372 16,372 43.00 Radioisotope 530 530 530 530 44.00 Laboratory 14,531 14,531 14,531 14,531 44.01 Pathological Lab 46.00 Whole Blood 47.00 Blood Storing, Processing & Transfusion 624 624 624 624 48.00 Intravenous Therapy 49.00 Respiratory Therapy 1,803 1,803 1,803 1,803 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 125 125 125 125 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 12,545 12,545 12,545 12,545 60.01 Infusion Therapy Clinic 7,218 7,218 7,218 7,218 60.02 Cancer Clinic 2,034 2,034 2,034 2,034 62.00 Observation Beds 65.00 Ambulance Services 82.00 83.00 84.00 85.00 86.00 NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop & Canteen 865 865 865 865 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 94 94 94 94 TOTAL 127,364 127,364 127,364 127,36400000000 COST TO BE ALLOCATED 2,100,657 3,155,027 1,666,012 946,99300000000 UNIT COST MULTIPLIER - SCH 8 16.493334 24.771733 13.080714 7.435327 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPITAL GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 4.00 New Cap Rel Costs-Movable Equipment 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 CENTERS 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 9.1 Fiscal Period Ended: MAY 31, 2008 EMP BENE STAT STAT STAT STAT STAT STAT STAT STAT ADM & GEN MAINT & (GROSS (ACCUM REPAIRS SALARIES) COST) (SQ FT) 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) 4,440,021 0 29,932 2,721,654 271,277 973,495 415,826 1,460,724 0 0 1,101,066 1,467,994 130,033 495,924 832,404 3,376,609 1,103,850 2,430,297 337,534 483,900 0 0 0 0 0 245 248 1,625,790 0 5,446,136 9,616,994 2,264,612 4,697,697 0 0 0 0 0 0 0 0 0 0 0 0 STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPITAL 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 & Transfusion 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 CENTERS 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 COST TO BE ALLOCATED UNIT COST MULTIPLIER - SCH 8 SCHEDULE 9.1 Fiscal Period Ended: MAY 31, 2008 EMP BENE STAT STAT STAT STAT STAT STAT STAT STAT ADM & GEN MAINT & (GROSS (ACCUM REPAIRS SALARIES) COST) (SQ FT) 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) 1,234,795 2,766,058 277,189 617,299 0 1,052,546 3,348,336 331,410 539,167 332,382 88,204 196,681 1,017,897 3,893,666 101,093 375,131 2,098,348 6,245,362 0 0 126,199 2,693,688 0 541,590 817,712 99,924 115,903 0 0 6,757 82,907 0 4,388,485 23,403,761 208,227 0 0 0 0 0 2,057,221 3,940,254 1,535,135 2,373,423 297,355 524,836 0 67,473 0 0 0 0 0 45,722 239,375 0 0 0 0 0 0 0 0 0 0 0 0 69,618 623,651 27,082,6620000000087,416,378 0 292,8550000000023,491,233 0 0.010813 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.268728 0.000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPITAL GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 4.00 New Cap Rel Costs-Movable Equipment 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 CENTERS 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 9.2 Fiscal Period Ended: MAY 31, 2008 OPER LAUNDRY HOUSE- DIETARY CAFETERIA MAINT OF NURSING CENT SERV PHARMACY MED REC SOC SERV STAT PLANT & LINEN KEEPING (MEALS (FTES) PERSONNEL ADMIN & SUPPLY (COSTED (GROSS (TIME (SQ FT) (LB LNDRY) (SQ FT) SERVED) (# HOUSED) (NURSE HR) (CST REQ) REQUIS) REV) SPENT) 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) 777 806 4,133 4,133 196,141 173 173 10 1,897 1,897 2 2,886 2,886 25 2,833 2,833 30 569 569 4 18,166 18,606 18,166 39,530 75 50 17,133,181 72 3,633 4,430 3,633 7,742 32 43 9,441,901 56 STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPITAL 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 & Transfusion 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 CENTERS 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 COST TO BE ALLOCATED UNIT COST MULTIPLIER - SCH 8 SCHEDULE 9.2 Fiscal Period Ended: MAY 31, 2008 OPER LAUNDRY HOUSE- DIETARY CAFETERIA MAINT OF NURSING CENT SERV PHARMACY MED REC SOC SERV STAT PLANT & LINEN KEEPING (MEALS (FTES) PERSONNEL ADMIN & SUPPLY (COSTED (GROSS (TIME (SQ FT) (LB LNDRY) (SQ FT) SERVED) (# HOUSED) (NURSE HR) (CST REQ) REQUIS) REV) SPENT) 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) 7,275 5,759 7,275 17 13 17,129,932 1,313 2,658 1,313 3 8 1,343,948 7,102 7,102 16 9,282,915 620 620 4 19,210,120 125 125 1,988,914 1 1,778,573 16,372 3,101 16,372 15 23,386,128 20 530 530 1 1,413,368 14,531 6,645 14,531 28 33,129,665 624 624 1 3,346,946 1,803 1,803 6 3,662,096 1 793,685 125 125 586,182 100 21,289,421 100 142,260,796 643,412 12,545 3,101 12,545 4,711 26 3,825,526 7,218 7,218 13 10 6,031,984 76 2,034 2,034 4 360,197 865 865 1 18,195 94 94 1 109,049 44,300 107,466 266,319 316 0 124 100 100 318,038,890 224 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 0 31.665015 8.324613 11.730425 7.632255 4737.336115 0.000000 15462.632578 7209.883369 45276.717135 0.010528 2935.621806 0.000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPITAL GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 4.00 New Cap Rel Costs-Movable Equipment 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 CENTERS 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 9.3 Fiscal Period Ended: MAY 31, 2008 STAT STAT NONPHY NURSE I&R-SAL I&R-PRG PARAMED ANESTH SCHOOL & FRINGES COST EDUCAT (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) 19.02 19.03 20.00 21.00 22.00 23.00 24.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) 3,112 3,112 STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: USC KENNETH NORRIS JR. CANCER HOSPITAL 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 & Transfusion 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 CENTERS 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 COST TO BE ALLOCATED UNIT COST MULTIPLIER - SCH 8 SCHEDULE 9.3 Fiscal Period Ended: MAY 31, 2008 STAT STAT NONPHY NURSE I&R-SAL I&R-PRG PARAMED ANESTH SCHOOL & FRINGES COST EDUCAT (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) 19.02 19.03 20.00 21.00 22.00 23.00 24.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) 3,344 3,344 352 352 248 248 124 124 496 496 100 100 00007,7767,7760 00003142,062,685 0 0.000000 0.000000 0.000000 0.000000 0.040406 265.263039 0.000000 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. PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 0 0 000 0000 0 0 0 0 0 000000 0000000 0 0 0 0 0 126 825,499 0 15,792,068 15,792,068 000000007,294,013. PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) 00000135887,040