STATE OF CALIFORNIA CONTRACT SCH 2 Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F REPORTED AUDITED REASONABLE COST OF MEDI-CAL INPATIENT SERVICES 1. Cost of Covered Services (Contract Sch 3) $ 113,981,887 $ 107,891,164 CHARGES FOR MEDI-CAL INPATIENT SERVICES 2. Inpatient Routine Service Charges (Adj 25) $ 203,045,096 $ 193,824,812 3. Inpatient Ancillary Service Charges (Adj 25) $ 346,252,157 $ 329,006,907 4. Total Charges - Medi-Cal Inpatient Services $ 549,297,253 $ 522,831,719 5. Excess of Customary Charges Over Reasonable Cost (Line 4 minus Line 1) * $ 435,315,366 $ 414,940,555 6. Excess of Reasonable Cost Over Customary Charges (Line 1 minus Line 4) $ 0 $ 0 (To Contract Sch 1) * If charges exceed reasonable cost, no further calculation necessary for this schedule. COMPUTATION OF LESSER OF MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 3 Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F REPORTED AUDITED 1. Medi-Cal Inpatient Ancillary Services (Contract Sch 5) $ 58,030,007 $ 56,796,878 2. Medi-Cal Inpatient Routine Services (Contract Sch 4) $ 55,951,880 $ 51,094,286 3. Medi-Cal Inpatient Hospital Based Physician for Intern and Resident Services (Sch ) $ 0 $ 0 4. $ 0 $ 0 5. $ 0 $ 0 6. SUBTOTAL (Sum of Lines 1 through 5) $ 113,981,887 $ 107,891,164 7. Medi-Cal Inpatient Hospital Based Physician for Acute Care Services (Contract Sch 7) $ 0 $ 0 8. SUBTOTAL $ 113,981,887 $ 107,891,164 (To Contract Sch 2) 9. Coinsurance (Adj 26) $ 0 $ (1,640,687) 10. Patient and Third Party Liability (Adj 26) $ 0 $ (71,410) 11. Net Cost of Covered Services Rendered to Medi-Cal Inpatients $ 113,981,887 $ 106,179,067 (To Contract Sch 1) COMPUTATION OF MEDI-CAL NET COST OF COVERED SERVICES This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 4 Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F REPORTED AUDITED GENERAL SERVICE UNIT NET OF SWING-BEDS COSTS INPATIENT DAYS 1. Total Inpatient Days (include private & swing-bed) (Adjs 6,7) 206,861 232,502 2. Inpatient Days (include private, exclude swing-bed) 206,861 232,502 3. Private Room Days (exclude swing-bed private room) (Adj ) 0 0 4. Semi-Private Room Days (exclude swing-bed) (Adjs 6,7) 206,861 232,502 5. Medicare NF Swing-Bed Days through Dec 31 (Adj ) 0 0 6. Medicare NF Swing-Bed Days after Dec 31 (Adj ) 0 0 7. Medi-Cal NF Swing-Bed Days through July 31 (Adj ) 0 0 8. Medi-Cal NF Swing-Bed Days after July 31 (Adj ) 0 0 9. Medi-Cal Days (excluding swing-bed) (Adj 23) 23,010 20,150 SWING-BED ADJUSTMENT 17. Medicare NF Swing-Bed Rates through Dec 31 (Adj ) $ 0.00 $ 0.00 18. Medicare NF Swing-Bed Rates after Dec 31(Adj ) $ 0.00 $ 0.00 19. Medi-Cal NF Swing-Bed Rates through July 31(Adj ) $ 0.00 $ 0.00 20. Medi-Cal NF Swing-Bed Rates after July 31(Adj ) $ 0.00 $ 0.00 21. Total Routine Serv Cost (Sch 8, Part I, Line 25, Col 27) $ 303,119,796 $ 335,286,340 22. Medicare NF Swing-Bed Cost through Dec 31 (L 5 x L 17) $ 0 $ 0 23. Medicare NF Swing-Bed Cost after Dec 31 (L 6 x L 18) $ 0 $ 0 24. Medi-Cal NF Swing-Bed Cost through July 31 (L 7 x L 19) $ 0 $ 0 25. Medi-Cal NF Swing-Bed Cost after July 31 (L 8 x L 20) $ 0 $ 0 26. Total Swing-Bed Cost (Sum of Lines 22 to 25) $ 0 $ 0 27. Inpatient Routine Cost Net of Swing-Bed (L 21 minus L 26) $ 303,119,796 $ 335,286,340 PRIVATE ROOM DIFFERENTIAL ADJUSTMENT 28. Gen Inpatient Routine Serv Charges (excl swing-bed chgs)(Adjs 8,9) $ 749,552,889 $ 834,733,030 29. Private Room Charges (excluding swing-bed charges)(Adj ) $ 0 $ 0 30. Semi-Private Room Charges (excluding swing-bed chgs)(Adjs 8,9) $ 749,552,889 $ 834,733,030 31. Gen Inpatient Routine Service Cost/Charge Ratio (L 27 / L 28) $ 0.404401 $ 0.401669 32. Average Private Room Per Diem Charge (L 29 / L 3) $ 0.00 $ 0.00 33. Average Semi-Private Room Per Diem Charge (L 30 / L 4) $ 3,623.46 $ 3,590.22 34. Avg Per Diem Prvt Room Charge Differential (L 32 minus L 33) $ 0.00 $ 0.00 35. Average Per Diem Private Room Cost Differential (L 31 x L 34) $ 0.00 $ 0.00 36. Private Room Cost Differential Adjustment (L 35 x L 3) $ 0 $ 0 37. Inpatient Rout Cost Net of Swing-Bed & Prvt Rm (L 27 minus L 36) $ 303,119,796 $ 335,286,340 PROGRAM INPATIENT OPERATING COST 38. Adjusted General Inpatient Routine Cost Per Diem (L 37 / L 2) $ 1,465.33 $ 1,442.08 39. Program General Inpatient Routine Service Cost (L 9 x L 38) $ 33,717,243 $ 29,057,912 40. Cost Applicable to Medi-Cal (Contract Sch 4A) $ 11,034,780 $ 11,768,786 41. Cost Applicable to Medi-Cal (Contract Sch 4B) $ 11,199,857 $ 10,267,588 42. TOTAL MEDI-CAL ROUTINE COST (Sum of Lines 39, 40 & 41) $ 55,951,880 $ 51,094,286 (To Contract Sch 3) MEDI-CAL INPATIENT ROUTINE SERVICE COST COMPUTATION OF This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 4A Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F SPECIAL CARE AND/OR NURSERY UNITS REPORTED AUDITED NURSERY 1. Total Inpatient Routine Cost (Sch 8, Line 33, Col 27) $ 7,910,324 $ 7,910,329 2. Total Inpatient Days (Adj ) 16,584 16,584 3. Average Per Diem Cost $ 476.99 $ 476.99 4. Medi-Cal Inpatient Days (Adj 23) 1,865 1,501 5. Cost Applicable to Medi-Cal $ 889,586 $ 715,962 INTENSIVE CARE UNIT 6. Total Inpatient Routine Cost (Sch 8, Line 26, Col 27) $ 34,664,749 $ 34,664,771 7. Total Inpatient Days (Adj ) 10,680 10,680 8. Average Per Diem Cost $ 3,245.76 $ 3,245.77 9. Medi-Cal Inpatient Days (Adj 23) 1,394 1,519 10. Cost Applicable to Medi-Cal $ 4,524,589 $ 4,930,325 CORONARY CARE UNIT 11. Total Inpatient Routine Cost (Sch 8, Line 27, Col 27) $ 2,780,566 $ 2,780,568 12. Total Inpatient Days (Adj ) 890 890 13. Average Per Diem Cost $ 3,124.23 $ 3,124.23 14. Medi-Cal Inpatient Days (Adj 23) 41 45 15. Cost Applicable to Medi-Cal $ 128,093 $ 140,590 SURGICAL INTENSIVE CARE UNIT 16. Total Inpatient Routine Cost (Sch 8, Line 29, Col 27) $ 23,895,533 $ 23,895,548 17. Total Inpatient Days (Adj ) 7,325 7,325 18. Average Per Diem Cost $ 3,262.19 $ 3,262.19 19. Medi-Cal Inpatient Days (Adj 23) 696 758 20. Cost Applicable to Medi-Cal $ 2,270,484 $ 2,472,740 SURGICAL ICU-7 21. Total Inpatient Routine Cost (Sch 8, Line 29.01, 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 SURGICAL ICU-8 26. Total Inpatient Routine Cost (Sch 8, Line 29.02 , Col 27) $ 22,082,665 $ 22,082,681 27. Total Inpatient Days (Adj) 7,306 7,306 28. Average Per Diem Cost $ 3,022.54 $ 3,022.54 29. Medi-Cal Inpatient Days (Adj 23) 1,066 1,161 30. Cost Applicable to Medi-Cal $ 3,222,028 $ 3,509,169 31. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ 11,034,780 $ 11,768,786 (To Contract Sch 4) MEDI-CAL INPATIENT ROUTINE SERVICE COST COMPUTATION OF This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 4B Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F SPECIAL CARE UNITS REPORTED AUDITED PEDIATRIC INTENSIVE CARE UNIT 1. Total Inpatient Routine Cost (Sch 8, Line 29.03, Col 27) $ 7,410,985 $ 7,410,989 2. Total Inpatient Days (Adj ) 1,912 1,912 3. Average Per Diem Cost $ 3,876.04 $ 3,876.04 4. Medi-Cal Inpatient Days (Adj 23) 923 644 5. Cost Applicable to Medi-Cal $ 3,577,585 $ 2,496,170 NEONATAL INTENSIVE CARE UNIT 6. Total Inpatient Routine Cost (Sch 8, Line 30, Col 27) $ 32,319,451 $ 32,319,475 7. Total Inpatient Days (Adj ) 14,302 14,302 8. Average Per Diem Cost $ 2,259.79 $ 2,259.79 9. Medi-Cal Inpatient Days (Adj 23) 3,373 3,439 10. Cost Applicable to Medi-Cal $ 7,622,272 $ 7,771,418 N/A 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 N/A 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 N/A 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 N/A 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) $ 11,199,857 $ 10,267,588 (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: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F RATIO COST TO CHARGES ANCILLARY COST CENTERS 37.00 Operating Room $ 95,710,199 $ 585,456,449 0.163480 $ 32,872,436 $ 5,373,973 39.00 Delivery Room and Labor Room 29,518,483 75,488,257 0.391034 4,090,159 1,599,392 40.00 Anesthesiology 55,602,856 446,285,096 0.124590 12,073,177 1,504,202 41.00 Radiology-Diagnostic 49,746,582 193,969,630 0.256466 9,057,218 2,322,867 43.01 Ultrasound 4,215,379 29,801,839 0.141447 5,221,339 738,542 43.02 CAT Scan 12,997,062 201,731,626 0.064427 13,018,173 838,728 44.00 Laboratory 81,858,827 694,170,211 0.117923 80,089,877 9,444,461 44.01 Laboratory-Pathological 25,512,941 62,236,846 0.409933 2,381,048 976,070 44.02 HLA Lab 4,969,551 11,666,069 0.425983 0 0 47.00 Blood Storing, Processing & Trans 25,970,759 39,817,972 0.652237 5,464,559 3,564,188 49.00 Respiratory Therapy 29,840,758 292,629,267 0.101975 26,391,671 2,691,281 50.00 Physical Therapy 11,777,981 41,779,821 0.281906 1,857,504 523,641 51.00 Occupational Therapy 4,439,833 22,511,543 0.197225 870,498 171,684 52.00 Speech Pathology 1,689,666 8,339,831 0.202602 490,718 99,420 53.00 Electrocardiology 13,588,420 98,869,613 0.137438 9,920,401 1,363,438 54.00 Electroencephalography 4,408,169 21,049,131 0.209423 1,354,592 283,683 54.01 Electromyography 166,799 1,342,237 0.124269 213,412 26,521 55.00 Medical Supplies Charged to Patients 125,543,810 522,478,410 0.240285 38,561,597 9,265,780 56.00 Drugs Charged to Patients 93,304,736 462,202,429 0.201870 55,532,278 11,210,293 57.00 Renal Dialysis 8,102,366 31,845,109 0.254430 3,806,900 968,591 59.00 Gastro Intestinal Services 17,677,073 51,780,517 0.341385 1,240,517 423,493 59.01 Eye Laboratory 116,474 643,684 0.180950 0 0 59.02 Cardiac Catheterization Laboratory 10,383,847 81,800,167 0.126942 5,736,240 728,168 59.03 Vascular Laboratory 4,491,186 49,819,261 0.090150 0 0 59.04 Psychiatric/Psychological Services 948,688 4,444,067 0.213473 0 0 59.05 Nuclear Medicine - Therapeutic 14,418,226 116,313,021 0.123961 2,122,755 263,138 59.06 Magnetic Resonance Imaging 15,976,382 140,454,524 0.113748 4,760,185 541,460 59.07 Pulmonary Function Testing 1,901,599 3,728,114 0.510070 336,231 171,501 59.08 Recreational Therapy 139,834 833,837 0.167700 0 0 60.00 Clinic 5,867,508 3,544,413 1.655425 0 0 60.01 Psychiatric Clinic 4,048,115 6,939,317 0.583359 0 0 60.02 Medical Oncology 101,988,606 315,812,474 0.322940 0 0 60.03 Psych - Partial Hospitalization 894,863 2,902,036 0.308357 0 0 60.04 Clinic 2 - Gen Risk Center 406,378 124,968 3.251855 0 0 60.05 Clinic 3 - Neuro Surgical Institute 5,137,193 1,367,847 3.755678 0 0 60.06 Clinic 4 - Prostate Cancer Program 463,111 194,947 2.375574 0 0 60.07 Clinic 5 -Endocrinology Center 1,082,093 973,406 1.111657 0 0 60.08 Clinic 6 - Spine Injury Institute 4,253,159 2,992,983 1.421044 0 0 60.09 Clinic 7 - Pediatric Center 2,929,172 1,490,379 1.965387 0 0 61.00 Emergency 38,372,548 260,197,483 0.147475 11,543,422 1,702,363 TOTAL $ 910,461,233 $ 4,890,028,831 $ 329,006,907 $ 56,796,878 (To Contract Sch 3) * From Schedule 8, Column 27 (Contract Sch 6) MEDI-CALTOTAL ANCILLARY COST* TOTAL ANCILLARY CHARGES (Adj ) MEDI-CAL CHARGES COST SCHEDULE OF MEDI-CAL ANCILLARY COSTS This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 6 Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F ANCILLARY CHARGES 37.00 Operating Room $ 29,374,396 3,498,040 $ 32,872,436 39.00 Delivery Room and Labor Room 6,957,705 (2,867,546) 4,090,159 40.00 Anesthesiology 18,055,309 (5,982,132) 12,073,177 41.00 Radiology-Diagnostic 11,190,100 (2,132,882) 9,057,218 43.01 Ultrasound 1,537,588 3,683,751 5,221,339 43.02 CAT Scan 13,869,978 (851,805) 13,018,173 44.00 Laboratory 75,847,381 4,242,496 80,089,877 44.01 Laboratory-Pathological 2,117,121 263,927 2,381,048 44.02 HLA Lab 268,678 (268,678) 0 47.00 Blood Storing, Processing & Trans 4,925,935 538,624 5,464,559 49.00 Respiratory Therapy 46,191,718 (19,800,047) 26,391,671 50.00 Physical Therapy 1,824,592 32,912 1,857,504 51.00 Occupational Therapy 852,668 17,830 870,498 52.00 Speech Pathology 445,203 45,515 490,718 53.00 Electrocardiology 7,981,657 1,938,744 9,920,401 54.00 Electroencephalography 1,846,065 (491,473) 1,354,592 54.01 Electromyography 58,540 154,872 213,412 55.00 Medical Supplies Charged to Patients 29,370,561 9,191,036 38,561,597 56.00 Drugs Charged to Patients 56,002,540 (470,262) 55,532,278 57.00 Renal Dialysis 3,991,880 (184,980) 3,806,900 59.00 Gastro Intestinal Services 1,415,038 (174,521) 1,240,517 59.01 Eye Laboratory 0 0 59.02 Cardiac Catheterization Laboratory 4,384,761 1,351,479 5,736,240 59.03 Vascular Laboratory 3,689,266 (3,689,266) 0 59.04 Psychiatric/Psychological Services 0 0 59.05 Nuclear Medicine - Therapeutic 3,143,030 (1,020,275) 2,122,755 59.06 Magnetic Resonance Imaging 5,780,291 (1,020,106) 4,760,185 59.07 Pulmonary Function Testing 96,564 239,667 336,231 59.08 Recreational Therapy 0 0 60.00 Clinic 482 (482) 0 60.01 Psychiatric Clinic 0 0 60.02 Medical Oncology 556,456 (556,456) 0 60.03 Psych - Partial Hospitalization 0 0 60.04 Clinic 2 - Gen Risk Center 0 0 60.05 Clinic 3 - Neuro Surgical Institute 322 (322) 0 60.06 Clinic 4 - Prostate Cancer Program 00 60.07 Clinic 5 -Endocrinology Center 0 0 60.08 Clinic 6 - Spine Injury Institute 0 0 60.09 Clinic 7 - Pediatric Center 0 0 61.00 Emergency 14,476,332 (2,932,910) 11,543,422 TOTAL MEDI-CAL ANCILLARY CHARGES $ 346,252,157 $ (17,245,250) $ 329,006,907 (To Contract Sch 5) AUDITEDADJUSTMENTSREPORTED (Adj 24) ADJUSTMENTS TO MEDI-CAL CHARGES This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 7 Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F 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 TOTAL CHARGES TO ALL PATIENTS RATIO OF REMUNERATION MEDI-CAL COSTCHARGES COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED REMUNERATION (Adj )(Adj ) (Adj ) PHYSICIAN'S REMUNERATION TO CHARGES MEDI-CAL This is trial version www.adultpdf.com STATE OF CALIFORNIA COMPUTATION OF COST ALLOCATION (W/S B) SCHEDULE 8 Provider Name: Fiscal Period Ended: JUNE 30, 2008 CEDARS-SINAI MEDICAL CENTER NET EXP FOR NEW CAPITAL NEW TRIAL BALANCE COST ALLOC BLDG & MOVABLE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC EXPENSES (From Sch 10) FIXTURES EQUIP COST COST COST COST COST COST COST COST COST 0.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 GENERAL SERVICE COST CENTERS 3.00 New Cap Rel Costs - Bldg & Fixtures 93,263,076 4.00 New Cap Rel costs - Mvble Equipment 53,121,584 0 4.01 0 0 0 4.02 0 0 0 0 4.03 0 0 0 0 0 4.04 0 0 0 0 0 0 4.05 0 0 0 0 0 0 0 4.06 0 0 0 0 0 0 0 0 4.07 0 0 0 0 0 0 0 0 0 4.08 0 0 0 0 0 0 0 0 0 0 4.09 0 0 0 0 0 0 0 0 0 0 0 4.10 0 0 0 0 0 0 0 0 0 0 0 0 5.00 Employee Benefits 217,410,973 685,744 55,597 0 0 0 0 0 0 0 0 0 6.01 Non-Patient Telephones 5,738,789 1,109,740 2,044,988 0 0 0 0 0 0 0 0 0 6.02 Data Processing 56,726,549 2,270,717 21,108,462 0 0 0 0 0 0 0 0 0 6.03 Purchasing, Receiving & Stores 1,106,304 270,016 7,946 0 0 0 0 0 0 0 0 0 6.04 Admitting 11,518,813 726,200 107,498 0 0 0 0 0 0 0 0 0 6.05 Cashiering / Accounts Receivable 27,457,119 1,776,821 86,142000000000 6.06 Other Administrative & General 140,424,119 7,748,939 5,151,028 0 0 0 0 0 0 0 0 0 7.00 Maintenance and Repairs 6,818,686 4,308,705 661,800 0 0 0 0 0 0 0 0 0 8.00 Operation of Plant 29,724,811 17,021,722 230,992 0 0 0 0 0 0 0 0 0 9.00 Laundry and Linen Service 4,273,071 102,010 160 0 0 0 0 0 0 0 0 0 10.00 Housekeeping 13,876,897 384,622 31,218 0 0 0 0 0 0 0 0 0 11.00 Dietary 12,755,026 1,037,290 135,641 0 0 0 0 0 0 0 0 0 12.00 Cafeteria 0 968,820 0 0 0 0 0 0 0 0 0 0 14.00 Nursing Administration 13,791,656 391,848 560,236 0 0 0 0 0 0 0 0 0 15.00 Central Services & Supply 11,380,346 6,393,912 1,052,200 0 0 0 0 0 0 0 0 0 16.00 Pharmacy 4,420,182 382,999 309,676 0 0 0 0 0 0 0 0 0 17.00 Medical Records and Library 17,738,550 3,653,255 121,202 0 0 0 0 0 0 0 0 0 18.00 Social Service 3,723,749 60,472 4,249 0 0 0 0 0 0 0 0 0 22.00 I&R Services - Salary & Fringes 15,842,281 305,565 4,818 0 0 0 0 0 0 0 0 0 23.00 I&R Services - Other Program 12,692,176 0 0 0 0 0 0 0 0 0 0 0 24.00 Paramedical Ed Program 0 0 0 0 0 0 0 0 0 0 0 0 24.01 Paramedical Ed Program-Pharmacy 445,939 16,8860000000000 INPATIENT ROUTINE SERVICES CENTERS 25.00 Adults and Pediatrics 127,672,334 9,482,753 989,196000000000 26.00 Intensive Care Unit 15,394,666 1,578,520 13,263 0 0 0 0 0 0 0 0 0 27.00 Coronary Care Unit 1,009,543 107,149 39,137 0 0 0 0 0 0 0 0 0 29.00 Surgical Intensive Care Unit 11,195,624 616,076 28,020 0 0 0 0 0 0 0 0 0 29.01Surgical - ICU-7 000000000000 29.02 Surgical - ICU-8 9,958,441 623,881 69,687 0 0 0 0 0 0 0 0 0 29.03 Pediatric Intensive Care Unit 3,294,956 218,355 31,892 0 0 0 0 0 0 0 0 0 30.00 Neonatal Intensive Care Unit 14,730,474 605,063 60,363000000000 31.00 Subprovider I 7,148,742 660,396 7,614000000000 31.01 Subprovider II 4,345,812 450,388 9,296000000000 33.00 Nursery 3,840,718 137,558 8,826 0 0 0 0 0 0 0 0 0 ANCILLARY COST CENTERS 37.00 Operating Room 38,598,663 3,687,220 2,617,099000000000 39.00 Delivery Room and Labor Room 14,600,884 979,949 496,774000000000 40.00 Anesthesiology 22,957,224 1,206,958 1,457,348 0 0 0 0 0 0 0 0 0 41.00 Radiology-Diagnostic 21,456,455 1,795,291 770,854 0 0 0 0 0 0 0 0 0 43.01 Ultrasound 2,038,757 204,715 26,755000000000 43.02 CAT Scan 5,079,601 327,435 385,888000000000 44.00 Laboratory 42,514,836 626,277 491,835000000000 44.01 Laboratory-Pathological 11,286,735 1,161,518 822,854000000000 44.02 HLA Lab 2,873,113 179,405 233,744000000000 47.00 Blood Storing, Processing & Trans 13,304,501 317,118 10,697000000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA COMPUTATION OF COST ALLOCATION (W/S B) SCHEDULE 8 Provider Name: Fiscal Period Ended: JUNE 30, 2008 CEDARS-SINAI MEDICAL CENTER NET EXP FOR NEW CAPITAL NEW TRIAL BALANCE COST ALLOC BLDG & MOVABLE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC EXPENSES (From Sch 10) FIXTURES EQUIP COST COST COST COST COST COST COST COST COST 0.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 49.00 Respiratory Therapy 13,862,035 334,081 408,862000000000 50.00 Physical Therapy 5,986,219 436,709 36,305000000000 51.00 Occupational Therapy 2,411,512 65,495 11,123000000000 52.00 Speech Pathology 928,342 14,954 2,505000000000 53.00 Electrocardiology 4,645,206 510,086 945,681000000000 54.00 Electroencephalography 2,008,024 85,278 182,982000000000 54.01Electromyography 48,41821,0972,402000000000 55.00 Medical Supplies Charged to Patients 84,902,612 104,985 952,409000000000 56.00 Drugs Charged to Patients 53,028,744 227,435 14,595000000000 57.00 Renal Dialysis 6,146,344 61,5150000000000 59.00 Gastro Intestinal Services 7,905,627 523,417 962,910000000000 59.01Eye Laboratory 37,65418,00677000000000 59.02 Cardiac Catheterization Laboratory 4,354,575 473,456 474,426000000000 59.03 Vascular Laboratory 2,180,194 77,009 10,953000000000 59.04 Psychiatric/Psychological Services 393,825 66,499 1,262000000000 59.05 Nuclear Medicine - Therapeutic 7,888,756 484,429 136,427000000000 59.06 Magnetic Resonance Imaging 6,499,005 987,522 996,487000000000 59.07 Pulmonary Function Testing 347,192 86,708 97,185000000000 59.08Recreational Therapy 76,3170331000000000 60.00 Clinic 1,802,391 636,053 38,907000000000 60.01 Psychiatric Clinic 1,589,773 428,286 1,249000000000 60.02 Medical Oncology 77,601,806 2,812,024 18,849000000000 60.03 Psych - Partial Hospitalization 427,578 58,385 523000000000 60.04 Clinic 2 - Gen Risk Center 128,639 68,3540000000000 60.05 Clinic 3 - Neuro Surgical Institute 2,446,024 344,437 50,571000000000 60.06Clinic 4 - Prostate Cancer Program 59,73999,498431000000000 60.07 Clinic 5 -Endocrinology Center 503,847 64,954 560000000000 60.08 Clinic 6 - Spine Injury Institute 1,630,114 483,850 76,413000000000 60.09 Clinic 7 - Pediatric Center 1,193,112 307,226 47,169000000000 60.10 Clinic 8 - Orthopedic Center 2,112,625 53,980 31,673000000000 60.11 Clinic 9 - Wound Care Program 000000000000 60.12 Clinic 10 - Cardio Surgical Center 1,015,371 0 148000000000 60.13 Clinic 11 - Endourology Institute 811,709 147,952 55,946000000000 60.14 Clinic 12 - Lifeline 562,896 4,134 3,314000000000 60.15 Clinic 13 - Urogynecology 304,885 48,300 5,493000000000 60.16 Clinic 14 - Breast Center 890,121 177,667 5,264000000000 60.17 Clinic 15 - Reproductive Med Center 578,624 70,4410000000000 61.00 Emergency 18,285,661 910,512 400,087000000000 82.00 Lung Acquisition 1,029,034 3,130 5,320000000000 83.00 Kidney Acquisition 4,918,412 42,272 7,375000000000 84.00 Liver Acquisition 2,283,016 23,532 35,962000000000 85.00 Heart Acquisition 1,877,711 6,723 920000000000 85.01 Pancreas Acquisition 186,86800000000000 NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop 2,918 165,4560000000000 97.00 Research 79,468,990 6,072,002 6,774,770000000000 97.01Research: Davis II 000000000000 97.02 Research Recharge 57,893 196,909 3,663000000000 98.01 Physician Billing 4,208,188 396,485 62,145000000000 100.00 Meals-On-Wheels 0 30,7190000000000 100.01 Other Nonreimbursable Cost Centers 3,023,988 22,025 5,244000000000 100.02 Coach Program 766,315 415,612 442000000000 100.03 Outpatient Meals 530,37000000000000 100.04 Community Services 0 11,167 7,223000000000 TOTAL 1,541,501,994 93,263,076 53,121,584 0 0 0 0 0 0 0 0 0 This is trial version www.adultpdf.com [...]... 210,798 3,967,206 847,067 83,084 623,980 0 667,169 176,480 950,065 319,568 131,381 149,606 CASHIERING 6.05 Fiscal Period Ended: JUNE 30, 2008 Provider Name: CEDARS-SINAI MEDICAL CENTER COMPUTATION OF COST ALLOCATION (W/S B) STATE OF CALIFORNIA This is trial version www.adultpdf.com 63,966,636 21,807,473 37,473,870 35,320,343 3,117,455 9,433,776 64,204,242 17,646,612 3,904,666 15,252,813 197,435,679 24,112,407... CENTERS Employee Benefits Non-Patient Telephones Data Processing Purchasing, Receiving & Stores Admitting Cashiering / Accounts Receivable Other Administrative & General Maintenance and Repairs Operation of Plant Laundry and Linen Service Housekeeping Dietary Cafeteria Nursing Administration Central Services & Supply Pharmacy Medical Records and Library Social Service I&R Services - Salary & Fringes I&R . CHARGES TO ALL PATIENTS RATIO OF REMUNERATION MEDI-CAL COSTCHARGES COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED REMUNERATION (Adj )(Adj ) (Adj ) PHYSICIAN'S REMUNERATION TO CHARGES MEDI-CAL This. Hospital Based Physician for Intern and Resident Services (Sch ) $ 0 $ 0 4. $ 0 $ 0 5. $ 0 $ 0 6. SUBTOTAL (Sum of Lines 1 through 5) $ 113,981,887 $ 107,891,164 7. Medi-Cal Inpatient Hospital. $ 0 $ (71,410) 11. Net Cost of Covered Services Rendered to Medi-Cal Inpatients $ 113,981,887 $ 106,179,067 (To Contract Sch 1) COMPUTATION OF MEDI-CAL NET COST OF COVERED SERVICES This is